The Resident Global Elective program is for PGY-4 orthopaedic surgery residents at the University of California – San Francisco (UCSF) to take part in a one-month elective rotation at a trauma hospital abroad. IGOT has partnered with several academic trauma hospitals in an effort to expose our residents to valuable overseas experiences, and to inspire them to develop their skills, knowledge, and continuing interest as an orthopaedic surgeon. The PGY-4 Residents are placed at different sites based on their interests in global orthopaedics and trauma and will conduct research and/or provide clinical care to patients under the supervision of local mentors. UCSF Residents are embedded into local trauma teams and serve as residents in training at our partner institutions.
The below toolkit is designed to help prepare for the Global Elective. Please use this page in order to fulfill all requirements and participate in the program.
Please complete the application form for your Global Elective:
|Global Elective Timeline||Tasks|
|As a PGY-4||Apply for CIR Global Elective funding and the HVO Young Surgeon Traveling Fellowship|
|As soon as the elective schedule is released||Apply for elective and send to Whitney for approval|
|Three months prior to elective||If HVO Site, apply for grant (see HVO Application Steps)|
|At least six weeks before departure||Book travel/ arrange accommodation|
|Reference site specific information||Apply for visa / immunizations|
|Upon return||Return PEP Kit to Whitney|
El Antonio Lenin Fonseca Hospital
Program description: The goal is to improve the training in the state hospital residents’ program in Managua by providing clinical and didactic education in general orthopaedics and orthopaedic sub-specialty areas as requested by the site. This hospital allows the resident to work in a diverse health system, similar to UCSF SFGH. Residents shadow in the private government clinic and the university hospital. This is an ideal rotation for a holiday block, first or last rotation, or if fellowship interviews are anticipated, as travel stateside is convenient. Please note that the winter holiday season is an especially busy time of year at the hospital.
Volunteers are principally involved with the four hospitals in Managua – Hospital Antonio Lenin Fonseca (HALF), Hospital Escuela Roberto Calderón, Hospital Militar (adult hospitals) and Hospital La Mascota (pediatric hospital). The project is primarily designed to provide sub-specialty surgical and didactic training to residents at HALF, but may also have the opportunity train residents at the military hospital or one of the other 2 public hospitals mentioned above. There has been a recommendation of providing training in basic care principles in diabetic foot management.
HALF is a 90 bed hospital and receives referrals of difficult or complex cases from hospitals around the country outside of Managua. Common cases at HALF are complex articular fractures, pelvic fractures and machete injuries to the hand. The wards are inhabited mostly by open fracture cases in various stages of treatment. The faculty at HALF are Dr. Aguilar, residency supervisor and former chair, who specializes in hip, knee and pelvic surgery; Dr. Carmona, who specializes in foot and ankle surgery has recently retired and as of now does not have a replacement; Dr. Reyes, spine surgery; Dr. Arteaga, who has some expertise in external fixators; and Drs. Ruiz and Gaitan, who are hand surgeons.
There is no certification program for a specialty of orthopaedics in Nicaragua. Orthopaedic residents are selected on a merit basis during their final year of medical school. Medical school takes 6 years to complete following a year of community service. Three years of salaried residency are required upon completion of medical school. Many choose to spend a fourth, unpaid year working as a resident. The residents complete a thesis at the end of their training and are evaluated by the attending surgeons. In general, the residents at HALF make excellent use of CD-Rom texts and journals, and computer and Internet access is provided in the residents’ room. Standard texts such as Rockwood and Green, and Lovell and Winter are also widely used.
Weekly conferences are held with all attendings present. In these conferences, they present cases, often using digitalized photographs on a computer screen with X-rays present. This is followed by ward rounds, with X-rays all kept by the bedside, ready for review. The attendings supervise the clinics, with one attending on each day. Attendings also have one room every day in the operating room. For more information on Nicaragua’s program, please visit the HVO page.
Flights: Arrival Airport: Augusto C. Sandino International Airport (MGA), Managua.
Accommodation: There are several housing options for volunteers at this site. It is possible to stay as a guest in the home of one of the attending surgeons. Additionally, relatively inexpensive hotels or bed-and-breakfasts are no more than a 15-minute taxi ride to the hospital. Note: AirBnB is not an option. See options below:
The most popular option is Hotel Los Pinos which has single rooms for $46.75/night and double rooms for $65/night. Book directly through the website for the lowest rates or reach out to Dino Aguilar (program director). Also, HVO volunteers are given a 10% discount on the prices, so mention you are part of HVO. They are able to provide pickup service at the airport for a fee. The hotel is located close to the hospital and places to eat.
Another option is Hotel Colonnade which offers HVO volunteers a discounted rate of $50/night plus tax. They are also able to provide pickup service at the airport if provided with arrival information.
Amoco Housing Apart-Hotel is about $50/night for bungalows with kitchenettes. It is a one-block safe walk to Nicaragua’s restaurant row, and to a major supermarket just a couple blocks further. There is a locked, gated entrance and it is safe.
Other housing options include:
Transportation: Pablo Corea or Dino Aguilar can help or put you in touch with someone. Pablo will set up a local resident to take you around.
Currency: The Nicaraguan Córdoba is 1 USD to about 28 C$.
Komfo Anoyke Teaching Hospital (KATH)
Program Description: The goal is to provide assistance to KATH faculty to increase the number and quality of trained orthopaedics, plastics, trauma, and hand surgery physicians in Ghana. This site has a dedicated trauma center with a special focus on hand deformities. The University of Michigan also collaborates with KATH’s emergency residency program, and is the tertiary referral center for much of Ghana.
KATH is a 1000+ bed, general hospital organized into four main inpatient blocks housing Medicine, Pediatrics, Ob-Gyn, and Surgery. KATH also has a state of the art Accident and Emergency Center facility which is connected to the old hospital. It is equipped with a triage area, minor and major treatment facilities, a resuscitation ward, 3 sub-acute wards for men, women, and children, an intensive care unit, modern surgical suite, and a helipad. There is a high volume of trauma patients. Close to 200 orthopaedic in-patients are typically present. About 70 are housed in the Trauma Center and 130 in the main hospital orthopaedic wards. The vast majority have trauma-related problems, often with multiple injuries. The major burden of disease is trauma-related. Multi-trauma patients are many with long bone and articular fractures, often open. There are a number of pelvic and acetabular injuries, most managed without surgery. For more information on Ghana’s program, please visit the HVO page.
Flights: Arrival Airport: Kotoka International Airport (ACC), Accra, Ghana.
Connecting flight to Kumasi, Ghana. Exit international terminal and walk to domestic flights departures. Connecting flights can be arranged ahead of time or at arrival. The flight costs roughly $60 USD cash one-way or you can take a bus to Kumasi which is roughly a six-hour drive. Traveling to Ghana is extensive (about two days each way is lost with travel).
Accommodation: Accra: Guest house arrangements can be made for overnight stay in at the OSDA House. Kumasi: The KATH guest house is available and covered by the KATH Hospital. Arrangements and reservations are made through HVO. Note: AirBnB is not an option.
Visa: A $60 USD Single Entry Tourist visa is required prior to departure. Must have flights booked before applying for a visa. The visa process takes awhile; you must mail off your passport to the consulate.
Transportation: Phyllis Osei-Donkar coordinates free transportation from the airport to the guest house as well as transportation to and from the hospital. You may also get rides with other residents.
Currency: The Ghanian Cedi (GH¢) is 1 USD to about 4 GH¢.
Must have proof of a yellow fever vaccination.
Muhimbili Orthopaedic Institute (MOI)
Program Description: The goal is to improve the quality of orthopaedic care by increasing the knowledge among orthopaedic surgeon faculty members and residents through training in the following areas: fracture fixation techniques, arthroscopy, non-surgical management of club foot, and orthopedic sub-specialty training in hand, foot and ankle, knee and hip, and spine. This site offers an orthopaedic specialty hospital and trauma center for the MUHAS (Muhimbili University of Health and Allied Sciences). UCSF has a strong presence at MUHAS with multiple departments having partnerships across the compound. For more information on Tanzania’s program, please visit the HVO page.
Flights: Arrival Airport: Julius Nyerere International Airport (DAR), Dar es Salaam. Fly with Emirates from SFO to Dubai. Overnight stay in Dubai included, then Dubai to DAR. Emirates if booked early is not more expensive. British Airways and KLM also offer reasonable options. Flights to and from DAR are extensive. On average two days are lost each way.
Accommodation: Note: Residents are required to stay at the Kalenga House. It is on campus for $50 a night and can be organized through Madeline MacKechnie or Whitney Milyard. If there is no availability, please contact Madeline or Whitney (see “contact”). Note: AirBnB is not an option.
Visa: A $100 USD (cash) visa can be obtained on arrival. Obtain the Multiple-Entry Tourist visa. If you are planning to stay longer than three months, you must leave and re-enter. If applying for a work permit, visit the Tanzania Commission for Science and Technology (COSTECH).
Transportation: Airport transportation can also be arranged through the Kalenga House. The rate is about $60. The best option for transportation around MOI is with reliable taxi drivers (see “Travel Checklist & Contacts” for details).
Currency: The Tanzanian Shilling is 1 USD to about 2000TSH.
Safety: Safety is of concern in Dar es Salaam. Be careful. Do not walk around at night, especially downtown in the city center area. When touring around, travel with others and do not bring valuables or larger bags, as it is common for bags to be swiped from you. Do not take public buses or motorcycle taxis.
Health: You do not need insurance to be seen at any hospital in Tanzania, however you will be charged a “private” price. Muhimbili is an option but is expensive and the wait is oftentimes very long. For basic consultations, the best option is Premier Care Clinic. They charge 70,000TSH for a consultation (walk-in or appointment). It is staffed by foreign doctors and has services that many hospitals did not, such as a flu vaccine and a pharmacy. Another option in Upanga is Regency Hospital. They have their own lab which is very fast.
Malaria: The most worrisome disease for foreigners is malaria. If you ever catch a fever, go to the labs in Regency Hospital to get tested. You can go directly to the lab and request the test without seeing a doctor. It is fast and cheap (4000TSH for blood smear or about 40,000TSH for the blood test). Do not go to Muhimbili because they are required to charge a 60,000TSH consultation fee plus the cost of the tests.
Phone / WIFI: Any unlocked phone will work in Tanzania. You can buy a SIM Card at any vendor. Internet is through your cellphone via the personal hotspot function. Airtel and Vodacome have the best signal and is usually good enough for high-definition skype calls, streaming youtube, etc.
Tanzania’s country code is +255. When you are within the country using a local phone, you can drop the +255 and add a 0. When you are outside the country, you drop the 0 and add +255.
Food: Close to MOI, the best option for groceries is Viva Towers. They have a shop on the first floor. The best places in Dar es Salaam to buy food are Shoppers Plaza. The other option is Nakumatt. Outside of Mlimani City, Kariakoo is the best place. There are many late night delivery options.
Leisure: Join the Facebook group “Team Tanzania” which is used by all expats for everything. Other good social places are Trinity (Wednesday Trivia nights and Friday night parties) and High Spirit Lounge. The Hyatt Regency (“The Kilimanjaro”) has a good rooftop bar and Sunday brunch for 35,000TSH. A trip to Zanzibar is about 1.5-2 hours by ferry. Take the Azam Marine – Kilimanjaro Ferry.
Queen Elizabeth Hospital
Affiliated Hospital: BEIT CURE Hospital
Program Description: The goal is to provide educational support and resources to the Department of Surgery at Queen Elizabeth Central Hospital (QECH) in Blantyre. UCSF’s main partnership is with Queen Elizabeth Hospital, which is a tertiary referral center for orthopaedics and trauma in Malawi. Queen’s also has a partnership with BEIT CURE, which is an NGO hospital. Residents can experience the juxtaposition of working in a government referral hospital versus a NGO hospital.
Queen’s is the largest hospital in Malawi with 1,100 beds and more than 1,300 patients at any given time. It also has the largest malnutrition ward in Africa. The pediatric department serves 100,000 children a year for various illnesses, including malnutrition, malaria, and gastritis. Of the 24,000 admitted, 60% are found to be HIV positive.
Dr. Mkandawire, the first fully-trained Malawian orthopaedic surgeon, is one of only six or seven orthopaedic surgeons for a population of 13.5 million. In addition to his busy orthopaedic practice, he serves as the Head of the Department of Surgery and the Deputy Undergraduate Dean of the Malawi College of Medicine. Since his return to Malawi in 1999, an approved training program has been started to train medical doctors as fully qualified orthopaedic surgeons. Currently, there are two Registrars in this orthopaedic residency-training program.
Malawian medical assistants who have practiced for a minimum of 4 years are eligible for the Orthopaedic Clinical Officer (OCO) training program. The current training program has 21 OCOs. The Malawian OCOs treat orthopaedic patients in hospitals and out-patient clinics. They are quite good at closed reductions and setting up traction. They do minor surgery such as sequestrectomy and Achilles tendon lengthening and occasionally open reductions. They have a good knowledge of orthopaedic principles. They know their limitations and refer the more difficult cases to the central hospitals or save them for the visiting orthopaedic volunteer. For more information on Malawi’s program, please visit the HVO page.
Flights: Arrival Airport: Chileka International Airport (BLZ), Blantyre.
Fly from SFO to JFK to Capetown to Blantyre.
Flights from SF to Malawi are on average about 25 hours one-way.
Accommodation: Accommodations can be booked with Pam Mitunda at Beit CURE (please see Travel Checklist & Contacts). Beit CURE housing for international travelers is about $400 per month. These guest houses are within a five minute walk of the CURE Hospital. Note: AirBnB is not an option.
Visa: A $75 USD cash visa is required on arrival and needs to be renewed for MK 5000 every 30 days (Roughly $7 USD). It is recommended to schedule travel in blocks of 30 days.
Transportation: Travel from the airport to the Guest House can be arranged either with Pam or their driver, Levy, based out of Queens. The typical rate is MK 9000 (roughly $13 USD). One can travel around Blantyre by foot, minibus, or taxi. It is strongly recommended, though, that all travel be conducted in taxis and in groups at night.
Currency: The Malawian Kwacha (MK) is 1 USD to about 700 MK. The best way to acquire Kwacha is to bring a bank card and ask the airport driver to take you to an ATM and withdraw directly.
Food: Chipiku, Shoprite, and Superior are supermarkets close by. Superior accepts visa and is located on Kamuzu Central Highway, which is the first exit to your right as you enter the roundabout from QECH.
Leisure: There is a movie theatre in Shoprite and clubs: The Basement and Chez.
A typical morning schedule usually consists of the resident attending the “Handover Meeting” held in the lecture room at the surgery department annex. This is also a good time to catch Dr. Nyengo Mkandawire and Christopher Ngulube because their offices are located next to the lecture room.
Hospital Rehabilitation Disabled Children (HRDC)
Program Description: HRDC is a pediatric NGO rehabilitation hospital. This site is great for residents who are interested in pediatrics or hand deformity surgery. The hospital is particularly active in cerebral palsy research. HRDC is located north of the valley (outside of Katmandu).
Consider applying for the AAP Global Outreach Mentored Scholarship Program.
Flights: Arrival Airport: Tribhuvan International Airport (KTM), Katmandu. Most flights connect through China.
Accommodation: Volunteer housing arranged by local mentors such as Damodar Shrestha. Most residents stay at a contact’s house and pay 750 euros/ month. Note: AirBnB is not an option.
Visa: A $40 USD one-month Multiple-Entry or $100 USD three-month Multiple-Entry Tourist visa is required and can be purchased on arrival or before. In addition, a Chinese visa may also be necessary depending on connecting flights and layovers.
Transportation: Organized through local mentors.
Currency: The Nepalese Rupee रू is 1 USD to about 100 Rupee.
“The Global Elective opportunity is why I chose to come to UCSF. To be able to make a sustainable impact on how trauma patients are treated in less-resource settings is not only rewarding, but it also reminded me of why I chose to go into medicine in the first place.” – Patrick Horst, UCSF Class of 2014 (Ghana)
“I am so grateful to UCSF for giving me my first overseas volunteer experience in surgery. I have learned so much from amazing doctors and patients around the world. My experience in South Africa as a resident gave me the tools and desire to continue work overseas after finishing my training. Most recently, I have had the chance to visit the wonderful and warm people of Malawi. I have been inspired by the dedication and skill of the surgeons there who work in challenging circumstances with limited resources. I consider it a true privilege to work as partners with them.” – Todd Kim, UCSF Alumni
If you have not already applied, please do so first.
In order to be eligible for the Global Elective, the below is required as part of the pre-elective:
Dates and Site: Elect a site that allows you to get the most out of your educational exchange. Apply for the Global Elective as soon as you find out the schedule. Review each site carefully and speak to PGY-5 Residents if you have more site specific questions.
HVO Site: If the destination you are going to is part of the Health Volunteers Overseas (*HVO), you are required to apply for an HVO Grant. Please reference “HVO Application Steps” below. Once the grant has been submitted, please upload it to dropbox.
Airfare: If you choose to book on your own you can submit for reimbursement. The maximum allotted for travel and accommodations per resident is $2,500. Check out hipmunk.com to search travel options and query quotes.
NOTE: Many sites involve multiple layovers or connections. If you choose to book yourself, plan early as flights can become very expensive. Some flight connections require visas.
Connexus: Use the app under MyAccess to book a flight directly through Connexus or send a screenshot of a preferred flight to Connexus travel agent to book directly and charge to Department Account.
NOTE: Booking through Connexus automatically signs you up for emergency insurance through UCSF.
Security and Documents:
NOTE: Passport must be current for six months after you return home.
Occupational Health: Residents will be required to meet with the Occupational Health NP to obtain PEP and receive consultation for immunizations.
Unlock Cell Phone: Make sure that your cell phone is unlocked so that you can buy and use a local SIM card.
Immunizations: Check the CDC website to see exactly what you need (location dependent).
Common required immunizations or boosters for: Typhoid, HepA/B, Polio and DTap
PEP: IGOT provides a PEP kit for your use during the Global Elective. Before your elective you must obtain this kit and sign off on its contents. Part of the post-elective protocol is to return the kit if not used, and if used, you must follow Occupational Health guidelines and instructions. Check the PEP Ref
Check the PEP Ref.
If PEP is needed while abroad: Residents are required to notify the “Hotline” and iJet of the incident as well as IGOT leadership and local mentors. Local mentors will be responsible for facilitating lab testing and monitoring of the resident per Occupational Health guidelines. If there are any clinical concerns or adverse events related to the use of PEP the Resident will activate emergency evacuation insurance per UCSF protocols using iJet and notifying IGOT leadership. Occupational Health will file the incident and bill for medication per UCSF protocols. Consignment medication will be refilled for availability to next Resident.Hotline – UCSF: +01 (415) 353 – STIC (7842)
Hotline – ZSFG +01 (415) 469 – 4411
*Let the answering service know you are with ZSFG
Malaria Prophylaxis: Tanzania, Ghana, and Malawi meds are needed. Review CDC Recommendations to choose which drug you prefer.
NOTE: Malarone or Doxycycline are preferred. Chloroquine is resistant in Tanzania, Ghana, and Malawi. Click here for a list of drug recommendations for each country.
Some suggest taking a four-week supply if traveling overseas to high-risk area. A five-day supply is sufficient to get home and start formal regimen under ID supervision. You may need to cross-reference up to date recommendations from CDC based on site. It is your responsibility to take these on time, if necessary for the site you are visiting. If you lose the medicine, you are required to pay. Many countries check your Yellow Fever card upon arrival.
Adult Immunization Clinic, SFDPH
101 Grove, RM 102
San Francisco, CA 94102
CPMC Travel Clinic: http://www.cpmc.org/services/travel/
The below is required in order to complete the post-elective steps for the UCSF Resident Global Elective program:
Expenses: Please keep your receipts (PDF) and use this Expense Template to submit your expenses for reimbursement. Once the template has been filled out, please upload it to dropbox.
Pictures: Social media is important to us – we need your help by uploading pictures during your elective. We encourage you to post images on social media (Facebook, Instagram, and Twitter) from your Global Elective using the [email protected] and hashtags #IGOTglobal, #IGOTGlobalElective
Evaluation: You are required to meet with Dr. Rick Coughlin or Amber Caldwell for an exit consultation.
Inventory: Please return all borrowed equipment and PEP kit if unused.
UCSF offers a “Global Health Clinical Scholars Program (GHCSP)” for residents and graduate level trainees. IGOT and Department of Orthopaedic Surgery encourage residents whom are dedicated to pursuing global health as part of their long-term professional career to apply.
The Department is awarded at least one scholar per year. By being designated as a “Global Health Scholar” you are able to spend up to eight (8) weeks at one of IGOT’s partner sites to play a significant role in a locally driven research project.
Global Health Scholar Requirements:
Timeline for “Global Health Scholar” Program
Global Health Scholar Alumni:
Past Alumni who were designated as Global Health Scholars have continued to be active in global health and have played leadership roles within IGOT and major global health organizations. Below is a list of Alumni Global Health Scholars in the Department of Orthopaedic Surgery:
Dr. Brian Lau
Dr. Derek Ward
Dr. Mia Smuchy
Dr. Jeremy Shaw
Dr. Amanda Whitaker
Dr. Dave Shearer
Dr. Scott Kaiser
Dr. Andrew Pedtke
Dr. Carol Lin
Dr. Adam Warren
Dr. Rosanna Wustrack
Dr. Eric Hansen
Dr. Tenner Guillaume
For those of you going to Nicaragua, Ghana, and Malawi, your site is part of the Health Volunteers Overseas (HVO). Therefore, you are required to follow these next application steps:
The following FAQ’s are those typically asked by incoming PGY-4 Residents interested in participating in a Global Elective.
What should I bring?
* Different sites require different gear. Be mindful of seasonal weather during your elective and pack accordingly.
Am I responsible for booking my flight and will I be reimbursed? Yes, you are responsible for either going through an agency or booking a flight on your own. The maximum amount allotted for travel and accommodations per resident is $2,500. Please see “Contact Info” for who deals with reimbursement.
Will my cell phone work there? Typically. Although it may slightly differ between countries, you can often use an unlocked phone with a local SIM card bought at any vendor. Contact your service provider to confirm your coverage and fees if applicable if choosing to use your phone abroad.
Who is my go-to contact for my site? Please refer to the site specific “Travel Checklist & Contacts”. Each location has a UCSF mentor and a local/ HVO mentor. Coordinate your travel itinerary with the site mentor in advance.
Who deals with my accommodation / transportation logistics? Please reference site specific information. If your site is part of the Health Volunteers Overseas (*HVO), coordinate with your HVO local mentor. Typically, the resident will stay where the past residents have stayed. These are all fairly close to the trauma clinic. If you have any questions or need assistance, Whitney Milyard or Maddy MacKechnie can help.
Who should I contact at UCSF if I need help? Please reference site specific information and “Contact Info”.
What should I do with my pictures / information after the elective? Share them with us! As part of the post-elective requirement, you will be asked to complete an exit consultation which includes sending a few of your favorite images from the Global Elective.
How safe is the site I am traveling to, and how can I stay safe?
Take safety seriously. The accommodations for the residents are safe and most are close to the hospital or part of the hospital. Each site differs but, in general, it is wise to travel in groups at night. Be aware of your surroundings. Have a reliable source for transportation. Lock the doors when in the taxi. Have more than one bank card, but only carry one around, in case of theft. Use ATMs in public locations. Do not carry too much cash at once. Do not bring valuables in checked-bags. Save any study-related data onto secured cloud-based files.
|Global Surgical Education Coordinator
Institute for Global Orthopaedics and Traumatology
Email: [email protected]
|Whitney Milyard||Administrative Assistant||Office: +01-415-206-4261
Email: [email protected]
|Rick Coughlin, MD||Director
Program Clinical Supervisor
Email: [email protected]
|Ted Miclau, MD||Chief of Trauma||Office: +01-415-206-8812
Email: [email protected]
|Andrea Moody||HVO Program Assistant||
Email: [email protected]
|Suzanne Louie||SFGH Notary||Office: +01-415-206-8811
Email: [email protected]
|AnnaLissa Wi||Reimbursements||Office: +01-415-206-8890
Email: [email protected]
|Gina Baldoza||Reimbursements||Office: +01-415-206-3529
Email: [email protected]
|Nicola Sequeira||Director of Education & Alumni
|Office: + 415-476-6043
Email: [email protected]
|Orthopaedic Trauma Institute||General Information||Office: +01-415-206-4261|