Training the First Generation of Neurologists in Haiti

Training the First Generation of Neurologists in Haiti
University Hospital in Mirebalais, Haiti

This story originally appeared in the Fall 2015 issue of Brigham and Women's Magazine.

In December 2014, Janel, a 24-year old man from rural Haiti, arrived at Brigham and Women’s Hospital (BWH) for life-saving neurosurgery. A tumor in the center of his brain had grown to a baseball’s size, causing crushing headaches and an inability to walk.

Louine Martineau, MD, is Janel’s general practitioner at the University Hospital in Mirebalais, Haiti. Since BWH helped the University Hospital open in 2013, Martineau has regularly consulted on his neurologic patients with Aaron Berkowitz, MD, PhD, who leads BWH’s Global Neurology Program. Martineau knew Janel would become progressively disabled and die in Haiti if he didn’t receive proper treatment. He reached out to Dr. Berkowitz for help.

“When Dr. Martineau sent me Janel’s CT scan,” Berkowitz recalls, “I thought, ‘If we can get him to BWH, we can save him.’” A generous donation from The Ray Tye Foundation helped finance the effort to bring Janel to BWH.

Seeing the bigger picture

Haiti has just one neurologist for 10 million citizens, but Berkowitz and Martineau say the burden of neurologic disease there is enormous.

“By opening an outpatient neurology clinic in communication with Dr. Berkowitz, we have created a way to manage patients with neurologic problems. That is how I was able to diagnose Janel,” says Martineau.

To address the larger problem, Berkowitz and colleagues are launching Haiti’s first neurology training program. Initial seed funding will allow them to train two neurologists over the next two years.

“With further investment in the fellowship, we hope to train a few neurologists every year,” says Berkowitz. “These neurologists will serve different regions of the country so patients can get the care they need from local providers.”

Before the surgeons, neurologists, oncologists, and nurses from BWH and Dana-Farber Cancer Institute could treat Janel, Martineau and his colleagues in Haiti spent months clearing the young man’s travel to Boston. After enduring 1,500 miles on a medical flight and several procedures by neurosurgeon Ian Dunn, MD, Janel took his first steps after not having been able to walk for more than a year.

“Janel comes from one of the poorest, most remote places in Haiti, and he received BWH/Dana-Farber level care,” says Berkowitz. “While this is remarkable, it’s not a long-term solution. It is critical to create opportunities for specialized neurology training in Haiti. Today, there is nothing of the kind.”

Developing local expertise

Along with colleagues at Partners In Health and Equal Health, two nonprofits connected with the University Hospital and BWH, Berkowitz will train the first two neurology fellows, and will mentor them to train the next class and become the program’s core faculty.

Currently hosting five residency programs, including Haiti’s first emergency medicine residency, University Hospital is the ideal location for the neurology fellowship. Michelle Morse, MD, MPH, assistant program director for the internal medicine residency at BWH, is an advisor to the University Hospital’s medical director and has seen the Haitian residents’ progress from the beginning.

“Watching the first class of residents support and guide the next, evolve as phenomenal clinicians, and begin to dream of the impact they can have on health in Haiti is fantastic,” says Morse.

The team hopes the fellowship will become a self-sustaining neurology residency program, so patients like Janel can get the care they need closer to home.

“The neurology fellowship at University Hospital in Mirebalais will plant the seeds for neurology in Haiti going forward,” Berkowitz says.

Given the overwhelming global need for neurologic care, Berkowitz and Morse envision expanding this educational model to other underserved countries.

“Mirebalais will give us incredible evidence to share with the world on how to go from one neurologist serving a large population to many neurologists,” says Morse. “Then we can begin to address the global burden of neurologic disease in earnest.”