Renowned for the care they provide in Boston, MGH emergency medicine experts also aim to improve care for the critically ill and injured around the world.
Mass General's Chief of Emergency Medicine, David Brown. MD
Mass General’s Chief of Emergency Medicine, David Brown, MD

 Physicians in Massachusetts General Hospital’s Department of Emergency Medicine are probably best known for the expert care they provide to the thousands of patients with critical injuries and illnesses who seek treatment in Boston. They handled mass casualties after the 2013 Boston Marathon and are ready in case a deadly virus like Ebola spreads.

But the Department of Emergency Medicine also has a mission focused far beyond the walls of Mass General. “We think globally across all our divisions,” explains Chief of Emergency Medicine David Brown, MD. “We learn things while practicing and teaching emergency medicine in austere environments with few medical resources, which help us take better care of patients back here.”

Through the Department of Emergency Medicine’s Division of Wilderness Medicine, for example, Stuart Harris, MD, treats and studies the effects of high altitude and low oxygen on the body at Mount Everest in Nepal. Vicki Noble, MD, head of the department’s Division of Emergency Ultrasound, is teaching healthcare providers in resource-poor countries like Uganda to use portable ultrasound scans to help diagnose a variety of conditions and more safely guide medical procedures. And Pediatric Emergency Medicine’s Sigmund Kharasch, MD, has been working in Israel, caring for both Israeli and Palestinian children.

Emergency Medicine and Ultrasound

Hundreds of women’s lives are being saved in sub-Saharan Africa because of an innovation devised by Mass General’s Dr. Thomas Burke and his team.

The department also includes a Division of Global Health and Human Rights, led by Thomas Burke, MD.  Since its founding in 2008, it has launched initiatives in 12 countries. Hundreds of women’s lives are being saved in sub-Saharan Africa because of an innovation devised by Dr. Burke and his team, for example. In the developed world, uncontrolled bleeding after childbirth, known as post-partum hemorrhage, is handled with a one-use, $400 uterine balloon tamponade. By adapting it with cheaper and more easily available components, Dr. Burke’s team created a uterine balloon kit costing less than $5. It’s being used in South Sudan, Kenya and Sierra Leone.

Dr. Noble’s ultrasound program is similarly increasing the healing capacity of healthcare providers in resource-poor areas by providing equipment and training. In the United States, bedside ultrasound has become a quick way emergency medicine physicians get an image to establish what’s happening inside a patient. Prices have come down for ultrasound and the technology is now portable.

Ultrasound training in Butare, Rwanda.
Ultrasound training in Butare, Rwanda.

“We use it for almost anything in the body,” Dr. Noble says. “To look for appendicitis, pneumonia, bowel obstruction, fractures or even a detached retina in the eye.”

At Bedside in Uganda

One team member was teaching at a patient’s bedside in Uganda, for example, when the patient became short of breath. “Within minutes of putting the probe on his chest,” says Dr. Noble, “we found a large pericardial effusion [abnormal amount of fluid around the heart] that needed immediate attention.”

She and her residents have been doing ultrasound training globally for a decade. They are training emergency physicians, obstetricians, surgeons, pediatricians and others to use and interpret ultrasound images.

Dr. Kharasch spent a sabbatical year from 2010-2011 working in the Emergency Department of Hadassah Hospital in East Jerusalem, a hotspot of regional conflict. “Medicine is the great equalizer,” Dr. Kharasch says of his experience. “Half the patients are Jewish and half are Arab. Within the hospital, no one talks about politics and medicine is delivered equally. The hospital is a place of peace.”

Dr. Sig Kharasch found Hadassah Hospital in Jerusalem, Israel, to be a "place of peace."
Dr. Sig Kharasch found Hadassah Hospital in Jerusalem, Israel, to be a “place of peace.”

Peace Through Medicine

To increase intercultural understanding, he has created a research and educational exchange for research fellows and physicians in training, which he is calling an “MGH Peace Through Medicine Program.”

Dr. Brown went to Kenya and Uganda in 2014 to observe department programs in action. In Uganda, he drove with others to a remote village to check on an HIV-positive patient. It took hours on muddy, rutted roads. The woman lived in a small home with a dirt floor. “I was struck with not only the challenges of living there but also with the good spirits of the people who warmly welcomed me into their homes,” Dr. Brown says.

Dr. Brown greatly admires those in his department who devote their time and imagination to help others globally. He’s determined to find donors willing to endow some of these global projects so his team doesn’t have to scramble for funding each year. “If we can partner with some generous friends,” he says, “we can do so much more good in each of our programs.”

For more information about how you can support the global efforts of Emergency Medicine, please contact us.