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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 epnelson@partners.org. 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.