Stephen Dunlop, MD, MPH, FACEP

Hennepin Healthcare

tephen Dunlop, MD, MPH, FACEP, a board-certified emergency medicine physician-scientist with formal training in public health, advanced ultrasound techniques, and tropical medicine, has partnered with colleagues in low- and middle-income countries (LMICs)—primarily in Tanzania and Kenya—for more than a decade. In Tanzania, he has been involved with the development of emergency care.

A founding member of the African Federation for Emergency Medicine, Dr. Dunlop initially sought to work in a resource-limited hospital serving the world’s most vulnerable patients. “It became clear that I could make a much greater impact through education and systems development,” he said. “However, there was a huge discrepancy between where funding streams were aimed, what conventional wisdom was on the biggest issues facing LMICs, and what the reality was on the ground within ‘emergency departments’ across Sub-Saharan Africa.”

Dr. Dunlop now concentrates on epidemiologic analysis of burdens of disease; education of emergency medicine residents in Sub-Saharan Africa; advocacy aimed at U.S.-based funders; and administration of an emergency department that now has the first residency-trained emergency medicine physician in Northern Tanzania. Among his many other roles, he serves as co-director of emergency services at Arusha Lutheran Medical Centre in Arusha, Tanzania, which expects to see 70,000 patients in 2020.

He currently has active research collaborations in Tanzania, Kenya, and Uganda, including studies on the use of ultrasound for elevated intracranial pressure in cryptococcal meningitis, lung ultrasound for diagnosis of pediatric pneumonia, and acute coronary syndrome among urban Tanzanians. At Hennepin Healthcare, his interests include health issues faced within immigrant communities.

“This experience provides me with a unique perspective on how to tackle our current and future global health challenges that our patients, both at home and abroad, face,” Dr. Dunlop said. “Global emergency medicine is a prime example of a multifaceted approach to health maintenance, and places me at the intersection where efforts in public health fall short, attempts at restoration of health begin, and the data for future public health intervention can be collected.”

Brent Nelson, MD

PrairieCare

rent Nelson, MD, is an interventional psychiatrist and technologist who has volunteered his time to work with Stillpoint Engage and Doctors Without Borders in Johannesburg, South Africa. He is Chief Medical Information Officer (CMIO) at PrairieCare, and is an assistant affiliate professor at the University of Minnesota.

Outside of his time practicing psychiatry, he provides training and education to humanitarian aid outreach workers around the world on topics that range from the neurobiology of stress to coping with trauma and building resiliency in the field. We know that most humanitarian aid workers are ill-prepared to cope with the stress and trauma that can happen either directly or vicariously through their work in many developing areas of the world. It is paramount that these workers find ways to cope with the challenges that many face in the field—including trauma, isolation, and anxiety. His style of teaching includes a balance of science, theology, experience, and storytelling. Dr. Nelson’s passion for teaching others, and his openness to new idea, allows him to quickly build rapport with his audience and allow for profound learning and lasting memories.

As a technologist, Dr. Nelson is working with the non-profit Stillpoint Engage (Minneapolis) to develop a web-based application that allows humanitarian aid workers to access ongoing training materials to bolster resiliency. This app will also help them remain connected to their peers and supervisors while deployed in the field. This innovative application will help track levels of stress and overall functioning while workers are managing their daily duties. The long-term vision is to incorporate a degree of machine-learning or artificial intelligence that will help predict patterns and behaviors in humanitarian aid workers that put them at-risk for trauma or mental illnesses.

The combination of the learning content that he delivers and the online application he is building will be the groundwork for true transformation and enhancement of the humanitarian aid community. Dr. Nelson is passionate about this work, and has worked selflessly with countless stakeholders and third-party experts to help bring this critical training and technology to the individuals who need it. He has made contributions in almost every aspect of this initiative and has proven himself invaluable as a psychiatrist, teacher, visionary, and application developer. 

Michael Nelson, MD

University of Minnesota Medical School

ichael Nelson, MD, (at left) a professor in the Department of Radiology at the University of Minnesota Medical School and a radiologist in breast imaging, volunteers at the Kilimanjaro Christian Medical Center (KCMC) in Misho, Tanzania.

This service was inspired by former University of Minnesota Medical School faculty member, Helmut Diefenthal, MD, who recognized a need to expand and improve radiological services in Tanzania. Dr. Diefenthal founded the East Africa Medical Assistance Foundation (EAMAF) to accomplish that goal and serve the communities there. Dr. Nelson, a student of Dr. Diefenthal, shared his commitment to world health.

Dr. Nelson volunteered to be one of the first to travel to Tanzania through EAMAF in 1989. During that first visit, he served as a board examiner, and since then, he has served on EAMAF’s board and traveled to Tanzania over 30 times to volunteer at KCMC in various capacities, helping to build the program into what it is today.

One of his proudest accomplishments is helping to install the first mammography unit in East Africa. Once the diagnostic radiology infrastructure for the 18 million Tanzanians whose main referral hospital was KCMC was in place, treatment was the next challenge that Dr. Nelson addressed through his volunteer efforts.

The Foundation for Cancer Care in Tanzania (FCCT) was formed to expand treatment options by working closely with EAMAF. FCCT raised money to build a cancer treatment center in Tanzania that now sees 75 to 90 patients per day and provides chemotherapy.

This partnership, which included leadership from Dr. Nelson, contributed to a decline in mortality rates, such as the mortality rate of Burkitt’s lymphoma, from 85% to less than 15%. In 2018, Dr. Nelson received the American College of Radiology (ACR) Foundation Global Humanitarian Award for his service at KCMC for the last 25 years. In the time that he has served, he has seen the average life expectancy rise by decades. Dr. Nelson continues to go to Tanzania; in 2019, his time was spent conducting breast and liver cancer workshops. 

Mary Owen, MD

University of Minnesota Medical School, Duluth campus

ary Owen, MD, assistant professor and executive director at the Center of American Indian and Minority Health (CAIMH) at the University of Minnesota Medical School, Duluth campus, administers multiple programs that support Native students. The school is second in the nation for graduating American Indian and Alaskan Native medical doctors, thanks in large part to recruitment efforts by Dr. Owen and her colleagues.

After completing her undergraduate studies, Dr. Owen worked with the Alaska Alliance for the Mentally Ill and the Alaska Psychiatric Institute while receiving health care at the Alaska Native Medical Center. “There were no Native people who were taking care of patients. There were no Native doctors and very few Native nurses,” she said. Dr. Owen resolved to become a doctor. After completing her residency, she moved to her home town of Juneau, Alaska, as a family physician at the Southeast Alaska Regional Health Consortium.

In her current capacity at the Duluth campus, Dr. Owen opens career paths for other new physicians. “I love it because I get to help get Native students into medicine,” she said. “I tell students, you can be a doctor in our communities or you could be a neurosurgeon who mentors Native students. But you have to give back. That should be required of all medical students.”

That same commitment extends to the larger population as well. Dr. Owen teaches an American Indian Health seminar, open to all students, that addresses health disparities and the gap in health care between the “haves” and the “have nots.” “It isn’t just the Native communities,” she says. “Outside of our community, the same immense health disparities affect many groups. The health seminar covers the ways we can make change.”

Outside the walls of the Duluth medical school, Dr. Owen continues her parents’ legacy of community advocacy and service in Juneau. In addition to encouraging medical students to volunteer and serve their communities, she has written proposals to support even more students—starting as early as grade school—to pursue careers in the health care field.

She practices with the Fond du Lac Band of Lake Superior Chippewa. 

Brianne Barnett Roby, MD

Children’s Minnesota

n October 2019, Dr. Roby traveled to Hermosillo, Mexico, with Children’s Surgery International (CSI), a Minnesota-based, nonprofit volunteer organization that provides free medical and surgical services to children in need around the world. Dr. Roby has been volunteering with CSI since 2016, and has served on its Board of Directors since 2017. In addition to her own trips to Hermosillo, Vietnam, and Liberia, she also helps recruit surgeons for similar missions to Ethiopia, Liberia, and Tanzania. She had planned to provide care in India this year before that trip was canceled due to COVID-19.

In Hermosillo, a city of over 800,000 people in the state of Sonora, Dr. Roby and her team work alongside the local CIMA Hospital and St. Andrew’s Children’s Clinic, which is based out of Nogales, Arizona. She describes this as “essentially an international cleft team, in that we base the care on what patients in the United States would get for cleft care.” Services include not only cleft lip and palate but also alveolar bone grafts, orthodontic work, and cleft rhinoplasty.

Over three days each trip, Dr. Roby’s team typically screens about 120 children and performs around 60 surgeries. She then works closely with the local nursing staff to help care for the patients after surgery.

“It feels like a continuity clinic just like I would have in the United States,” she says. Her team is comprised of four surgeons (three pediatric facial plastics/cleft surgeons and one oral surgeon), one lead anesthesiologist and four others on the anesthesia team (anesthesiologist or nurse anesthetist), 1–2 pediatricians, operating room nurses, recovery room nurses, and floor nurses.

Each and every time she visits Hermosillo, Dr. Roby is touched by how warm, kind, and patient the children and their families are as they wait to be screened or have surgery, even after traveling hours or even days to get to CIMA hospital to be evaluated.

Dr. Roby has a special place in her heart for Hermosillo because, she says, “many of the kids I have operated on I did their cleft lip at a few months of age and returned a year later to do the cleft palate surgery.” She also loves that the parents, St. Andrew’s Clinic, and volunteers at CIMA Hospital keep her posted on the recoveries of the patients and, “each year we are greeted warmly like we’ve been friends forever.”  

David Schultz, MD

Nura Pain Clinics

ven before Gov. Tim Walz’s Shelter-at-Home directive was issued, Nura Pain Clinics recognized that some of its patients would require an elevated level of in-home care during the COVID-19 pandemic. Dr. Schultz (pictured first from left with care team members) is founder and medical director at Nura, whose multidisciplinary approach to chronic pain includes targeted spinal drug delivery via pain pumps for its most extreme cases—a treatment unavailable to patients who can’t travel to the clinic or who have limited financial resources.

Dr. Schultz directed his mobile care team to waive charges for many of those patients. “We did not want cost to stand in the way of patients receiving the care they need during this pandemic, and decided to use our mobile care team to provide in-home visits for high-risk patients in need, regardless of insurance coverage,” he said. “We’ll continue to do so until this crisis is past.”

The in-home visits are available on a case-by-case basis. Nura’s mobile nurses provide a variety of in-home patient care, including medication management, refills of pain pumps, medical evaluations, and arranging tele-medical consultations directly with physicians as necessary.

The decision to offer the free service comes at a time when Nura has had to furlough over 50% of its staff while elective pain procedures are on hold. For Schultz, though, it’s a case of patients over profits. “We’re providing free homecare for selected patients who are high risk for COVID-19, and who we feel would be put in jeopardy by leaving their homes during the crisis,” he said. “We feel it’s the right thing to do regardless of payment.”

The vast majority of Nura patients requiring in-home care are those with pain pumps. Normally these patients visit the clinic every few months to refill the devices. Without timely refills, these patients could go into withdrawal, end up in an ER, or take up an inpatient bed that hospitals are trying to reserve for COVID-19 patients. Switching patients off of their pump medication and onto high-dose oral opioids for short-term care during the pandemic would create other potential problems.

The home visits may save lives of some high-risk patients. “If I had to go out into the public with my immune system, generally I [would] pick up every bug around,” said Nura pain pump patient Brenda Standmark.