DALLAS – Nov. 04, 2024 – On a Thursday morning in Dallas, Fiona Strasserking, M.D., chats with her UT Southwestern colleague while internal medicine residents from the University of Zambia log on to their Zoom call. Rafic Berbarie, M.D., Associate Professor in UTSW’s Division of Cardiology, is today’s guest lecturer and the topic is “Evaluation of Chest Pain.” He’ll cover everything from chronic angina to myocardial infarction.
This cross-continental training session is one in a series that Dr. Strasserking, along with her UTSW teammates and Zambian collaborator Dr. Ngosa Mumba, have planned. The goal is to educate enough primary care doctors on how to manage cardiovascular disease to make a meaningful, lifesaving difference in Zambia, an African nation that has more than 20 million people but fewer than 10 formally trained cardiologists.
Protecting the hearts of people nearly 9,000 miles away may seem daunting, but it’s not impossible – and besides, Fiona Strasserking is no stranger to Herculean tasks and defying the odds.
She escaped a civil war in Sierra Leone, where she was born, and made it back to medical school in the U.S. despite multiple detours – including a stint working at Blockbuster Video.
Now, as an Assistant Professor in UTSW’s Division of Cardiology, she is leading global health initiatives in Zambia with her colleagues in Internal Medicine, Obstetrics and Gynecology, and Family and Community Medicine. Together, they are bringing much-needed knowledge and care to the sub-Saharan nation while collaborating with teams in Zambia on research and education projects. In July 2024, a team from UTSW traveled to a rural clinic there to perform complex surgeries. In November, UTSW specialists will co-host an African conference on stroke with colleagues in Zambia.
Helping others, in Dallas or a world away, is exactly what Dr. Strasserking has always dreamed of doing, ever since she was a little girl growing up in Freetown, Sierra Leone. That’s where she was inspired by the nurse in her close-knit neighborhood.
“Everyone went to her for everything,” Dr. Strasserking said. “I wanted to be like her, someone who served the community and that the community could depend on. As a doctor, I have always strived to give back,” she added.
“Now, with our team at UT Southwestern, we can do much more together.”
Dr. Strasserking’s efforts in Zambia are inspiring her colleagues, too, said Mark Drazner, M.D., Professor and Clinical Chief of Cardiology at UTSW.
“Not only does she personally make important contributions, but she also is leveraging the expertise at UT Southwestern,” he said. “As I’ve told her often, she is trailblazing the global health initiative within the UT Southwestern Cardiology Division, and we are so proud of her!”
In 1989, Fiona Strasserking enrolled in the College of Medicine and Allied Health Sciences – Sierra Leone’s only medical school. But in her third year, civil war broke out. She first fled to Guinea and then the U.S., settling with an aunt in Houston.
Eager to continue her medical training, she tried reaching out to medical schools in the U.S. but was turned away. Her parents were still living in war-torn Sierra Leone, so she went to work, often holding down two or three jobs at a time so she could send money home.
One of those jobs was at Blockbuster, the video rental retailer that had thousands of storefronts in the early 2000s but is now nearly extinct. Her Blockbuster was located next to a military recruitment center, and she often chatted with a Navy recruiter who would browse the store shelves in his working whites. One day while checking out, he persuaded her to consider a career in the Navy. The G.I. Bill could further her education, he said, and increase her chances of re-enrolling in medical school.
For the next eight years, she trained and then served as a cardiovascular tech, performing echocardiograms, pacemaker testing, and other evaluations for active duty and retired service members – first at the then-National Naval Medical Center in Bethesda, Maryland, then at the U.S. Navy Hospital in Guam. Along the way, she fell in love with the human heart, an organ whose simple and elegant design is matched only by its power and pivotal role in life itself, she said.
When her military service ended, Dr. Strasserking enrolled in community college to obtain her medical school prerequisites and took night classes while working as a cardiac sonographer at UTHealth Houston, the academic medical center connected to UT Houston’s McGovern Medical School. Two years later, Dr. Strasserking was accepted to medical school there with the enthusiastic support of her cardiology colleagues.
A rare condition and connection
With her medical education back on track, Dr. Strasserking thought more and more about how she might be able to help back home. “I always knew I would go back and give back to the people who needed it the most,” she said.
She enrolled in McGovern’s global health concentration and developed her own mission, traveling for two months to Sierra Leone to screen for cardiovascular risk factors in four different communities. She then published results that would be used to help develop the country’s public health policy.
She continued her global health work during an Internal Medicine residency at Washington University in St. Louis/Barnes-Jewish Hospital, traveling to Peru to screen patients for abdominal aneurysms. Later, during her cardiology fellowship at Vanderbilt University Medical Center, she accepted a prestigious Fogarty International Fellowship from the National Institutes of Health (NIH). Awarded during the height of the COVID-19 pandemic, this fellowship allowed her to travel to Zambia from 2021 to 2022, a place where Vanderbilt already had established public health collaborations.
While at Vanderbilt, Dr. Strasserking had one of the most influential experiences of her life. One night, she was asked to consult on an emergency case by the Department of Obstetrics and Gynecology – a mother who had given birth about six weeks prior had low cardiac function. With Dr. Strasserking’s help, the patient was diagnosed with peripartum cardiomyopathy, a form of heart failure that can arise toward the end of pregnancy and in the weeks after delivery. Peripartum cardiomyopathy affects between 1 in 1,000-4,000 pregnancies every year in the U.S. and it is more prevalent in Black women.
Intrigued by this relatively rare condition, Dr. Strasserking used her Fogarty Fellowship to study peripartum cardiomyopathy while also helping patients survive it in Zambia, a place that lacked the resources to collect basic data on this condition and had even fewer resources to improve its outcomes.
“It’s easy to go to another country on a research grant, come in and collect data, and leave,” she said. “But I realized that I could do something much more meaningful than get a publication.”
Over the next year, she worked in a clinic affiliated with the University of Zambia to collect data on peripartum cardiomyopathy. Along with her local colleagues and research team, she developed a heart failure clinic to care for this population. After establishing relationships with patients and caring for them for a year, half regained normal cardiac function, and the other half improved significantly compared to baseline measurements. One patient even named her baby from a subsequent pregnancy Fiona, after Dr. Strasserking.
Giving women hope and working with them to ensure safe future conception was a priority for Dr. Strasserking and her team.
In fact, she said recently that “it’s the most impactful thing I’ve accomplished in my life.”
A path to learning in Dallas and Zambia
After cardiology training at Vanderbilt, Dr. Strasserking carefully considered her next move. Her parents had since immigrated to the U.S. and were living near her aunt in Houston. Being close enough to help care for them if necessary was a priority, but so was continuing her global health work.
Soon, after talking with Roger Bedimo, M.D., Director of UTSW’s Office of Global Health, she found a perfect match.
“What I noticed in her more than anything else is an incredible drive and passion for her global health work, which I was eager to nurture,” said Dr. Bedimo, a Professor in UTSW’s Division of Infectious Diseases and Geographic Medicine. He is originally from Cameroon.
Since 2016, UT Southwestern has cultivated a global health partnership in Ethiopia with Bahir Dar University Hospital, largely thanks to Mehari Gebreyohanns, M.D., Associate Professor of Neurology. The Ethiopian native founded Bahir Dar Outreach for Neurology Education (BORNE) after learning the hospital had no neurologists, and that project has grown to include collaborative educational, clinical, and research activities between UTSW and Bahir Dar.
Dr. Bedimo realized that Dr. Strasserking’s work would be a great addition to the improvements he’d planned to the Office of Global Health, so in 2022 she joined UTSW’s Cardiology faculty and began building on her connection with the University of Zambia. A group of UTSW physicians visited in the summer of 2023, and the trip was inspiring, said Joseph Schaffer, M.D., a urogynecologist who serves as Chief of Gynecology at Parkland Memorial Hospital and UT Southwestern.
“There aren’t any trained urogynecologists in the whole country,” he said. “It’s a very under-resourced setting.”
Working with Zambian partners, Dr. Schaffer and his UTSW colleagues began developing a nascent collaboration to study the prevalence in Zambia of vesicovaginal fistulas (leaks between the vagina and bladder often caused by obstructed labor) as well as the prevalence of pelvic organ prolapse and urinary incontinence. He and his colleagues also observed and participated in surgeries for fistulas and other conditions at University Teaching Hospital, the tertiary hospital for the University of Zambia. In addition, Dr. Bedimo began setting up additional collaborations to study HIV and other conditions in Zambia.
In July, a team from UTSW headed back to Zambia to further these collaborations and work in a temporary fistula surgery clinic in rural Zambia, repairing these defects for women unable to travel to University Teaching Hospital. A multidisciplinary symposium during the same trip helped UTSW and the University of Zambia raise awareness of their budding collaboration and cultivate new ideas for the two institutions to help each other. Later this month, UTSW physicians, including Dr. Gebreyohanns, will co-host the African Stroke Organization Conference with University of Zambia partners in the Zambian capital Lusaka, combining efforts to help combat a major cause of death and disability for people throughout Africa.
Back in Dallas, Dr. Strasserking is continuing to work with Zambian colleagues by organizing a series of video lectures to educate internal medicine residents on cardiac issues. After she gave the first lecture herself, on hypertension, Dr. Berbarie delivered the second.
“Giving lectures to health professionals in another country on the other side of the world is thrilling, important work,” said Dr. Berbarie. “I’m honored to be part of this effort.”
Dr. Strasserking plans to continue looking for other ways to work with colleagues in Zambia to improve that country’s health, particularly in her specialty.
“Cardiovascular disease is still the No. 1 killer of people in the world, and in lower- and middle-income countries, the mortality rate is significantly higher compared to higher-income countries. For example, heart failure mortality in sub-Saharan Africa is 30%, compared to 7% in the U.S.,” she said. “My hope is that the path that brought me to both Zambia and UT Southwestern will provide the education, training, and resources necessary for these statistics to dramatically improve.”
Dr. Drazner holds the James M. Wooten Chair in Cardiology. Dr. Schaffer holds the Frank C. Erwin Jr. Professorship in Obstetrics and Gynecology.
Making a Difference with the Office of Global Health
UT Southwestern’s work as an academic medical center that integrates teaching, research, and patient care doesn’t stop at its campus borders. Through its Office of Global Health, this mission extends to collaborating institutions scattered throughout the world, said Roger Bedimo, M.D., the office’s new Director. Since 2010, the Office of Global Health has formed partnerships with several other academic medical institutions in countries around the world:
- Nepal: UTSW and collaborators are performing a comprehensive school-based child health study as well as a study and intervention to treat pelvic organ prolapse.
- Ethiopia: Colleagues in this country worked with UTSW faculty to hold a joint symposium and workshop for neurology education and a webinar on evaluation and management of strokes in resource-limited settings.
- Peru: UTSW faculty provided training on antimicrobial stewardship and other topics.
- South Korea: UTSW has set up a physician training program in Dallas with colleagues in the Korean Association of Medical Colleges.
- The Republic of Türkiye (Turkey): A fellows and faculty exchange program provides training in pediatric emergency medicine and infectious diseases.
Although some of these institutions have resources on par with UT Southwestern, most operate on significantly smaller budgets in low- and middle-income countries that lack similar expertise, technology, and research capabilities. By joining forces, Dr. Bedimo explained, both UT Southwestern and partnering institutions benefit through a cultural exchange of education, research collaborations, and opportunities to deliver care that patients wouldn’t be able to access otherwise.
There’s a common misconception that forming these global health partnerships requires enormous financial and other resources, Dr. Bedimo said, but even modest resources can make a huge positive difference, he said.
“For people like me who have visited these settings, it’s very easy to get overwhelmed by the magnitude of need, but it is not necessary to have a huge amount of resources to do something tangibly beneficial,” Dr. Bedimo added. “Right now, with the resources already in our possession, we have the ability to impact the health and lives of a lot of people in resource-limited settings.”
To learn more, go to Office of Global Health.
About UT Southwestern Medical Center
UT Southwestern, one of the nation’s premier academic medical centers, integrates pioneering biomedical research with exceptional clinical care and education. The institution’s faculty members have received six Nobel Prizes and include 25 members of the National Academy of Sciences, 24 members of the National Academy of Medicine, and 14 Howard Hughes Medical Institute Investigators. The full-time faculty of more than 3,200 is responsible for groundbreaking medical advances and is committed to translating science-driven research quickly to new clinical treatments. UT Southwestern physicians provide care in more than 80 specialties to more than 120,000 hospitalized patients, more than 360,000 emergency room cases, and oversee nearly 5 million outpatient visits a year.
