WAVELENGTHS: Care on another continent

Elizabeth DeVos, MD, MPH knows a few words in Kinyarwanda, in case you want to go to Rwanda in Africa.

“Their official language became English, literally overnight in 2007. They went from French to English to help spur economic development. It worked,” said DeVos..

DeVos has “always” been interested in medicine. Her mother was a pediatric nurse and her father was a dentist. She is a graduate of the Northeast Ohio Universities College of Medicine and later earned a Master of Public Health degree from George Washington University.

“I remember visiting the Neonatal Intensive Care unit when my mom was a charge nurse when I was young,” she said. “As I got older, I volunteered at her annual asthma camp.”

As a young woman, she also considered pharmacy before deciding on medical school. After completing her emergency medical residency here in Jacksonville at UF Health, she was invited to become an attending physician. Later DeVos became an Associate Professor in Emergency Medicine, along with several other distinguished titles, including president-elect of the Duval County Medical Society.

According to DeVos, her choice to work in academic medicine was driven by the opportunity to teach others in the same specialty.

“I have the opportunity not only to help individual patients, but also be on the cutting edge of technology and build a workforce to ensure that we have access to skilled and talented emergency care providers in the future,” said DeVos.

DeVos also serves as medical director for international emergency medical education and program director for COM International Medical Educational Programs.

During her studies at George Washington, she was able to visit Turkey, China, India and Ethiopia. During those travels, she helped develop their systems and educational programs. Through that work, she developed a special interest in Africa’s emergency medical programs.

Emergency medicine as a specialty is less than 50 years old in this country, and UF Health was one of the first programs to be established. One of its earliest graduates, Atlantic Beach’s John Stimler, still enjoys his 50-plus years in the field and remains a part-time attending physician.

DeVos trained under his supervision and her work in Africa continues the cycle by developing emergency medicine as a new specialty there.

"In Africa, the idea of specialty trained physicians for acute illness is taking hold,” she said. “Currently there are 10 national EM societies affiliated with the African Federation for Emergency Medicine.”

In 2014, she was hired by a program at Columbia University to serve as technical director for the EM program in Rwanda.

“There I worked with developing curriculum and training teams in what would become their first EM residency program,” said DeVos. “It also teaches emergency skills to nurses and general doctors in rural areas.”

She notes that differences in the number of doctors for Rwanda (and Africa) in general is striking. There are 0.13 doctors per 1,000 people there, compared to 2.59 per thousand for the U.S.

Of those, very few are specialists.

“They are concentrated in four hospitals in two cities. Most medical care is delivered in health centers and district hospitals,” she said. ”The government has made a big investment in health care. Up to 90 percent of the people have insurance coverage.”

With such limited numbers, the scope of practice for specialists is often much wider than it is here. DeVos reported that they have more training in surgical procedures and oversee more critical care than she does.

“Medical school there is a six-year total university program, rather than four years undergraduate work and four years of medical school here. My colleagues in Africa have taught me their impressive physical exam skills and it has been exciting to watch them develop protocols to incorporate the best technology available,” said DeVos. “For instance ultrasound is something they’ve used significantly in the ED and have adopted for far more applications than we have been able to do in the U.S.”

DeVos and her husband Ted, who once owned a running shop here, were living in Rwanda when the Ebola outbreak occurred in 2014. It took place more than 2,000 miles away, but they quickly began preparations, because there were already too few intensive care beds.

Her husband does not work in the medical field, but supports her work and is an enthusiastic travel partner. He does work as a CFO for a nonprofit that helps Rwandan entrepreneurs.

“We also saw many patients with malaria, tuberculosis and complications of rheumatic fever that are not so common in the U.S.” she said.

Despite those serious diseases, road traffic still causes the most deaths in Africa, due to trauma from bus and motorcycle crashes.

“The coolest thing about being an emergency medicine doctor is that I have the opportunity to provide care across the spectrum of illnesses and injury for acute problems. Emergencies come in obstetrics, pediatrics, trauma and medical problems [heart attacks, diabetes and more],” said DeVos. “We do lifesaving and urgent procedures, but I get to partner with other specialties for problems requiring surgery and long term care.”

Patients often ask her if she could be their doctor. While she appreciates their interest, she quickly explains that she does not have an office practice, but would be happy to help again if the need arises.

Most of her work abroad is funded by grants like one from the GE Foundation that helped pay for her early work in Rwanda, and the AMB Foundation, which helped provide services at the national Pediatric Hospital of Paraguay.

DeVos is always looking for grants to help send UF Health emergency medical residents abroad.

“My work is divided between several roles. I am the Director of Global Health Education Programs for the UF College of Medicine,” she said. “I oversee a four-year discovery pathway in Local/Global Health Equity for medical students and supervise students’ spring break learning trips in six countries, as well as elective rotations, by traveling one day a week to Gainesville.”

Her normal routine also includes shifts in the UF Health emergency department here and the new UF Health Wildlight Urgent Care Center, as well as UF’s Northside emergency department. She is also the chair-elect of the American College of Emergency Physicians’ Section on International Emergency Medicine. Never a dull moment.

She and Ted usually travel to Africa two or three times a year for week-long visits. Because Ted now coaches at Nease High School, his travel time is limited. The couple lives in Ponte Vedra, which serves as a wonderful respite from the many days of work and travel.

Bill Longenecker is a lifelong Neptune Beach resident and frequent Shorelines contributor. Send feedback to shorelines@jacksonville.com.