Mobile ‘endoscopy on wheels’ brings lifesaving GI care to rural South Africa

Medical University of South Carolina

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Dr. Michael Deal

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Credit: Medical University of South Carolina

A study led by the Medical University of South Carolina (MUSC) Global Surgery Program, in partnership with George Regional Hospital in South Africa, reported that a traveling mobile endoscopy team performed more than 500 procedures across five rural hospitals in South Africa’s Western Cape. The study was published in BMJ Open Gastroenterology in December 2025.

Between January and November 2024, the team performed procedures on adults at district hospitals where endoscopy is not routinely available. The findings highlighted both the heavy burden of treatable gastrointestinal disease in rural communities and the feasibility of bringing diagnostic care directly to patients’ doorsteps. The outreach substantially reduced patient travel, while uncovering high rates of gastrointestinal disease, including early cancers, pointing to a scalable model for expanding specialist care in low-resource settings. A health care gap that costs lives Across rural South Africa, access to timely gastrointestinal care remains a major barrier to health. The country has only 0.1 gastroenterologists per 100,000 people, leaving vast regions without specialist services and forcing patients to wait up to nine weeks for a routine endoscopy. At the same time, South Africa has one of the world’s highest rates of Helicobacter pylori

infection, or H. pylori, a known driver of gastritis, peptic ulcers and gastric cancer. Together, these factors contribute to delayed diagnoses and more advanced disease, particularly in remote communities where travel to care can be costly, time-consuming, or simply not an option. To address this gap, clinicians piloted a mobile endoscopy-on-wheels program at George Regional Hospital. A small traveling team transported portable endoscopy equipment by car to five district hospitals. Sites were visited two to four times per month based on referral volume. The program was supported through the MUSC Global Surgery Program, with key leadership

from Mike Mallah, M.D., and local champion Hugo Stark, M.D., at George Regional Hospital. Lead author of the study, Michael Deal, M.D., of the MUSC General Surgery program, praised the qualities that define Stark’s work and his commitment to patients. “Dr. Stark is an unending well of empathy. That’s what drew him to medicine, what drives him to do surgery and what drives him to lead this program, on these long drives to deliver care to his patients.”

Who received treatment

The team performed 515 adult procedures on 495 unique patients, most of whom were women with an average age of 56. The vast majority of procedures – 94% – were upper endoscopies. Colonoscopies made up 5% of procedures, and 0.2% were proctoscopies. The mobile program revealed a high burden of treatable gastrointestinal diseases. Gastritis was identified in 76% of patients, hiatal hernia in 70% and esophagitis in 69%. Duodenitis was found in 19% of patients while gastric ulcers were present in 7%. Many patients had overlapping conditions, most commonly the classic triad of gastritis,

esophagitis and hiatal hernia, consistent, Deal explained, with long-standing untreated reflux disease. A small percentage of patients were diagnosed with malignancy, including 12 cases of esophageal cancer and five cases of gastric cancer. Seven of these patients were referred to George Regional Hospital for advanced management, such as stenting or surgery, highlighting the program’s role in earlier cancer detection and medical care. Most patients received immediate treatment, typically proton pump inhibitors, and a subset were scheduled for local follow-up. Deal emphasized the community component of care, noting the unique connection built with patients. “They recognize that you have come to their community to deliver the same level of care they would receive at a major regional hospital. I think it does a lot for that patient-provider relationship.” Dramatically cutting travel burdens

Perhaps the most tangible impact of the program was how much travel it reduced. On average, patients traveled over 8 miles to a mobile site, compared with about 63 miles to reach George Regional Hospital. For the most remote location, patients saved an average of 137 miles per visit. A small group of 18 ultra-rural patients, individuals living in remote and underdeveloped areas with little access to health care, collectively avoided over 1,864 miles of travel during the study period. Their average travel distance dropped from 59 to just under 7 miles per visit. Deal noted that distance is only part of the barrier. “Not only did they possibly not have reliable transportation, but they might have jobs or family responsibilities that even by missing half a day

to make that travel would be a significant barrier.” By reducing geographic obstacles, the program also improved continuity of care, ensuring that patients could receive follow-up care when needed.

A scalable model for low-resource settings The success of this initiative aligns with prior mobile endoscopy programs conducted in rural India, where similar efforts proved both feasible and scalable. The study suggests that portable,

cost-conscious specialist services can meaningfully expand access to care in low- and middle- income countries facing workforce shortages. At the same time, the authors acknowledged key limitations: Most upper endoscopies were performed with topical throat anesthesia, which, while cost-effective, could potentially limit the detection of subtle lesions. Secondly, the study was conducted in a single region only. And lastly, long-term patient outcomes were not tracked. Future work, the team concluded, may include analyzing cost-effectiveness and expanding into

other regions. Looking ahead, Deal sees broader potential. “To take this type of program and expand it to include additional clinical support throughout South Africa would be incredible,” said Deal. “I think that would be the next translatable step. We've done this for endoscopy. Can we do this for minimally invasive surgery?” By bringing diagnostic endoscopy directly to rural communities, the mobile outreach program reduced inequities in gastrointestinal care, enabled earlier detection of serious disease and saved patients thousands of miles in travel. The study demonstrated that mobile specialist care can be both practical and transformative for underserved communities in South Africa and beyond. (left to right: Dr. Deal, Dr. Mallah: co-senior author and Global Surgery Program Director, Dr. Stark: co-senior author, Dr. Eskandari: Global Surgery Associate Program Director, and a member of the George Regional Hospital staff). Credit Medical University of South Carolina

Journal

BMJ Open Gastroenterology

DOI

10.1136/bmjgast-2025-002040 

Method of Research

Observational study

Subject of Research

People

Article Title

Mobile endoscopy in rural South Africa: outcomes of a decentralised outreach programme to improve gastrointestinal healthcare access

 

Study finds memories of childhood adversity shift with present-day relationships

Michigan State University

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EAST LANSING, Mich. – New research from Michigan State University finds that how young adults recall adverse childhood experiences fluctuates based on the current quality of their relationships — particularly with their parents.

In a study tracking nearly 1,000 emerging adults over a two-month period, researchers asked participants three times about memories of their experiences growing up before turning 18. Each time, participants reported on their adverse childhood experiences, as well as their current relationships with parents, friends and romantic partners.

The research team, led by MSU Associate Professor William Chopik, found that while reports of childhood adversity remained stable, they did see meaningful differences in participants’ answers over the eight weeks of the study. The most consistent predictor of these fluctuations was relationship quality. When people reported more support and less strain from their parents than usual, they tended to report fewer adverse childhood experiences, particularly emotional abuse, sexual abuse and neglect.

The findings suggest that reporting on adverse childhood experiences contains both stable and dynamic information.

“People are generally consistent in how they recall their past, but the small shifts in reporting are meaningful,” said Chopik, co-author of the study and faculty at MSU’s Department of Psychology. “It doesn’t mean people are unreliable, it means that memory is doing what it does — integrating past experiences with present meaning.”

The researchers hope that recognizing the dual nature of these memories could improve how we interpret adverse childhood experiences in research and in clinical settings.

“From research forms to clinical intakes, people often report on their adverse childhood experiences,” said Annika Jaros, co-author and research associate. “Caring about the small differences in reporting can encourage more thoughtful use of these measures when predicting mental health, well-being and life outcomes.”

One idea for more accuracy could be to assess adverse childhood experiences more than once rather than relying on a single snapshot to better evaluate how people’s memories might be shaped by their current mental states.

“Those small changes in reporting may tell us something important about how people are currently coping, how they’re making sense of their life story and how relationships in adulthood continue to shape the way the past is understood,” said Chopik.

By Shelly DeJong

Read on MSUToday.

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Michigan State University has been advancing the common good with uncommon will for 170 years. One of the world’s leading public research universities, MSU pushes the boundaries of discovery to make a better, safer, healthier world for all while providing life-changing opportunities within an inclusive academic community through more than 400 programs of study in 17 degree-granting colleges.

For MSU news on the web, go to MSUToday or x.com/MSUnews.

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Journal

Child Abuse & Neglect

DOI

10.1016/j.chiabu.2025.107873 

Article Title

Record of the past or reflection of the present? Fluctuations in recollections of childhood adversity and fluctuations in adult relationship circumstances

Article Publication Date

1-Mar-2026

 

Mapping the urban breath

Chinese Academy of Sciences experts evaluate the global race to track city-scale carbon emissions and reveal the blueprints for a carbon-neutral future

Biochar Editorial Office, Shenyang Agricultural University

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Advances in the design of urban CO2 emission monitoring networks: a review

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Credit: Jing Li, Pingyang Li, Pengfei Han, Zhineng Cheng, Jun Li, Tao Zhang, Duohong Chen, Yijun Zheng, Ning Zeng & Gan Zhang

Cities occupy just a small fraction of Earth's land, but they act as the planet's massive carbon engines, pumping out the lion's share of global CO2 emissions. To stop climate change, we first have to measure it accurately—street by street and chimney by chimney. A comprehensive new review published in Carbon Research takes a deep dive into the sophisticated networks designed to "sniff out" these emissions, highlighting both the technological triumphs and the massive gaps still remaining in our global monitoring net.

Leading the charge is Professor Gan Zhang from the State Key Laboratory of Advanced Environmental Technology at the Guangzhou Institute of Geochemistry, Chinese Academy of Sciences. Along with an international perspective, the study provides a critical look at how high-precision atmospheric observations are becoming the gold standard for tracking whether climate policies are actually working in real-time.

The research synthesizes data from ten major long-term monitoring networks and over 20 cities worldwide. It highlights a stark geographical divide: while North America, Western Europe, and East Asia are becoming "smart-monitored" hubs, vast regions across Africa, South America, and South Asia remain almost invisible to high-precision carbon tracking.

"We cannot manage what we do not measure," says Professor Gan Zhang. "By integrating top-down atmospheric measurements with traditional bottom-up inventories, we can create a transparent, evidence-based framework for carbon neutrality. Our work at the Chinese Academy of Sciences is focused on refining these tools to meet the complex challenges of modern, sprawling urban landscapes."

Critical Insights from the Review:

1. The China Phenomenon: The study underscores China's rapid leap forward in urban carbon monitoring, providing a template for how emerging economies can scale up climate technology.
2. Urban Shifting: Researchers identified a new challenge in "industrial relocation." As factories move away from city centers, monitoring networks must adapt to a widening gap between where people live and where carbon is actually released.
3. The Biogenic Blur: Distinguishing between carbon from fossil fuels and carbon from natural "breathing" ecosystems (plants and soil) remains a major technical hurdle that requires advanced network designs to solve.
4. Customized Blueprints: One size does not fit all. The review argues that a megacity in a desert requires a completely different sensor layout than a medium-sized city in a forest.

This review serves as a strategic manual for policymakers and scientists alike. It calls for a global push toward technology transfer and data-sharing, ensuring that cities in the Global South have the same tools to fight climate change as those in the North.

By bridging the gap between atmospheric science and urban planning, Professor Gan Zhang and the team at the Guangzhou Institute of Geochemistry are helping to ensure that the cities of tomorrow are not just centers of commerce, but leaders in environmental stewardship.

Corresponding Author:

Gan Zhang

State Key Laboratory of Advanced Environmental Technology, Guangzhou Institute of Geochemistry, Chinese Academy of Sciences, Guangzhou, China.

 

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Journal reference: Li, J., Li, P., Han, P. et al. Advances in the design of urban CO2 emission monitoring networks: a review. Carbon Res. 5, 3 (2026).

https://doi.org/10.1007/s44246-025-00239-z  

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About Carbon Research

The journal Carbon Research is an international multidisciplinary platform for communicating advances in fundamental and applied research on natural and engineered carbonaceous materials that are associated with ecological and environmental functions, energy generation, and global change. It is a fully Open Access (OA) journal and the Article Publishing Charges (APC) are waived until Dec 31, 2025. It is dedicated to serving as an innovative, efficient and professional platform for researchers in the field of carbon functions around the world to deliver findings from this rapidly expanding field of science. The journal is currently indexed by Scopus and Ei Compendex, and as of June 2025, the dynamic CiteScore value is 15.4.

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Journal

Carbon Research

DOI

10.1007/s44246-025-00239-z 

Method of Research

Literature review

Subject of Research

Not applicable

Article Title

Advances in the design of urban CO2 emission monitoring networks: a review

Article Publication Date

31-Jan-2026