Surgical resident Alexandra Sansosti, MD, has spent one of her two research years in an unexpected setting: the remote Sicilian island of Lampedusa, where thousands of migrants arrive each year seeking safety. Positioned just 70 miles from Tunisia and about 180 miles from the Libyan coast, Lampedusa has become a natural—albeit perilous—gateway to Europe for migrants fleeing violence, exploitation, persecution, and poverty in Africa and the Middle East. Its proximity to North Africa makes it one of the primary entry points for those risking dangerous journeys by sea in overcrowded and unseaworthy boats.
With a Fulbright grant and institutional support, Dr. Sansosti has dedicated herself to bridging the gap between medical care and policy for one of the most vulnerable populations in the world. Recently she wrote an op-ed in her home paper, the Pittsburgh Post-Gazette. In this interview, she shares her latest research, the relentless dedication of Lampedusa’s medical community, and her vision for how this work can inspire change on a global scale.
Could you tell us a little about how you came to work with doctors in Lampedusa and what motivated you to take on this project?
I love this project. It was a passion project of mine that stepped a little bit outside of the box of what most surgery residents do for their research years. And I am lucky that Fulbright and the surgery department supported me. One of my main goals was to really share the experience that I had with not only just the medical community but also the lay community. I’ve spent years building relationships in Italy, learning the language, understanding the politics, and developing connections. I’d read and heard so much about the situation there, especially as a medical student at Pitt, which has a hospital in Palermo, and ultimately, this experience gave me the confidence to embark on this project of my own.
What are some of the biggest challenges the doctors in Lampedusa are facing?
Lampedusa has around 6,500 residents year-round. And just to impress upon everyone the magnitude, last year Tunisia sent 110 boats carrying 7,000 people in a single day—effectively doubling the population overnight. It was retaliation because the Italian government hadn't paid the reciprocity fee that the Tunisians had come to agree on to not send people. That was an extreme event, but there are boats arriving every single day.
The scale of need versus resources is probably the biggest challenge. The infrastructure simply doesn’t exist to handle this many people consistently, especially since they’re dealing with critical situations, from severe burns to complicated pregnancies.
What specific healthcare gaps are you addressing with your research?
We’re looking at a few areas, but our first project focused on triaging and treating pregnant migrant women. Historically, when boats arrived, these women would undergo quick assessments at the port. If there were no overt signs of imminent labor or serious trauma and injury, they were taken to the "hotspot"—essentially the primary welcome center—where they’d wait 48-72 hours to be transferred to other asylums in Italy. The transfer process after reaching the hotspot can take weeks because they are most often transported via boat to other Italian cities, so you can imagine how dangerous this might be for a woman late in gestation.
The other problem is there are no delivery rooms, no ICU, or much medical equipment at all. There’s really nothing. If a woman went into labor, it was a 90-minute helicopter ride to Palermo, which is incredibly risky. That’s why we created a new protocol. It was just instituted last March to improve the initial screening process for pregnant women and brought a full-time OB-GYN to the island so they have someone skilled on the ground to triage appropriately and potentially avoid unnecessary helicopter flights.
What has it been like working with the local medical team and the community there?
It’s been incredibly inspiring. Sicilians are so warm and generous. Very few Americans go to Lampedusa. A lot of Italians vacation there in the summer, and in winter, everything is closed. To get there, you have to take a jumper plane from Palermo. The doctors who rotate from Palermo are mostly young, moonlighting residents or fellows, filling in where they’re needed. It’s really incredible, the dedication. There’s a real “all hands on deck” mentality. The community as a whole is so welcoming to migrants despite the strain on already scarce resources and the fact that they are being affected by this every day. When they experienced that influx of 7,000 migrants, locals housed them until they were able to be taken to these other refugee centers in Italy. The dedication of everyone involved really deserves attention and some accolades.
These days, Lampedusa really functions on tourism essentially, and there are people who won’t go there anymore because of the migrant crisis. It's really affected their livelihood, and yet they still are welcoming. They are still very warm, and they still continue to provide whatever very few means they have to help other people.
Given these limited resources, how has the care protocol impacted the local community in Lampedusa?
Interestingly, it actually helped access to care for Lampedusa residents. My understanding is that prior to the migrant crisis, they really had no healthcare structure. There's now a very small polyclinic where they have care 24/7. Again, I want to emphasize that all of these doctors rotate from Palermo. It's usually a five-day rotation every two or three months. So now they have 24/7 pediatric coverage, 24/7 OB-GYN coverage, and they have much more frequent cardiology coverage.
Wow, what an incredible impact. Are there other areas of care you’re exploring in your ongoing research?
We started with pregnant women because we had just instituted this protocol, using all these forms, collecting data, and evaluating outcomes. Prior to this protocol everything was done on carbon paper, so you can imagine the grind, the time everything takes. Now, we have a digital system these doctors can use. Even with the protocol, we still had a lot of missing data, and that’s just the reality of doing this kind of research.
But when you think about these boats—there are about 60 people to a boat. Most are repurposed fishing boats or rubber rafts. Depending on the structure, it’s assumed the safest place on the boat is the middle, so they put the woman and children there. The problem is that when the type of gasoline that they use mixes with saltwater, it creates a caustic mixture of acid. All of the women and children in the lowest part of the boat are sitting in acid. So when they come in, they have burns all over their back and buttocks and back of their legs. That can range from being pretty minor and treatable at the port to extremely severe. They had someone arrive with 70 percent of their body surface area burned a couple of months ago. One of the latest things coming out of Libya is the use of iron boats, and you can imagine how hot those get. So, not only chemical burns but iron burns anywhere your skin touches the boat.
Oh my god. That’s horrific.
It really is. Addressing the burns is one of the highest priorities. But we also started another project to address very strange phenomena. Essentially, a lot of people are arriving with methemoglobinemia, a condition where hemoglobin changes and can’t carry oxygen effectively. So, many migrants arrive in respiratory distress, and there’s no ICU. Something happens in transit, and we don’t know what it is. Maybe it's gasoline fumes, maybe it’s from paint varnish, maybe it’s a combination of things mixing with salt water. We’re trying to develop a new protocol to diagnose and treat this condition right at the port with an on-site methemoglobinemia meter and a protocol they can implement on the island when people are waiting for transit to Palermo.
What’s the bigger picture for this research, and how do you hope it’ll make a difference?
Beyond improving immediate care, my goal is to raise awareness and bridge the gap between local practice and international policy. As well as support the Italians doing these scientific projects on the ground. The next step is to really connect with organizations like the UN and WHO. Lampedusa’s experience in managing this influx could serve as a model for other places experiencing similar crises, like the Greek islands or parts of southern Spain. The protocols that the Sicilians have developed over time can offer a blueprint for other vulnerable locations so they don’t have to start from scratch.
On the immediate care front—my dream is to have an OR there. So they can do C-sections if they need to, and have 24-hour surgery coverage. And again, are they doing surgery all the time? No, not necessarily. But in those moments when you are 200 kilometers from Southern Sicily, and someone needs an operation, or they need a cardiac stent, that's a terrifying 90-minute helicopter ride that should not have to exist.
It also sounds wasteful from the perspective of properly allocating resources to best benefit the community.
One hundred percent. When Lampedusian women give birth, they have to leave the island. A month before their due date, they move to Palermo and live in government housing until they give birth. It’s kind of unfathomable.
So I think that's the third branch, resources. Is there a way for us to get them funding to have a surgeon full-time or at least someone who can do a C-section? Imagine the savings and the efficiency that that would allow for. Then you don't have to have the helicopter leaving all the time. And when you really do have a problem that you can't deal with on the island, it's there when you need it.
What’s the greatest takeaway you want people to grasp at this moment?
This humanitarian situation has been ongoing for over 20 years, and yet there’s so little international involvement. If the EU is really serious about helping with the problem, not just making high-level promises, the daily needs to be seen. It's very granular, tangible changes that need to be made from a resource and funding standpoint.
I feel a responsibility to share these stories, especially since the doctors there rarely get the chance to publish or share what they’re seeing and doing on a daily basis. A problem a lot of international researchers face is a lack of resources to have someone who's a native English speaker help write up these papers. And I think for our residents, learning how to collaborate with international physicians who maybe don't actually have that research background but have the data to back it up, that's a meaningful experience. Maybe it's not something totally novel or the newest technology or robotic surgery, but learning how to interact with people who live in a totally different world from you but have the same job as you? That’s really meaningful.
Beyond the scientific community, I think it’s essential for the general public to understand what’s happening in Lampedusa and the incredible resilience and generosity that the locals show in the face of such daunting circumstances. The most important takeaway is remembering the humanity of it. To see each other.
Related:
- Caracas to Santo Domingo: Creating Access to Pediatric Liver Transplant from the Ground, Up
- Bringing Life Saving Heart Surgery to Children in Nigeria
- The Modern International Surgical Mission Starts Local and Stays Local