Making Good on a Promise Made to the People of Haiti


Dr. George Dyer, an orthopedic surgeon at Brigham and Women's Faulkner Hospital, speaks in Haiti.

Dr. George Dyer, an orthopedic surgeon at Brigham and Women’s Faulkner Hospital, speaks in Haiti.

Over the course of the last five years, Brigham and Women’s Faulkner Hospital orthopedic  surgeon Dr. George Dyer has traveled to Haiti 14 times. His commitment to the country began immediately following the 2010 earthquake when he signed up to travel there with Partners in Health. His mission then and now has been to help train skilled orthopedic surgeons.

Reflecting on his first trip to Haiti in the aftermath of the earthquake Dr. Dyer says, “It was very rewarding. We did a lot of good. But as the two weeks that I was there wore on it, it was clear that the earthquake was really only a small blip in the number of orthopedic injuries that overwhelm the local capacity of surgeons in Haiti.” At the time there were just 40 orthopedic surgeons in a country of 12 million.

With the support of the American Academy of Orthopaedic Surgeons and their generous grant, Dr. Dyer and his colleagues have worked tirelessly to foster an interest in orthopedics in young Haitians and help them get the training they need to practice their profession. They organize orthopedic training for residents and also fully trained orthopedists in Haiti.  They bring visitors to Haiti to teach local physicians on the ground. They organize an annual conference. And they bring their Haitian colleagues out of the country to go to the US or elsewhere for training courses and to see techniques that are not taught anywhere in Haiti. Continue reading

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After Earthquake, BWHers Coordinate Relief Efforts in Nepal


BWH’s Duncan Maru, MD, PhD, of the Division of Global Health Equity

When an earthquake struck Nepal on Saturday, April 25, two Brigham and Women’s Hospital faculty members were in Achham District, in the far west of Nepal, about  200 miles from the epicenter. Duncan Maru, MD, PhD, and Dan Schwarz, MD, MPH, both of the BWH Division of Global Health Equity, were in Nepal working for Possible, a partner program of the Division of Global Health Equity based in Achham District. The staff at Possible felt the earthquake’s powerful tremors and aftershocks, but fortunately all are safe. As lines of communication were re-established later in the weekend, Possible’s staff members communicated with family and friends in other parts of Nepal, all of whom were thankfully safe. While Achham District gracefully sustained itself through the earthquake with no reported loss of life, buildings, or farmland, the same cannot be said for the rest of the country.

Dan Schwarz

BWH’s Dan Schwarz, MD, MPH, of the Division of Global Health Equity

The death toll now stands at over 5,000 and more than 10,000 have been injured in this country of 30 million. These numbers will climb in the coming days as rescue teams reach the more rural districts closer to the earthquake’s epicenter. These areas were already marginalized prior to the earthquake, and the media has paid little attention to them so far. Preliminary reports on social media and from various local organizations indicate that up to 80-90% of homes and buildings have been destroyed in some communities in Gorkha, Lamjung, and Sindhupalchowk Districts, among others. The scope of the devastation is astounding. Continue reading

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Eight Years of Changing Lives: Operation Walk Boston

Abel Rodriguez gets back on his feet after hip replacement surgery.

For five years following a traumatic injury, 20-year-old Abel Rodriguez, of the Dominican Republic, experienced excruciating pain in both of his hips, forcing him to walk hunched over with crutches. Xiomara Concepcion, a 34-year-old woman suffering from rheumatoid arthritis and bilateral knee pain since adolescence, required a wheelchair to get around.

Rodriguez and Concepcion are among 39 patients whose lives were transformed last month when they received joint replacements, thanks to Operation Walk Boston.

For one week in March, a team of more than 50 volunteers, including surgeons, anesthesiologists, nurses, physical therapists and operating room staff traveled to the Hospital General de La Plaza de la Salud in Santa Domingo for Operation Walk Boston’s eighth mission. The BWH-led team performed 56 knee and hip replacements. Additionally, 58 volunteer medical students from the Dominican Republic cared for patients as part of the team’s goal of educating the next generation of health care professionals in the country.

Read the story in BWH Bulletin and visit Operation Walk Boston for more information.

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Slowing the Spread of Cholera

The Crisis in Haiti

Louise Ivers leading earthquake relief efforts in Haiti in 2010; at right, caring for a young patient at a clinic in Haiti.

Louise C. Ivers, MD, MPH, and colleagues published a paper that shows exactly how much the vaccine Shanchol slowed the spread of cholera in villages north of St. Marc, Haiti, in 2012.

Writing in The Lancet Global Health online, Ivers, the senior health and policy adviser at Partners In Health, finds that Shanchol was widely effective when administered to thousands of adults and children in the region. “We found that there were about 65 percent fewer cholera cases among people that were vaccinated than there were in those

that were unvaccinated,” says Ivers, who is a member of BWH’s Division of Global Health Equity in the Department of Medicine.

It’s fantastic news, and not just for the obvious reason that fewer cholera cases means fewer cholera fatalities. Read the original story on the Partners In Health website.

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Global Health Anesthesia: Touching Lives Here and Abroad

global-health2-e1423840374538In addition to their vital work at home, BWH anesthesiologists are making an impact on patient care, education and research across the globe—from Haiti and the Dominican Republic to Rwanda and beyond. Attending anesthesiologist Emily Nelson, MD, and Monica Sa Rego, MD, clinical director of the Department of Anesthesiology, Perioperative and Pain Medicine—who volunteered together in Haiti following the 2010 earthquake—recently shared some of these efforts with BWH Bulletin.

Medical Missions

Since 2008, Team Heart has traveled to King Faisal Hospital in Rwanda’s capital city of Kigali to perform lifesaving cardiac surgeries for people suffering from rheumatic heart disease. Each year, the team has performed more than a dozen successful heart valve surgeries per trip, a life-changing experience for those who receive surgery and an eye-opening one for volunteers.

J. Danny Muehlschlegel, MD, MMSc, FAHA, director of Cardiac Anesthesia Research, is part of a team of BWH anesthesiology attendings and residents, cardiac surgeons, perfusionists, nurses and pharmacists who volunteer for the mission. From beginning to end, the anesthesiologists provide the integral service of preparing patients for surgery, monitoring and administering anesthesia, and ensuring a stable recovery.

In addition to patient care and coinciding with the mission, Muehlschlegel is working on the RECHARGE (Rheumatic Heart Disease Genetics) Study. One component of the study is to see if genetic variants among Rwandan teens and young adults are associated with the development of heart valve lesions. He and his colleagues will examine 400 Rwandan patients with early onset severe rheumatic valve disease using next-generation sequencing.

In a similar vein, Operation Walk Boston has helped patients with arthritis and joint disease in the Dominican Republic get back on their feet through knee and hip replacement surgeries since 2007.

Nelson first joined Operation Walk as a resident at BWH, with anesthesiologist Mercedes Concepcion, MD, whom Nelson calls “the mother of global anesthesia.”

Every year, three anesthesiology attendings and two residents from the department participate in the mission, along with surgeons, pharmacists, nurses, physical therapists and technicians.

“Whenever you practice in a country that doesn’t have the same resources as we have here, it makes you more humble and appreciative of what we have,” said Sa Rego. “When you work in other countries, you become more flexible and better able to adapt to many different clinical situations.”

Added Nelson: “Operation Walk is not only a medical service trip, but we’re helping to improve the systems there and exchange ideas, so clinicians in the Dominican Republic can better care for patients on their own after we leave.”

Harvard Global Anesthesia Initiative

This year, anesthesia leaders at Harvard Medical School-affiliated hospitals have established the Harvard Global Anesthesia Initiative to support and develop anesthesia trainees and faculty committed to improving anesthesia access and safety in under-resourced settings. From short-term mission team members to future leaders in the field, the initiative seeks to help anesthesiologists hone the cognitive and technical skills necessary to make a sustainable impact in underserved populations around the world.

“The main thing that we try to teach residents in global health work is that it’s about collaboration,” said Nelson. “It’s about helping to enable local practitioners to take care of the population they’re serving as best as they can. Instead of asserting our way of doing things on local practitioners, it’s about an exchange of ideas and listening to our colleagues abroad who have a lot to teach us in terms of caring for patients with limited resources.”

Matt Kynes, MD, a fourth-year BWH anesthesia resident, co-founded the initiative and is helping to plan its first workshop, which will take place Saturday, Feb. 28, at BWH. Participation is open to residents and staff with interest in global health. It will consist of simulated clinical scenarios, teaching, case-based discussions and hands-on demonstrations.

“I think it’s fantastic that so many people in our department are concentrating on global anesthesia,” said Nelson. “There has been continuity in our presence and commitment to serving folks in under-resourced settings over the years, as well as a strong commitment by our interim Chair Bhavani Kodali, MD, and past leadership to enable and support people doing this work.”

Interested in learning more or participating in the Harvard Global Anesthesia Workshop? Email You can also learn more about Operation Walk Boston and Team Heart.

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Team Heart Begins Eighth Annual Mission to Rwanda

During the 2012 mission, five of Team Heart’s surgical patients were all smiles at King Faisal Hospital in Kigali, Rwanda, after completing physical therapy for the day.

During the 2012 mission, five of Team Heart’s surgical patients were all smiles at King Faisal Hospital in Kigali, Rwanda, after completing physical therapy for the day.

This week, the BWH-led Team Heart is embarking upon its eighth annual mission to Rwanda to perform life-saving heart surgery for patients with rheumatic heart disease. The team performs one out of every four cardiac surgeries in Rwanda.

Chip Bolman, MD, a cardiac surgeon at BWH, founded the team with his wife, Ceeya Patton Bolman, MSN, RN, in 2008. Read all about the team’s work in this Boston Globe article, and visit Team Heart’s website for more information.

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Hope in Sierra Leone

Regan Marsh wears personal protective equipment to admit a patient.

Regan Marsh wears personal protective equipment to admit a patient.

Regan Marsh, MD, MPH, of BWH’s Department of Emergency Medicine, shares the following update from Sierra Leone, where she is working with Partners In Health (PIH) to care for Ebola patients. Although the situation is dire, Regan says, “There is definitely hope.”

Partners In Health is managing Ebola in 4 regions of Sierra Leone, including an Ebola Treatment Unit, a maternity hospital, two public hospitals and many rural community sites. I am primarily based at the Government Hospital in Port Loko, trying to effectively reopen it in a robust fashion, since it was deeply impacted on all levels by the epidemic.

Continue reading

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BWFH experts help provide quality healthcare to women in Rwanda

Virtually unknown in the United States, obstetric fistulae, or holes between either the rectum and vagina or the bladder and vagina, which develop after difficult childbirth, leave thousands of women in Africa incontinent. As a result, these women, many of whom are very young and very poor, are ostracized from their community. Since 2003, it has been the mission of the International Organization for Women and Development (IOWD) to bring volunteer surgeons and nurses to Africa to operate and care for these women. At the same time, the group trains the local surgeons in these surgical skills.


In 2003, Brigham and Women’s Faulkner Hospital OR nurse Kathleen Scott, RN, traveled to Niger with the IOWD for the first time. “It’s something I always wanted to do,” says Scott. “And I just got hooked.” Since then, she has traveled with the IOWD to Niger and then Rwanda every year until 2010. “It’s a great group. The doctors come from all over the country,” says Scott. “The thing that’s special about this group is that they train the local doctors and nurses to do the work. You leave the groundwork behind.” Continue reading

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Ebola, A Year After the Epidemic Began

December marked one year since the first case of Ebola was found in Guinea, leading up to the deadliest Ebola epidemic in history.

Rajesh Panjabi, MD, MPH, of BWH’s Division of Global Health Equity and co-founder and CEO of Last Mile Health, recently returned from Liberia where he has been working with the government and other partners to respond. He spoke with WBUR’s “Here and Now” about the outbreak, the progress we have made and the new challenges we are facing in fighting the disease.

Panjabi told WBUR: “Ebola anywhere is a threat to people everywhere, and so you cannot have almost zero with Ebola. You’ve got to get to zero cases.”

Read more:

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Improving Birth Outcomes in Resource-Limited Settings

CC Lee 2

“It’s the saddest thing in the world to hold a baby who has died,” said Anne CC Lee, MD, MPH, FAAP.  ”But what is even worse and more unjust is holding a baby who has died, when it could have been prevented.”

Lee, who has worked in rural health clinics in Tibet, India, Africa and China, is now working to improve birth outcomes in places with few resources and weak health systems.

Read more about the work of Lee, a physician-researcher in the BWH Department of Pediatric-Newborn Medicine’s Clinical and Translational Research Program, and her team in BWH Clinical and Research News.

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