Spotlight: Dr. Fari Ngongoni

Dr. Rejoice Fari Ngongoni is the first Stanford Surgery resident to participate in the international elective rotation in Zimbabwe since the COVID pandemic.

Dr. Ngongoni, how did you develop your passion for global surgery?

I’m a fourth-year surgical resident and originally from Zimbabwe. Since I was a child, I was interested in medicine. So, right after high school I applied to the medical school at the University of Zimbabwe and was accepted. But I had always wanted to come to America to pursue something different.

So, when the opportunity arose, I decided to come to the U.S. I attended college at Ohio Wesleyan University. While I was there, I received a Theory-to-Practice Grant which allowed me to observe health care delivery in Durban, South Africa in 2010. I saw health care delivery at a smaller and rural hospital outside of the city which had limited resources; a smaller private HIV clinic that had funding from donors and had more resources for the population it was serving; and lastly, I spent some time at the teaching hospital in Durban called King Edward VIII. It was at this hospital that I discovered my interest in surgical care. I shadowed surgical trainees and the consultant and observed many operations including C-sections, amputations, and abdominal operations for abscesses. After that experience, my desire to attend medical school and become a surgeon was solidified. 

I say all this to highlight that my interest in medicine and healthcare was intimately tied to my “global health” pursuits because to me, global health is just health, the difference being that in some places there are a lot of resources while in other places the resources are limited.

Tell us about going to Zimbabwe after the rotation was on hold for several years.

The rotation was put on hold during the COVID pandemic and while I was a third-year resident, which is when most residents participate in the international rotation in Zimbabwe. It seemed as though my opportunity had passed. After most countries had emerged from shutdowns, Stanford and the University of Zimbabwe were interested in resuming the rotation. So, when I received an email about it from Drs. Wren and Liebert, I was hopeful and excited. After expressing my interest, Drs. Wren and Liebert really did most of the work to ensure that the paperwork was completed to set up the rotation and obtain all the necessary approvals. My rotation was financially supported by a grant from the Stanford Center for Innovation in Global Health and the Division of General Surgery. After obtaining a medical trainee license in Zimbabwe, I was able to visit with privileges as a practitioner.

How do you now value the efforts of healthcare providers in health systems with limited resources?

Healthcare providers who work in systems with limited resources are working under immense pressure. In the U.S., we often have the luxury of providing care without having to worry about the affordability of care because many patients have health insurance. In Zimbabwe, many patients (and at times, even those with health insurance) pay out of pocket. Those with insurance hope to get reimbursed after the fact and have little guarantee about how much of their bill will be covered. The doctors there have to factor in the patient’s ability to pay for care as they make medical decisions. Often, patient care was delayed while the family gathered funds to pay for medications or tests that were required.

The providers in limited resource setting accomplish so much with much less, and it is incredible to witness. Surgeons think of themselves as doers, and it was great to be surrounded by people who were “getting it done” despite the circumstances or the austerity. If a patient could not afford a particular diagnostic test such as a scan, then we relied on the signs and symptoms that the patient had and the blood tests. We operated expeditiously so as to avoid wasting oxygen or anesthesia that could be used for another patient. We instrument tied more often than not so that we could save suture. And if the preferred machine or instrument was unavailable, we improvised and used the next best available thing.

A surgeon that adapts to difficult circumstances is inspirational, and I want to be that flexible or adaptive.

How did this experience help you personally in your career?

I have an interest in working in another healthcare system in addition to the American one, and this gave me some exposure to a different healthcare system and the culture within the system. This experience also allowed me to prove to myself that I could adapt to a different health care system and enjoy it. I learned to operate as was done in the U.S. before the advancement of surgical technology. So, if I was ever in a situation where the number of patients overwhelmed the available resources, I would still be able to operate on patients who needed it, even in the absence of equipment that I am accustomed to.

I also learned to take care of more complex surgical problems. Patients typically had larger hernias than the patients I typically care for in the U.S. and the diseases of the patients who needed emergency procedures had usually progressed more than I was typically used to. The population had different comorbidities, for example there was a higher percentage of patients with HIV/AIDS or TB. So, I had to factor in those conditions as the team and I were determining a patient’s risk for a particular procedure. It broadened my knowledge and experience.

What were your challenges like?

In the beginning, I worried about connecting with the team I was working with and the patients. The first part was quite easy because the team was phenomenal, and I really enjoyed working with them and would love to work with them again. As for the patients, I was taking care of patients who spoke the same native language as me for the first time. There is something about taking care of “your people.” It is different and yet the same. I had never applied my native language, Shona, in a medical professional setting before so I was worried about not speaking well. But I dove in. I polished up on my Shona anatomy and soon found myself explaining how appendicitis and bowel obstruction came about and how they would be managed to the patients I was treating. Other minor challenges for me included switching units and learning the ranges of normal for lab tests such as kidney function tests. My phone was very useful for converting mmol/L to mg/dL.

I often confused the scrub nurses by asking for Adson’s forceps or DeBakey’s forceps out of habit, but the OR teams had different names for surgical instruments and at times, they had slightly different tools too. And soon, I learned that no matter how much I wanted to ask for DeBakey forceps (as a habit) after making a skin incision, what I really wanted to say was “Gillies, please,” because that’s what they had.

A final note?

The team I worked with were an absolute pleasure to teach, learn from, and work with. We are still in contact, and I hope we can always be supportive of each other’s careers in the future. My gratitude for this opportunity in boundless, and I thank the departments that supported me to participate in this experience.