By Dave DeFusco
For Alaa Etouni and Noah Newlon, both graduates of the M.S. in Physician Assistant Studies, traveling to The Gambia on a medical mission was more than an opportunity to practice medicine, it was a transformative experience that deepened their understanding of global healthcare disparities, honed their clinical skills and reinforced their commitment to compassionate patient care. Led by Dr. Lorraine Cashin, the PA program director, the mission provided much-needed medical attention to underserved communities while leaving an indelible mark on the students and patients.
Etouni, who graduated in December, brought with her years of hands-on experience, particularly in pediatric care. Her medical journey began at the age of 15 when she started volunteering at a pediatrician鈥檚 office specializing in hematology and oncology. This early exposure to medicine, especially working with children suffering from leukemia and other afflictions, provided a strong foundation for her studies at the Katz School.
鈥淢y mentors and professors at the Katz School have shaped me into the provider I am today,鈥 said Etouni, who was one of six PA students and graduates who made the trip in February. 鈥淥ne of the biggest lessons I learned was to look at the patient, not just the symptoms. Every patient is different, and it's important to treat them as individuals.鈥
Before embarking on the mission, Etouni had a general understanding that she would be providing care to a less fortunate community, but the reality of the conditions she encountered was still shocking. 鈥淢ost of the ailments we saw were preventable,鈥 she said. 鈥淢any patients had deep fissures on the soles of their feet caused by foot fungus. These fissures led to cellulitis infections simply because they lacked shoes, clean water and proper wound care. In the United States, such issues are easily treated but in The Gambia, they can become life-threatening.鈥
Skin infections, scabies, bedbugs and parasitic worms were rampant, exacerbated by inadequate sanitation and limited access to healthcare. The team distributed albendazole, an anti-parasitic medication, to entire families, understanding that if one member had worms, the others likely did as well.
One of the most impactful interactions for Etouni was with a woman who had suffered two miscarriages. In The Gambia, medical imaging is an out-of-pocket cost, discouraging proper diagnoses. After performing a bimanual exam, Etouni detected uterine fibroids, a condition that can lead to pregnancy complications.
鈥淚 spent 35 minutes with her, making sure she understood her condition and her options,鈥 she said. 鈥淲omen there often believe they have no hope鈥攊f they struggle with infertility, their husbands may marry another woman. I wanted to ensure she knew there were medical and surgical options available to her. When I walked her to the pharmacy for pain medication, she hugged me and told me I was very nice. That moment reinforced why I chose this career.鈥
Newlon said that one of the greatest challenges was adapting to a setting without modern diagnostic tools. 鈥淚n clinical rotations in the U.S., we have access to a full suite of resources鈥攍abs, imaging, advanced treatments,鈥 he said. 鈥淚n The Gambia, we had to rely solely on our clinical judgment. It made me more confident in my skills, especially in procedures like wound debridement.鈥
Newlon recounted treating a young boy with a severe wound infection that had been wrapped for months without being cleaned. 鈥淲hen we first unwrapped it, flies flew out and the smell was overwhelming. The infection was so advanced we feared he鈥檇 lose his leg,鈥 he said. 鈥淥ver the next few days, we debrided the wound, cleaned it with hydrogen peroxide and iodine, and applied antibiotic ointments. By the end of the week, the tissue was healing. Small victories like that made all the difference.鈥
Dr. Cashin, a veteran of international medical missions, has dedicated much of her career to providing care in resource-poor settings. 鈥淚 first became involved in global health while working at Montefiore in the Bronx with HIV patients,鈥 she said. 鈥淲e wrote a grant to establish a program in Rwanda for women infected during the genocide. That experience changed my life.鈥
She has since expanded her efforts to The Gambia, ensuring that students have an opportunity to experience international medicine firsthand. 鈥淲atching students go through the same transformative experience I did is incredibly rewarding,鈥 she said. 鈥淢any of them return after graduation to continue serving these communities.鈥
Dr. Cashin emphasized the importance of sustainability, ensuring that Penyem Village, where they visited, has continued access to care even after the mission ends. 鈥淲e purchase medications locally and work with community health workers to maintain continuity of care,鈥 she said. 鈥淲hen I asked villagers when they last saw a provider, they said, 鈥楾he last time you were here.鈥 That鈥檚 why we keep coming back.鈥
Newlon demonstrated the importance of clinical intuition when he diagnosed a patient with a strangulated hernia, a dangerous condition where the blood supply to the herniated tissue is completely cut off, leading to tissue death, requiring emergency surgery.
鈥淚n the U.S., we鈥檇 confirm it with an ultrasound and CT scan,鈥 said Dr. Cashin. 鈥淏ut in The Gambia, Noah had to rely entirely on his knowledge. His diagnosis saved the patient鈥檚 life, as we arranged an emergency transfer for surgery.鈥
For Etouni and Newlon, the experience cemented their desire to serve in underserved communities. Etouni will soon begin her career at Montefiore Medical Center in the Bronx, an area with significant healthcare disparities, and Newlon will start at Maimonides Medical Center in Brooklyn. 鈥淭he Gambia experience made me more confident in my abilities,鈥 said Etouni. 鈥淚t taught me to think outside the box and reinforced my belief in patient-centered care.鈥
The trip also reshaped their perspectives on privilege. 鈥淭he people there have so little, yet they are incredibly resilient,鈥 said Newlon. 鈥淭hey welcomed us wholeheartedly. Seeing their gratitude for even the simplest medical care was humbling.鈥
Dr. Cashin remains committed to these missions, ensuring that future students continue to have the opportunity to grow as clinicians and human beings. 鈥淎t the end of each day, I asked the students to sum up their experience in one word,鈥 she said. 鈥淥ne of them said 鈥榣ove.鈥 That鈥檚 what this work is about鈥攑roviding care, offering hope and making a difference, one patient at a time.鈥
