January 9, 2023
Dr. Aaron Epstein
The non-governmental organization (NGO) enables physicians, nurses, and medics trained in the US to provide care for patients in war-torn regions, including Ukraine and northern Iraq.1,2
“I was sitting on my couch during a long weekend, and I just Googled ‘How do you start a 501(c)(3) nonprofit?’ At the time, I wasn’t sure this was going to amount to anything, so I just made up a name that represented what I hoped to do—have a global impact and provide medical and surgical services—and I just mashed all those words together,” said Dr. Epstein, acknowledging he purposely selected the name, in part, because its acronym is a palindrome.
Prior to becoming a medical student, Dr. Epstein spent years working in national security after graduating from Rice University in Houston, TX, with a degree in international policy studies and economics, and later a masters degree in intelligence and security studies from the Georgetown University Walsh School of Foreign Service.3,4
Dividing his time as a general surgery resident at the University at Buffalo in New York and managing the day-to-day activities of the GSMSG delayed Dr. Epstein’s 5-year residency by 1 year, but the postponement has helped enhance his medical training experience.
“Basically, my fourth year has been split over 2 years,” explained Dr. Epstein. “Instead of one straight academic year, it's half academic and then half travel doing global surgery. I don't think of it as a sacrifice, because if you think about it, anyone who's gone through general surgery residency knows that you probably need a break in there somewhere—otherwise you are going to break.”
Dr. Epstein explained that the GSMSG re-energized him, while also helping him get through the general surgery residency grind. For other general surgery residents, he recommends considering a pause to pursue other endeavors.
“Sure, you can blast right through training and come out sane at the other end, but I would say there is real value in taking a year to pursue research, an MBA, or something you are passionate about outside of surgery,” said Dr. Epstein.
In January 2015, Dr. Epstein conducted his first medical mission to the Kurdistan Region in northern Iraq. During his fourth year of residency in February 2022, Russian troops began to gather on the Ukraine border.
“I'd say a lot of the people in our group saw this coming because they're prior military and intelligence,” Dr. Epstein said. “There were specific nuances to how the forces were getting deployed along the border and how their support units were getting set up, so many of us in the group were saying, ‘This isn't for show; this is for real.’”
Dr. Epstein started reaching out to members of the GSMSG volunteer roster, making them aware that if they went, “there was a good chance we might not come back.” At the time, the working assumption was that Russia would overrun all of Ukraine in a matter of days or weeks. “Despite that, we had dozens of people offering to go,” he said, although they ultimately selected just a handful of volunteers—a mix of prior US Army Special Forces medics, Navy Seal medics, a former US Army surgeon, an anesthesiologist, and an operating room (OR) nurse.
The GSMSG team arrived in Ukraine a week after the war started. In addition to providing health and surgical services to the injured, a primary aim of the GSMSG was to train local physicians and civilians in combat care. “Our surgeon and the surgical team trained our Ukrainian surgeon counterparts on damage control resuscitation, damage control surgery, and other interventions. The medics trained the civilian population en masse on combat casualty care,” said Dr. Epstein, a Fulbright Specialist in Healthcare and Peace/Security Development.
“I remember being in the Middle East and seeing a lot of a groups dumping supplies and leaving once they got their photo shoots with CNN,” mused Dr. Epstein. “I remember one place in Iraq, there was a remote medical clinic serving a refugee camp, and they had this brand-new CT scanner. It was still in the wrapper, and the medical staff there said, ‘No one's ever showed us how to use this thing.’ I remember thinking ‘Wow, we can do so much better and have such a bigger impact if we focus on education and training and building capacity.’”
To date, the GSMSG has rotating teams of 10 to 20 civilian physicians, nurses, and medics who have trained more than 20,000 Ukrainians in varying levels of combat casualty care via in-person or virtual platform instruction. These teams also have provided care to victims with horrific casualties, including adults and children with significant burns and patients with traumatic limb injuries. “Self-reliance in an area is the ultimate goal. We don't want to be needed. I think that is a difference between us and other groups engaging in similar international humanitarian work.”
When Dr. Epstein entered medical school, he was a few years older than the typical student. With that real-world experience under this belt came the desire to do something significant to enhance surgical patient care—and sooner, rather than later.
“I wanted to be able to do work that would make the world a better place,” he said. “And I remember thinking, ‘I've heard of so many doctors and surgeons who do that, but they do it at the end of their careers, after they've retired and that just seemed so limited. I figured ‘Well, why don't I just start now? What's the point of waiting until I'm at the end of my career?’”
Dr. Epstein decided to climb the learning curve, as he described it, as a “dumb med student, and subsequently, dumber resident.” He began organizing medical missions to some of the most dangerous hot spots in the world. “It just didn’t make sense for me to wait,” he said.
One of the reasons Dr. Epstein chose the University at Buffalo for his surgical residency is because the program offers the opportunity for residents to pursue their interests in addition to surgery. “If I hadn’t started the group, I probably would've burned out. And I think doing this from the get-go continuously showed me the light at the end of the tunnel because I was literally making the light.”
In reality, Dr. Epstein admits that medical students and residents looking to pursue research or, perhaps, another advanced degree while in training will inevitably sacrifice something, somewhere.
“For me it was sleep. I was getting up at 4:00 am and going to sleep at midnight every night, and I have been doing that through residency and med school. You’ve got to rise and grind,” he said, referring to an Instagram hashtag.
“You’re not socializing, you’re not going to bars or taking vacations, and that’s your call. My friends are the guys and gals in this group,” Dr. Epstein shared. He said he views every GSMSG trip as a vacation of sorts. “All I can say is—whatever you choose to take on in addition to your work—make sure it is your passion, and make sure that it is the life part of your work/life balance.”
It is well-known that mentors can help boost a young surgeon’s career and professional development, not only in the domain of education and skills acquisition, but also in areas not necessarily included in a traditional curriculum format. A savvy and committed mentor can provide support for developing values, professionalism, and communication skills that can ultimately lead to enhanced recovery from burnout, improved resilience, and increased productivity.5
One of Dr. Epstein’s mentors was Sister Deirdre Byrne, MD, FACS, a retired colonel in the US Army Medical Corp and a board-certified general surgeon who provides pro-bono care for those in need in the Washington, DC, area, and through her missionary work in Haiti and Iraq.6,7
“Working with Sister Dede when I was at Georgetown really opened my eyes to a lot of things that I think people in this country take for granted—drinkable water out of a sink, for example. The life we live in the US is pure luxury compared to most of the world,” he said.
When Dr. Epstein founded the GSMSG, the group comprised approximately 15 friends with experience in international humanitarian work. Once he decided the group’s first mission would be to Iraq, that number dropped from 15 to two, including Dr. Byrne.
“Our trip was during the height of ISIS, but Sister Dede, without any hesitation said, ‘Okay, let’s go,” he said. “So, we went and did a couple of surgeries, saw a bunch of patients, and got a real-deal assessment of what was needed in a situation like this from a surgical perspective.”
When Drs. Epstein and Byrne returned to the US, she confirmed to potential volunteers that the group was well organized and had security, housing, and other infrastructure in place overseas.
“It’s one thing to hear it from a brand-new med student, ‘Let’s go to Iraq and do surgery,’ but hearing that from a well-established surgeon like Sister Dede, who has such an impressive background, led to more and more people joining us; it just took off.”
Today, the GSMSG has a roster of approximately 1,500 volunteers. “We literally went from 15 to 1,500,” he said.
With the game-changing humanitarian work the GSMSG continues to provide, Dr. Epstein has transitioned from mentee to mentor.
“In terms of the advice I give people now, first—it goes back to developing an understanding of the larger context of what it is you’re trying to do. What I hear from a lot of friends who have done work with an NGO or other group, is that they find themselves buried in bureaucratic obstacles and hurdles. The unfortunate reality is that, in most parts of the world, doctors aren't power players. They're not the ones making decisions.”
He also advises that people should make sure that an international group or NGO aligns with their own values. “I have seen others somewhat blindly join an organization based on social media or public relations messaging without a real understanding of what that organization is all about. They are ultimately disappointed after realizing they are being taken advantage of or used for an ulterior motive. You absolutely need to do your due diligence with whatever group you align yourself and expect that any serious organization will do the same in order to make sure you are a quality individual who will bring value to the group,” he said.
No matter what pathway a medical student or resident chooses to augment surgical training, Dr. Epstein emphasized the importance of conducting a rigorous self-assessment to determine ultimate goals, partnering with experienced physicians and mentors, and developing a keen business acumen in order to understand the nuances of whatever option is chosen.
Tony Peregrin is Managing Editor, Special Projects, in the ACS Division of Integrated Communications in Chicago, IL.