When Jeff Punch looks back on his early trips to Ethiopia, kidney failure followed a grim and predictable arc. A patient would arrive desperately ill, receive a diagnosis, and be handed a choice: scrape together $35 for a dialysis session — a steep sum in a country where the average person earned roughly $20 a week — drain your family's savings over months to stay alive, or travel to India for a $30,000 transplant if you were wealthy enough. Most people, eventually, ran out of options.
A transplant surgeon at the University of Michigan, Punch wanted to change that outcome, not by flying in to perform surgery, but by making sure local surgeons could do it themselves.
The approach was built on a deceptively simple principle: sustainable healthcare capacity means training people where they live and work. It's a model he traces back to Tim Johnson, a colleague who had shown in Ghana that sending faculty to train physicians in-country, rather than bringing trainees to the US, produced something far more durable. Surgeons trained at home learned to practice within their actual environment, with the equipment and resources actually available to them. And crucially, they stayed.
His path to Ethiopia began through a neighbor: Senait Fisseha, an Ethiopian-born OB-GYN who had built a remarkable program there improving maternal health and surgical training. When she learned Punch was already traveling to East Africa through a church partnership in rural Kenya, she invited him in, and later secured the grant that funded the Ethiopia work. Kidney transplant, it turned out, was a natural fit: the alternative for patients with end-stage renal disease wasn't just worse health outcomes, it was financial ruin. And the surgical skills required overlapped directly with procedures the Ethiopian team was already building toward.
The timeline was long and cumulative. Beginning in March 2013, Punch and a rotating team of U-M nurses, nephrologists, and social workers made roughly a dozen trips to prepare and plan. The first transplants were performed in September 2015. Over the next three years, they trained four transplant surgeons. The graduation ceremony, held in September 2018 at the United Nations Economic Commission for Africa in Addis Ababa, drew families from across the country. Even through a pandemic and then civil war, the program kept going without him. That, Punch says, was the proof of concept.
In 2019 and 2020, the work continued with trips focused on expanding training to more complex patients and pediatric transplants. Then came Rwanda: beginning with virtual meetings in 2021, the team laid the groundwork for in-person training, performed the first transplant there in May 2023, and completed the training program in December 2025.
The work wasn't without surprises. The night before the very first transplant, he discovered that opioid pain medications simply weren't part of post-surgical recovery protocols at the hospital. Punch had assumed they were essential. The Ethiopian surgeons had no such assumption: their patients recovered without opioids after procedures as significant as hip replacements and colon resections, and fared just fine. What looked like a gap was, in fact, a different answer to the same question. It was a distinction that would come into sharp relief back home: around the same time, the United States was beginning to reckon with decades of opioid overprescription and the epidemic of addiction and harm it had quietly generated. "Many of the things we do," Punch says, "don't have the value we think they do."
From Ethiopia, the work moved to Rwanda, where Punch and his team trained two surgeons with excellent results. Surgeons there are now performing transplants independently, one to two a week, and have begun a fellowship to train the next generation themselves.
The results speak for themselves. In Ethiopia, the surgeons Punch trained have since launched their own fellowship, passing the knowledge forward without him. In Rwanda, the team is performing transplants independently, one to two a week, and growing. Kenya and Ghana are next.
What began as a small team of U-M faculty traveling to Addis Ababa has set something larger in motion: surgeons who were once students are now teachers, programs that once needed outside support are now building the infrastructure to train the next generation themselves. The goal was never to be needed forever — it was to make sure that a transplant wasn't something only the wealthy could access, and that the surgeons performing them were neighbors, not visitors.
