“Africa has tried to kill me twice, but I’m happy to say it hasn’t succeeded,” Jeff Punch says with a grin in a video call from Kigali, Rwanda. After a long day in the operating room, he’s resting on his hotel balcony as dusk settles on the rolling countryside.
Each year since 2013 (minus two Covid years), the sixty-six-year-old U-M prof has averaged seven weeklong visits to Africa with American volunteers training local teams to transplant kidneys. During those visits, he has weathered a heart attack and a pulmonary embolism, witnessed the start of Ethiopia’s civil conflict, and narrowly avoided being quarantined there at the start of the pandemic.
“Jeff Punch is one of the most remarkable people I’ve ever met,” says Alan Leichtman, a U-M nephrologist who joined Punch’s team in Ethiopia in 2013. “He is a very, very good surgeon. But beyond that, he’s also a remarkable teacher, very compassionate and giving. The program wouldn’t have happened without him.”
Before the program began, patients whose kidneys failed were consigned to a lifetime of dialysis or a trip to India for surgery. “But dialysis is expensive. So are travel and accommodations,” Punch points out. “And dialysis doesn’t cure the problem. We can offer transplants for three to five patients for the same cost as [lifetime] dialysis [for one patient]—and the patients are going to live longer and be productive members of their families and societies.”
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Photo: Lloyd Brown
The call to build kidney transplant programs in Africa came from Tedros Adhanom Ghebreyesus, then Ethiopia’s minister of health (and now director-general of the World Health Organization). It reached Ann Arbor via Ethiopian-born U-M physician Senait Fisseha, an OB/GYN who founded the university’s Center for International Reproductive Health Training.
Fisseha “knew if African doctors were sent to the U.S. for training, many wouldn’t go back,” Leichtman explains, “so she decided it was far more advantageous to train them in their native lands.” In Ethiopia, the center’s training program cut the infant mortality rate in half.
When Dr. Tedros asked for a kidney transplant program, Fisseha knew immediately whom to ask: At the time, Punch was not only director of U-M’s Transplant Center, he was her neighbor in Ann Arbor Hills. (Punch and his wife Margaret, a U-M OB/GYN, are still there; Fisseha now lives in Omaha, where she heads international programs for the Susan Thompson Buffett Foundation.)
She chose the right surgeon. Not only was Punch a pioneer in transplant procedures and studies, he and Margaret had a keen interest in Africa. The couple, who have three grown children, had previously worked in Kenya on mission trips with the First United Methodist Church.
He immediately signed on.
“Sustainability was—and is—our goal,” the surgeon explains. “We wanted to equip and train surgeons, doctors of internal medicine, nurses, and technicians in their own hospitals, to set them up for success, so they can run the transplant programs themselves, rather than relying on occasional visits from foreign specialists.”
Fisseha and Punch visited St. Paul Hospital in Addis Ababa repeatedly in 2013 to assess its capabilities. “What we saw was a run-down hospital comparable to an American hospital of the 1930s and ’40s, but with ultrasounds and CT machines,” recalls Leichtman, who they’d recruited to join them. “We agreed it could be suitable.”
Punch and Leichtman approached colleagues around the country to assemble a team of transplant professionals. “Coordinating a transplant team is like buying a new car—one missing component is a total deal-breaker,” Punch says. The volunteers discussed everything from hospital infrastructure to protocol, supply lists, how to screen live donors and patients, surgical requirements, and post-surgery regimens.
They arranged for Ethiopian doctors to observe transplant procedures in Ann Arbor and in the world’s largest kidney transplant program, located in São Paulo, Brazil, which averages 1,000 transplants a year, versus 350 at large United States programs. They surveyed local social workers and psychiatrists, and they trained nurses for cutting-edge surgery. Finally, in 2015, Punch helped an Ethiopian surgeon successfully perform the nation’s first kidney transplant.
There would be many more: It takes about twenty operations before a surgeon is proficient. In the midst of one transplant, an attending surgeon noticed that Punch showed signs of a heart attack. “Sit down,” he insisted. Punch resisted. “Jeff stayed at the table until he finished the surgery,” Leichtman recalls. “Then the doctor immediately put the patient and Jeff Punch side by side in ICU beds.” Margaret Punch flew out to supervise his treatment until she could get him home for surgery. Some time later, Punch suffered an aortic embolism in Africa; that time, he recovered there.
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The year 2020 interrupted all operations in Ethiopia, first with the Covid pandemic, and then when war broke out in the Tigray region. Last year, the region became stable enough to reopen the transplant program. The American medical team visited Addis Ababa to once more review the facility after the combined traumas of disease and war and to commend the doctors.
With the Ethiopian program functioning independently, the team moved on to King Faisal Hospital in Kigali. After two years of virtual meetings, this past May, Punch and his volunteer team assisted Rwandan surgeons as they performed the nation’s first kidney transplants. He returned twice this fall, and plans one more trip in December. “Usually I do three surgeries in one week,” he says. “In December I’ll do four.” He has planned seven trips for 2024.
Funding for the work in Ethiopia came from a grant of more than $1 million from the Susan T. Buffett Foundation. Impressed by its success, the foundation has granted an additional $50 million to expand programs into twenty African countries. Punch and his growing team are looking at the Democratic Republic of the Congo, Malawi, and Tanzania as possible next stops.
“My practice here in the U.S. is slowing down, but I want to continue my work in Africa,” he says. “I love the people. I love Africa. I have a terrific team. And the patients are so grateful.”
He pauses a moment to gaze again across the Rwandan landscape. “Transplants are sort of magical,” he adds. “They’re life-changing.
“Their challenges are unique, with a lot of potential plots. But we get to see chronically ill people immediately feel great after surgery.
“Yes, it’s magical.”
What has been said is impressive. I have worked with Prof. Jeff Punch as a nephrology fellow and he was an exceptional person. He is selfless, humble and approachable and handles cases quietly. Despite the MI he experienced, his concern was about those patients, not about himself.
What has been said is impressive. I have worked with him as a Nephrology fellow and witnessed the circumstance. He was selfless, humble and exceptional person. Despite the MI, his concern was about those patients than himself.