HCMC NETWORK FEATURE: International Emergency Medicine training in Tanzania improves care in Minnesota

by Hennepin Healthcare

Dr. Steve Dunlop, faculty physician in the HCMC Emergency Department, has pursued training in International Emergency Medicine and now works to share it with others.  He uses his expertise to give better and more cost-effective care in Minnesota, facilitates training of HCMC physicians and others in Arusha, Tanzania, and is working to establish an International Emergency Medicine Fellowship program at HCMC.


After travelling in Latin America as a teenager, Dr. Dunlop decided that
medicine would enable him to work effectively in developing countries and opted for Emergency Medicine a useful and practical specialty at home and abroad.  While in the HCMC Emergency Medicine residency program, he created a curriculum in International Emergency Medicine and obtained a Masters of Public Health through the University of Minnesota, with emphasis on global health and special training in tropical medicine, travel medicine, ultrasound, and parasitology.  Through participation in the Global Health Course, which is a partnership between the University of Minnesota and the Centers for Disease Control, he also achieved certification in Tropical and Travel Medicine by the American Society of Tropical Medicine and Hygiene.

Dr. Dunlop’s connection with Tanzania began as a medical student, when, accompanied by his wife, Amy, he spent two months in 2005-2006 working at Selian Lutheran Hospital (SLC) and rural clinics served by the Flying Medical Service (FMS).  Established on the outskirts of Arusha nearly 30 years prior, SLC had grown from a clinic for Masai tribesman to become one of the best health care facilities in northern Tanzania (Photos 1 and 2).

As the area has urbanized, early clinical focus on infectious diseases has evolved to include management of chronic diseases such as cardiovascular disease and depression, and trauma care for victims of motor vehicle collisions.  The hospital has since expanded, with the construction of Arusha Lutheran Medical Center (ALMC) and development of fee-for-service care to finance continued charitable/free care (Photo 3).

After completing his residency training, Dr. Dunlop returned for 6 months in 2010-2011 to assist in development of the new Urgent Care clinic and help start an Emergency Department.  Although he provided clinical care and consultation when necessary (Photo 4), he primarily focused on systems development, working to develop a formulary, keep critical medicines in stock, increase staff ratios, decrease wait times and patient elopements, and improve medical education.  He also facilitated training at Arusha facilities for physicians from numerous institutions in the US and abroad, including HCMC, Regions Hospital, and the University of Minnesota (Photo 5).

Dr. Dunlop emphasizes that, although international emergency medicine training develops expertise in clinical practice and systems development abroad, it also equips clinicians to provide better care in Minnesota.  Practice in resource-poor areas develops problem-solving and innovation (Photo 6) as well as skill and confidence in physical exam techniques and epidemiology, all of which are important fundamentals for provision of proficient and cost-effective health care in the U.S.  Physicians also develop expertise in immigrant and refugee health care, for effective treatment of immigrant populations across Minnesota, in cities like Rochester and Faribault as well as Minneapolis and St. Paul.

Amy Dunlop volunteered with local organizations on each trip to Arusha.  In 2010-2011 she worked at Plaster House, a rehabilitation home for children recovering from orthopedic and plastic surgery.  Although it is an 18-bed facility, it typically serves 40-50 children who come from more than 30 communities in the Arusha area (Photo 7).  In 2006, she assisted with English classes at Emawe Primary School (Photo 8).

Dr. Dunlop is currently working with the Hennepin Health Foundation and private donors to develop an International Emergency Medicine fellowship program so that other physicians can pursue international training.  Why does he do it?  “At the end of the day, living and working abroad makes you a better human and doctor.  You’re better adjusted.   You learn not to sweat the small stuff and worry about what really matters.”

See the Teaching and Training page of the HCMC  Impact website for information on diverse training opportunities at HCMC and the HCMC Emergency Department Activities Report (p. 22) for a description of diverse International Emergency Medicine projects and connections made by HCMC emergency physicians.

What’s coming up in HCMC NETWORK FEATURES?  A look at cutting edge scenario-based training in the Tactical Emergency Medicine Peace Officer (TEMPO) training course taught through HCMC/Hennepin EMS.