Dr. Nessa Meshkaty, graduate of Baystate’s Medicine-Pediatrics residency and Infectious Disease fellowship, moved to Haiti to work with Dr. Paul Farmer’s Partners in Health, serving impoverished patients with TB and HIV.
Baystate Prepared Me For This
Meshkaty says she has always been interested in global health. She was an intern at Partners in Health as a first year medical student before completing her residency and fellowship training at Baystate.
She believes her background in medicine, pediatrics and infectious disease is a perfect fit for international work.
“My training at Baystate helped in so many ways. It was my stellar training that allows me to be prepared to put out any fire in any environment.”
Monique is a 31 year-old Haitian woman living with HIV. When Meshkaty met her, she was hospitalized, frail, and unable to tolerate her HIV medication because she couldn’t afford food.
After 6 weeks of regular meals and directly observed medication therapy, she can get up and dress herself. She is learning to sew and ready to work. (Pictured: Monique and her 11 year-old daughter, who was her caretaker)
Facing Harsh Realities
Meshkaty is working in a very challenging environment—Haiti has a hot, humid tropical climate, with enormous tarantulas and relentless mosquitoes, and shortages of food and electricity.
But, she says that dealing emotionally and psychologically with the harsh realities she witnesses every day is the hardest part of her work in Haiti.
“My first week here, I lost a 17-year-old girl to pericardial TB. Port Au Prince is only a 2 hour plane ride from Miami but worlds away as far as resources. If she was born 2 hours away, she would be alive today.”
Appreciating the Small Victories
Meshkaty points to the many rewards of her work.
“I have seen firsthand what food, water, medication, and education can do on a community level. Despite all the challenges, there are many examples of victories and it is precisely those that keep us going on particularly hard days.”
“I've learned how amazingly resilient people, particularly Haitians, are—even when they are in destitute poverty and up against every systemic battle possible.”
> Learn about Baystate's residency programs
> Explore our Global Health Initiative: Residents Educated in Alternative Cultures and Health
Dr. Timothy J. Mader is a self-taught research investigator who arrived at Baystate in 1991 with little more than curiosity, broad-ranging interests, and internal motivation to be a research resource.
In 2015 he finally received that plum of research funding—a prestigious National Institutes of Health (NIH) grant.
Long Road to a Research Career
Dr. Mader began his research career as an undergraduate chemistry student working in the laboratory at the University of Wisconsin-La Crosse in the early 1980s.
Later, on a research elective during his residency training at Palmetto Health Richland in Columbia SC, his department chair, mentor, and friend, Dr. James I. Raymond, helped transform Dr. Mader into an emergency medicine clinician with a strong penchant for research and scientific writing.
Securing extramural funding proved to be a formidable challenge for many years, but Mader never gave up.
After receiving a Society for Academic Emergency Medicine Scholarly Sabbatical in 2005, he was among the first group of awardees to receive an Incubator Grant award from Baystate's Office of Research in 2006. Mader credits those research dollars with opening the door to other significant funding opportunities—additional internal seed grants, small professional society awards, and substantial funding from external foundations.
These successes finally led to NIH funding.
Persistence Finally Pays Off
After 25 years, Dr. Mader was awarded an R21 Exploratory/Developmental Research Grant in 2015. Now Director of Resuscitation Research in the Department of Emergency Medicine at the University of Massachusetts Medical School-Baystate, Mader's proposal is an innovative study involving heart attack patients.
The multi-center study is a comparative effectiveness analysis of whole-body cooling on survival and preservation of neurological function in cardiac arrest patients over age 75.
Only one year later, he received an R03 Small Grant for a pilot study to determine the feasibility of conducting a large clinical trial within the practice setting of a busy U.S. emergency department.
The trial will test a promising new cardiac risk stratification tool and collect preliminary data on its reliability and ease of use.
It may be hard to understand why a mother of a child with diabetes wouldn’t make sure he got his insulin every day. It may be just as hard to imagine being homeless, living in a motel, and lacking a refrigerator to store the insulin.
Narrowing that gap in understanding is the goal of a simulation training for interns at Baystate Medical Center.
Poverty is a Powerful Predictor of Disease and Death
The poorest 1% of people in the U.S. die a decade or more earlier than the richest 1%, according to an April 2016 article in Journal of the American Medical Association.
And poverty is a big issue in the community served by Baystate Medical Center—its poverty rate and reliance on government support programs is higher than the Massachusetts average.
Giving interns a better understanding of the complex social and economic issues affecting patients' health is a key goal of the simulation.
Understanding the Challenges of Poverty
Each resident in the simulation was assigned a role in a family that is struggling financially.
They must figure out how to survive on an extremely limited income—making difficult decisions about how to allocate their resources to pay for housing, buy food, get to work, keep their kids in school, and deal with unexpected challenges.
Built in to the simulation are constraints common to those living near the poverty line—no car, no phone, no back account.
A Big Eye-opener for Residents
“You are barely keeping your head above the water and you have to kind of play loose with the rules," explained resident Taylor Koerner MD. "We were supposed to have everybody home sick for a week but we sent people to work anyway.”
"As the month went on, expenses really started to get away from us and things got more and more overwhelming,” another resident, Anthony Nicolas MD, said.
“It was a big eye opener for all of us,” concluded Dr. Nicolas.
Running Out of Treatment Options
When a patient’s traditional treatment options are exhausted, an experimental drug might be the last resort.
A young man arrived at Baystate Medical Center’s ED in sickle cell crisis, which can cause liver or kidney failure, even death. A blood transfusion—the only proven treatment—was recommended. But the patient declined due to his faith.
Death seemed imminent, so doctors proposed a transfusion product derived from bovine hemoglobin instead of human blood. The family agreed to try it—but, it is an experimental treatment not yet approved by the Food and Drug Administration.
Experimental Drugs May Be the Last Chance to Save a Life
The FDA sometimes allows access to experimental drugs for patients with serious illnesses if all other comparable therapies have been ruled out—a process called Compassionate Use or Emergency Use.
To get an emergency use request approved takes a lot of coordination between the clinical team, Baystate’s investigational pharmacy, the FDA, and the pharmaceutical company, according to Jennifer Pacheco, Director of Baystate’s Human Research Protection Program. And the HRPP office drops everything else to do it.
"We will page, phone, email, whatever is needed."—Jennifer Pacheco
The HRPP Office got the Emergency Use request for the sickle cell patient's experimental transfusion product approved by the FDA—and he lived.
When Treatment is Needed Right Away—Even on Christmas
Pacheco recounts a case where a very sick child needed an experimental treatment—on December 25th.
She got a phone call, then enlisted some of her staff. The treatment was approved. But, no shipping company delivers on Christmas.
So Baystate reached out to police departments in Massachusetts and a neighboring state—and they made the delivery.
The police officers from the two states met at the state line and the experimental treatment was passed across—the child got needed treatment, when it was needed.
> More information about the Human Research Protection Program
> Learn about clinical trials at Baystate
In 2005, surgeons from Hyderabad, India shocked the world with their video of an appendix being removed through a patient’s mouth.
Thus was born a new type of surgery called NOTES, Natural Orifice Translumenal Endoscopic Surgery.
Less than three years later, Baystate doctors performed their own groundbreaking NOTES surgery—and became leaders in the new field.
Baystate Makes Incisionless Surgery History
In 2008, Drs. John Romanelli and David Desilets were confronted with a clinically unstable patient in the ICU who was not improving after having an endoscopic procedure to drain an infected pancreatic pseudocyst.
The patient needed another operation, called a cystogastrostomy, that previously had only been performed open or laparoscopically—but was too sick for either of these procedures.
Romanelli and Desilets successfully performed the procedure through the patient's mouth—the first surgery of its type performed anywhere in the world.
Research—and Collaboration—Leads to Patient Care Breakthroughs
Romanelli, a surgeon, and Desilets, a gastroenterologist, were ready for the challenge because they and their team had been collaborating for two years to research surgical techniques using an endoscope via natural orifices.
They were able to apply lessons learned from their experiments in the research lab to benefit this critically ill patient—who was discharged within 14 days and recovered completely.
“To us, this represents the future of healthcare delivery.” —Dr. Romanelli
Their collaborative work reinforces the importance of research in improving patient care.
Still on the Cutting Edge of Surgery Without Incisions
More recently, Baystate's expertise in a new operation called POEM (peroral endoscopic myotomy) has made it a regional referral center for the treatment of achalasia, a disease of the smooth muscle of the esophagus that prevents contractions and makes it difficult to swallow food or liquids.
After learning the POEM technique directly from its creator in Yokohama, Japan, the Baystate team has performed 61 POEM procedures—the largest series in New England.