Delaware EPs forge lasting partnership in Gambia

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Two EPs and a PA start non-profit to support The Gambia

Their web site says it concisely, “Looking to challenge yourself? It’s time!” Two emergency physicians and a physician’s assistant who shared an interest in international medicine decided it was their time to challenge themselves and their hospital. Their efforts created a connection between their home hospital, Christiana Hospital in Wilmington, Delaware, and Sulayman Jungkung General Hospital (SJGH) in Bwiam, The Gambia.
Lonnie Angstadt, a physicians’ assistant at Christiana, and Thinesh Dahanayake, MD, a 5th year EM resident, were seeking medical outreach opportunities in Africa when Angstadt saw a newspaper article about a Delaware-based non-profit, Power Up Gambia, that was started to provide electricity for an African hospital. She joined the board of Power Up Gambia and mentioned the project to an ED co-worker, Dr. Susan Thompson. Together, the trio traveled to Bwiam.
“In the beginning, it was really a fact-finding mission,” Angstadt said. But after one visit it was clear that they would be going back.
“I wanted to do everything I could to help,” said Thompson.  After the trip she told Angstadt that she was in it for the long haul. The result was Del-Med Aid for Gambia, a nonprofit dedicated to supplying medical volunteers and aid for SJGH.
While they found a determined and committed hospital administrator and nursing staff, there was no permanent medical staff.
“The Gambia didn’t have it’s own medical school until a couple of years ago,” said Thompson. “They’ve only graduated one class.” The Gambia has four hospitals and is dependent upon international physicians; SJGH has three internists and a surgeon, international staff who may stay two or three years. The local nursing staff is the backbone of health care for The Gambia.
alt “They have three different levels of nurses,” says Thompson, “the highest level is pretty extensively trained, I would say higher than our highest level of training.” Nurses at SJGH with advanced training from Royal Victoria Teaching Hospital perform procedures such as cataract removal, and dental extractions and fillings.
This is where visiting physicians make a difference. “What we would like is to get more physicians over there to train their staff. They want to be independent, they want to do things on their own.”

In terms of equipment, the greatest need is for electricity. Even with critically ill patients, the EPs often found themselves tapping their fingers, waiting for the generators would come on. Currently there are ten hours a day of diesel-powered electricity, but full-time electricity is close. Power Up Gambia continues to raise funds for the remaining solar panels, with a goal of installing them by summer, the start of malaria season.


The hospital also lacks certain basic equipment. There is no X-ray capability, no CAT scan or EKG machine. In contrast, there is donated equipment for which local staff are not yet trained. The ultrasound machine was used for occasional procedures by the surgeon. But the Delaware team’s main contribution was knowledge, lecturing to the nurses on a variety of topics.
Any long term planning in the region involves the road from the capitol of Banjul to Bwiam, which is being upgraded. A paved road will mean motor vehicle traffic and the accompanying trauma. The hospital is building two new surgical suites, says Angstadt, “and they’ve asked us about helping them with an ICU.”
Christiana’s EM residency is developing an IEM rotation program, with SJGH as the site of their first rotation in Jan 2009. After a presentation to the Delaware Medical Society, several community physicians expressed interest in volunteering. “We’re in the early stages but we’re really getting a groundswell of response,” says Thompson. Delaware’s Newcastle County Fire Department has even offered an ambulance.
Angstadt is excited, but sees more challenges, like how to ship equipment and supplies to The Gambia. They already have an EKG machine and an autoclave, to ship, among other supplies. The hospital also needs X-ray equipment, a dental chair and accompanying light.
Some final words from Susan Thompson: “I’d just like to get across the point that any help is appreciated – EMT, tech, PA or a nurse, doctor or pharmacist, if you have two weeks of time and want to help. Talk to us about what kind of equipment you can donate, or even just knowledge you can share from this side of the ocean; they would welcome any help in any form.”

You can find out more about Del-Med Aid for Gambia at


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