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Surgeon brings worldly view to new center by Mary Helen Yarborough Public Relations Coming to MUSC by way of Boston, New Zealand, Virginia, Seattle, Oregon—and occasionally Tanzania—Dilantha Ellegala, M.D., has become a part of a prestigious team of scientists who are building a clinic focusing on all aspects of cerebrovascular disease and anomalies.   As the co-director of MUSC’s new Stroke and Comprehensive Cerebrovascular Clinic (SCCC) and program, Ellegala said he seeks to tap the brightest among clinical experts specialized in cerebrovascular and interventional radiology and have them confer on various patient cases. It is the only such clinic in South Carolina, and one of a few in the Southeast.   Dr. Dilantha Ellegala   Previously the neurotrauma director for the Oregon Health and Science University, Ellegala has led dozens of neurological and cerebrovascular studies and has at least five in progress.   The cerebrovascular fellow and former clinical instructor at Harvard’s Brigham and Women’s Hospital, Ellegala is the developer of a groundbreaking blood flow detection method that can be done at the bedside painlessly. The blood flow detection method uses ultrasound to detect minute intravenous contrast agents called “microbubbles.” Being able to monitor brain blood flow, or perfusion, at the bedside will help in the management and treatment of patients with ruptured brain aneurysms, stroke and brain injury.   Ellegala, who worked with doctors at the University of Virginia to develop the technique, will be the only clinician in the country performing these studies in neurosurgical patients. Roots and an American dream Ellegala’s father was a teacher in Sri Lanka before moving his family to Sioux Falls, S.D., to provide a better life for his family.   “My father has the typical American immigrant's dream story,” Ellegala said. “He came here with $20 in his pocket and worked three jobs. He delivered papers, taught the disabled how to read, washed dishes at night while my mother worked as a bookkeeper during the day and took night classes in accountancy.”   His father became the first Fulbright Scholar from Sri Lanka, attended South Dakota State University, then moved his family to Seattle, Wash.   Growing up in Bellevue, Wash., Ellegala’s goal to become a doctor was established when he was 5, and his parents ensured that his focus would never waiver.   After earning a bachelor’s degree in biological psychology and medical degree from the University of Washington, Ellegala interned in general surgery and performed his neurosurgery residency at the University of Virginia.   In 2002, he turned his attention down under and spent a year at the Auckland (New Zealand) Hospital as senior registrar in neurosurgery.   Upon returning to the United States, where he became chief resident in neurosurgery at the University of Virginia in 2003, Ellegala’s sights diverted to remote and undeveloped regions devoid of suitable medical equipment and treatment. This distraction led him to becoming an international teacher and beacon for medicine and training through a novel, self-sustaining initiative. No pay, great gain After he completed his cerebrovascular fellowship at the Brigham and Women’s Hospital in Boston, Ellegala celebrated by traveling to Tanzania where he ended up spending six months with no income performing and teaching neurosurgery in this poor, sub-Saharan East African country. He shared his skills and compassion treating patients under extraordinary conditions. Tanzania is in a part of the world with extreme droughts and rainy seasons with spotty telecommunication and infra-structure; roads often are impassable. In a land where hydrocephalus is common, only 2 percent of Tanzanians have access to neurosurgical care. The few hospitals in the country have few technological advances and many clinical areas are virtually open air—only a screen separates the operating room from the hot, insect-infested environment.   Ellegala was faced with a dilemma. He could perform the surgeries himself, knowing he had to leave health care workers with nothing to work with; or he could train the people to help themselves. He decided that teaching people what to do with what they had would have a greater chance of sustainability.   So, he began teaching a handful of promising clinicians—with no formal medical education—how to perform brain surgery. Instead of lobbying medical device companies for fancy equipment, Ellegala developed a list of common items that could be easily retrofitted or used to perform a clinical procedure.   “We don’t want to send too much advanced equipment,” he said. “We have to break the cycle of dependency and teach them to use what’s available. For example, we used flashlights instead of microscopes. Wire saws and duct tape proved to be very useful,” Ellegala said with a laugh. “And for surgical headlights we used camping goggles. ... A device maker could send a piece of high tech equipment, but when it breaks, what do you do? They can’t fix it, so it’s useless after a while.”   His students, some of whom had no more than a two-year technical college education, have excelled to the point where they have enrolled in formal, advanced medical education, and have since trained other doctors, including university-trained doctors, Ellegala said.   After a few years since his medical mission to Tanzania, Ellegala has formed the Physician Training Partner-ship, which has drawn support and medical volunteerism from across the United States and the world. He said that nurses also are needed, especially to train the Tanzanian people in nursing skills, and to help train in infection prevention and post-operative care.   “We need doctors and nurses to commit at least two weeks, but we prefer four weeks,” he said. “Residents should commit to a minimum of four weeks.”   The Tanzania neurosurgical project also is considered a model for innumerable possibilities. “This model that we’ve demonstrated in neurosurgery could be used for other disciplines, like pediatrics, heart, orthopedics, etc.,” Ellegala said. “This also is allowing us to break down geographical and potential political barriers by building collaborative relationships with other African countries,” such as Kenya.   While he said many universities are trying to build global health programs, the Tanzania program, for which he credits MUSC’s Sunil Patel, M.D., chairman of Neurosciences, and Steven Glaser, M.D., chief of clinical neurosurgery, for “their farsighted and novel approach to building a neurosurgical department of the future,” the Physician Training Partnership is a type of pay-it-forward.   “You’re training one person, who could train another person, and it evolves and has a much larger impact,” said Ellegala, who will return to Tanzania to build upon his mission that includes getting a neurosurgery program into each of the country’s five hospitals. He also will nurture and expand burgeoning relationships with neighboring countries, including Kenya, to help provide resources and support, and collaborate with a growing list of American medical allies.   For more information about Physician Training Partnership, visit http://ptpafrica.org.      Friday, Oct. 3, 2008 Catalyst Online is published weekly, updated as needed and improved from time to time by the MUSC Office of Public Relations for the faculty, employees and students of the Medical University of South Carolina. Catalyst Online editor, Kim Draughn, can be reached at 792-4107 or by email, catalyst@musc.edu. Editorial copy can be submitted to Catalyst Online and to The Catalyst in print by fax, 792-6723, or by email to catalyst@musc.edu. To place an ad in The Catalyst hardcopy, call Island Publications at 849-1778, ext. 201.