Advancing Gastroenterological Care at Monument Health

By Alex Strauss

Ali Zakaria, MD, and Issam Turk, MD

Rapid City was not even remotely on Ali Zakaria's mental radar when he was studying medicine in Amman, Jordan. Nor was it a place he'd thought about during his internal medicine residency and gastroenterology fellowship at Ascension Providence Hospital & Medical Center MSU in Michigan.

It was not until he'd completed an additional advanced endoscopy fellowship at Moffitt Cancer Center/Tampa General Hospital that he began to look for an underserved area in which to work, to secure his visa status as an international medical graduate.

"I got an interview at Monument Health and my wife, who is an oncologist, also interviewed at the Cancer Care Institute," says Zakaria. "She really loved it here in Rapid City right away, and I liked it, too—happy wife, happy life, right?"

Interventional Gastroenterology Comes to the Hills

So the couple relocated to the area in July of 2022. Dr. Zakaria's arrival launched an interventional gastroenterology service that has never before been available in the Black Hills region.

"This area has always had good basic GI care with procedures like endoscopies and colonoscopies, but they were in much need of certain skills that I possess," says Zakaria. "Previously, patients had to travel to Denver or the Mayo Clinic for more complex GI care. It is humbling for me to be able to offer these high-risk procedures and this advanced technology locally."

Ali Zakaria, MD

Among the advanced technologies available since Dr. Zakaria's arrival is interventional endoscopic ultrasound, which is especially useful in the diagnosis and treatment of complex pathologies in patients with altered anatomies, such as a gastric bypass patient who develops a mass.

Dr. Zakaria is also working to introduce endo-hepatology to the area, an emerging field which utilizes the endoscopic ultrasound to diagnose and manage liver disease. Through a collaboration with the bariatric surgeons, endoscopic procedures for weight loss such as endoscopic gastroplasty, a same-day outpatient procedure, and transoral outlet reduction endoscopy (TORe), for those who have had a previous gastric bypass, are also now possible.

And many procedures can now be made even safer with Dr. Zakaria's introduction of single-use duodenoscopes, which significantly reduce the risk of infection in immunocompromised patients or those at high risk for complications.

The Team Grows Again

Issam Turk, MD

Issam Turk met Ali Zakaria while both were in training at Ascension Providence Park Hospital MSU in Michigan. Both applied for the same competitive gastroenterology fellowship and both were accepted. After training, Dr. Turk went into private practice in Michigan, his home state, while Zakarai left for his advanced interventional endoscopy training in Florida and eventually landed in Rapid City.

When Monument Health was ready to expand the gastroenterology team, Zakaria knew just who to call. Since they had last worked together, Turk had become burnt out by a relentless call schedule at his Michigan clinic, managing patients both in and out of the hospital, and rarely seeing his wife and two young children.

"At first when Ali suggested coming out to Rapid City, I thought it sounded crazy," he admits. "But I came out with my wife and fell in love with the city. It's family-friendly and offers a great quality of life, especially for a young family.

"I also really liked how the leadership here works with the doctors. They meet with and really listen to the physicians. Ultimately, that is what got me interested and led me to join Monument Health. I think we are here to stay."

Dr. Turk provides general outpatient care for a wide variety of GI conditions such as gastroenteritis and Crohn's disease as well as liver and pancreatic diseases and performs screening and diagnostic endoscopies.

CNP Jan Purcell works with Drs. Turk and Zakaria in the outpatient setting. The inpatient GI team includes gastroenterologist Jeegar Jailwala, MD, CNPs Jillian Elliot, Megan Epp, and Ashley Vermeulen and PA-C Emily Steadman. The expansion of the GI team coincided with an expansion of endo-dedicated surgical rooms, as well.

"For anything advanced and complicated that would warrant complex surgery or referral, my colleague and partner can handle it," says Turk. "Having that support is a huge help."

It is also helpful that the GI clinic is located in the same space as the surgery team, making it easy to set a patient up for surgery if they need it.

"It is rare for us to encounter any situation that we can't handle here," says Dr. Turk, the need for liver transplantation being the only exception. The hospital now works with a liver transplant team in Nebraska, that comes to the clinic every other week for followup visits..

Promoting Awareness and Prevention

Given the vital role that screening plays in preventing colorectal cancer, Dr. Zakaria worked with the hospital administration to organize a comprehensive educational campaign for Colorectal Cancer Awareness Month in March.

"With the rise of colon cancer, I wanted to help make people more aware of the risks, to realize that this is a preventable disease, and to understand that our technology is better for prevention," says Dr. Zakaria.

Among other things, the month included TV interviews, podcasts, social media campaigns, booths at various events, Grand Rounds talks with the primary providers and even a giant walk-through colon in the lobby of the hospital for 'Colon Day'. The event was more than a year in the making, but Zakaria says the results have been worth the effort.

"We saw a significant increase in screening colonoscopies even well into April," he says.

While the entire GI team is encouraged by the community's response to their efforts, Dr. Turk says it also means that they now have their work cut out for them.

"There is an especially high need here," he says.. "We are seeing an increasing number of referrals month after month."

That is likely due to many factors, including greater awareness, a reduction in the recommended screening age to 45, the fact that many people over 50 are still overdue for screening, a rise in digestive diseases nationwide, and the steadily growing population of the Black Hills.

"People in this community are recognizing the quality that we offer here at Monument Health." says Dr. Turk.  "We are committed to helping as many as we can without compromising the quality of our service."

"The takeaway is that Monument Health's mission is to make a difference every day," adds Dr. Zakaria. "We are truly making a difference by bringing new technologies and knowledge to the Black Hills, ensuring that the community has access to safe and excellent care locally, without the need to travel."