Operation Airway reflects Mass General's global efforts to improve pediatric care through on-the-ground visits, training programs and telehealth.

mghfc-trans-600Through global missions and telehealth, Natan Noviski, MD, chief of Pediatric Critical Care at MassGeneral Hospital for Children, is helping to expand Mass General’s reach to more children around the world who need expert care.

One example: A little boy has an airway injury and is holding both sides of his mouth open to catch a desperately needed breath. His physician in Ecuador suspects he needs a tracheotomy, in which a tube is surgically implanted in the windpipe, but needs advice from Dr. Noviski. The boy comes from a poor, rural Ecuadorian village with no electricity or running water. The surgery itself can be a death sentence if an infection sets in.

Natan Noviski, MD, co-founder of Operation Airway
Natan Noviski, MD, co-founder of Operation Airway

Dr. Noviski has visited Ecuador about five times since 2010 when he co-founded Operation Airway, a program that helps children like this boy who need airway surgery or reconstruction to breathe or to speak. Operation Airway flies in a team of physicians, surgeons and nurses from Mass General and Mass Eye and Ear Infirmary (MEEI).  They perform lifesaving surgery, provide follow-up care and train Ecuadorian physicians how to do the complicated surgery.

“Other than the most severe cases, they can do the surgery themselves now,” says Dr. Noviski, who continues to perform email consults for his Ecuadorian colleagues after five years of on-the-ground visits and training. “They know it’s life and death for a child and sometimes just need reassurance on the proper course.”

Future Missions

The goal of Operation Airway is to expand globally. “There is no other organization with our mission,” Dr. Noviski says. “There are others who handle cleft palates or congenital heart disease, but we’re the first to do airway surgery, which is very complicated. Even in the United States, there are only three or four centers where it is done.”

“But you can’t imagine the sleepless nights I go through worrying about the kids.”

Teams typically include Dr. Noviski, a pediatric intensivist and pulmonologist; Christopher Hartnick, MD, an ear, nose and throat (ENT) surgeon and director of Pediatric Otolaryngology at MEEI; additional pediatric intensive care doctors and ENT surgeons; an anesthesiologist; a speech therapist and specialized nurses. Each team, with the assistance of their Ecuadorian colleagues, provides round-the-clock care during the 10-day visit.

The work is intense, but extremely gratifying, says Dr. Noviski, who plans to take the team to El Salvador later this year.  “But you can’t imagine the sleepless nights I go through worrying about the kids.”

Through Operation Airway, Dr. Noviski (right) and his colleagues perform lifesaving airway surgery, provide follow-up care and train Ecuadorian physicians.

Dr. Noviski, who is originally from Brazil, is extremely well respected in Ecuador. When his Mass General/MEEI team arrives, it makes national news in Ecuador.

The success of the Operation Airway led to Dr. Noviski working with the Ecuador Minister of Health in evaluating pediatric hospitals in the greater Quito and Guayaquil area. Dr. Noviski also helped establish the Ecuadorian Society for Pediatric Critical Care Medicine and, with his Ecuadorian colleague Ernesto Quiñones, MD, he conducts training programs for bronchoscopy and other procedures for local doctors and medical students. In fact, the idea for Operation Airway was born after one such workshop.

Not all global health care is done in person. Dr. Noviski’s pediatric intensive care unit (PICU) has been using telehealth technology in Puerto Rico since 2007.

Expanding Telehealth Programs

Not all global health care is done in person. Dr. Noviski’s pediatric intensive care unit (PICU) has been using telehealth technology in Puerto Rico since 2007.

Telehealth programs have also been established in Ecuador and the Dominican Republic.

Local physicians in these locations use teleconferencing technology to consult with Mass General experts. With this form of telehealth, PICU doctors can control a camera remotely, zooming in and out to examine the child. The camera gets them so close that they can observe whether the pupils of the eyes are moving or how the chest is moving with every breathe. They can see the vital signs on the monitors.

“On the phone or in an email, we can’t see what is happening or help nearly as well with the decision-making,” Dr. Noviski says. “Telehealth is so obvious now.” In fact, his PICU has found uses for telehealth closer to home. They have created a telehealth program that connects attending physicians from their homes with the PICU when consults are needed in the middle of the night or weekends.

Support MGH Global Initiatives

Today, Mass General has 60 global health programs in 40 countries. Operation Airway and the global telemedicine programs are purely philanthropic. Dr. Noviski hopes that with more support, he and his colleagues can expand both initiatives and help more children with Mass General’s lifesaving expertise.

To learn more about how you can support such programs, please contact us.