Feb 19, 2019 Cedars-Sinai Staff
Cedars-Sinai investigators conduct influential, innovative work in their laboratories and clinics, but advances in biomedicine don’t end there. Partnerships around the globe help export lifesaving efforts to sites in need. Here, five experts—locals and visitors—share how they are making a difference for patients at Cedars-Sinai and on five continents.
David Kulber, MD
Founding Director, Plastic and Reconstructive Surgery Center of Excellence Director, Hand and Upper Extremity Surgery Cedars-Sinai
PROBLEM: Household fire accidents in Mozambique leave many children with scarred, unusable hands or limbs fused to their bodies. Less than a handful of plastic surgeons practice in this developing nation of more than 28 million. Surgical education is limited, and lagging infrastructure restricts access to care.
SOLUTION: Using live video streaming from his home in Los Angeles, Kulber mentors Mozambican surgeons through burn-correction and plastic surgery procedures that can be lifesaving for kids. Around midnight, he logs into a program that provides a real-time view into an operating room nearly 11,000 miles away. The surgeons in Africa wear Google smart glasses so Kulber can share their visual and auditory experience. In turn, he provides advice and even instructions drawn on video screenshots in real time.
BIG PICTURE: “The remote-streaming program allows for constant, continuous learning, far more than a trip to teach once or twice a year,” says Kulber, who has also made 10 surgical mission trips to Mozambique in eight years.
Danny Ramzy, MD
Director, Robotic and Minimally Invasive Cardiac Surgery Surgical Director, Lung Transplant Cedars-Sinai
PROBLEM: In Japan, unique laws and cultural wariness limit organ transplants. Though the U.S. population is nearly three times that of Japan, the number of transplants is more than 90 times higher. Transplantation is the best option for those who experience cardiogenic shock—a post-heart-attack complication that prevents the heart from pumping enough blood to sustain the body. However, the only treatment in Japan has been emergency life and organ support—an extreme, short-term solution.
SOLUTION: Last year, Ramzy trained Japanese physicians at Cedars-Sinai and in Tokyo and Osaka to implant a minimally invasive heart pump that replaces life support. The device acts as a bridge until the heart heals or the patient receives a more durable pump. Up to 80 percent of patients need no further treatment—a vast improvement over previous options since, if untreated, 80 percent of patients ultimately die from cardiogenic shock.
BIG PICTURE: “Japan struggles with the lack of donated organs, so it’s exciting to offer technology to help really sick people who need it,” Ramzy says.
Michele Hakakha, MD
Obstetrics and Gynecology Attending Physician, Cedars-Sinai Private Practice, Los Angeles
PROBLEM: In rural Guatemala, most mothers give birth in outdoor huts, guided by lay midwives with multigenerational experience. But because the midwives don’t have advanced tools to treat postpartum hemorrhage or high blood pressure, Guatemala has one of the highest rates of maternal mortality in Latin America—about 300 deaths per 100,000 live births.
SOLUTION: Hakakha and Cedars-Sinai anesthesiologist Michael Sanchez, MD, piloted a training program for midwives in the western highlands, an eight-hour bus ride from Guatemala City. They worried whether anyone would show up —but 26 women did. Hakakha distributed medical kits, including an ingenious makeshift device that uses surgical gloves and IV tubing. It can be inserted into the uterus and inflated to put pressure on blood vessels and stop hemorrhage. Next year, they hope to distribute tools that measure blood loss to indicate when a mother should seek hospital care.
BIG PICTURE: “I didn’t want to be the doctor from the U.S. telling these women what to do. They have years and years of experience, and I learned from them as well,” Hakakha says. “Many of their practices are similar to ours—when a baby is breach, they have the moms crawl around on all fours; here, we ask women to rock back and forth on their hands and knees to help turn the baby. Some of our hemorrhage medications are even derived from herbs the midwives use.”
Sarvee Moosavi, MD
Gastroenterologist, Mount Saint Joseph Hospital, Vancouver, BC, Canada
PROBLEM: Motility disorders of the esophagus, stomach, or intestines can severely diminish quality of life. Patients in Western Canada with functional motor problems like trouble swallowing or incontinence have few local specialists available for testing and treatment. Fearful of eating in public or having an “accident,” they retreat from social life.
SOLUTION: To help her patients with motility issues, Moosavi sought training in Calgary before completing an observership at the Cedars-Sinai GI Motility Program, where she learned to recognize symptoms and perform tests, and even collaborated with her mentors to update a textbook on the discipline. She hopes to open a similar lab in Vancouver.
BIG PICTURE: “I was born in Iran, moved to Canada at 10, and now I’m training at Cedars-Sinai,” Moosavi says. “There’s no way to advance medicine if you have rigid boundaries. Here, I gained friends and colleagues I can rely on in the future.”
Raghav Murali-Ganesh, MBBS
Co-Founder and President, CancerAid, a graduate of the Cedars-Sinai Accelerator
PROBLEM: Australians exhibit the world’s third-highest cancer rate. Eight years ago in Sydney, Murali-Ganesh, then a radiation oncologist, realized that his method of monitoring patients was outmoded and inefficient. His patients simply logged their symptoms on a printed-out chart over the course of their treatment cycles. “By the end of seven weeks, we were trying to make decisions around this tattered piece of paper,” he says.
SOLUTION: With the help of Cedars-Sinai’s tech-mentoring program, he developed the first cancer-tracking app, CancerAid, so patients can log their symptoms and doctors can monitor the patient-specific data in real time. At the Cedars-Sinai clinics where CancerAid is deployed, all entries are integrated into a patient’s electronic medical record and Apple Health. The app helps clinicians better understand patients’ progress, and provides a virtual space for conversations with doctors and with family and friends, helping patients feel supported.
BIG PICTURE: “Research shows that patients who record symptoms for clinicians are happier and more empowered, and have improved survival of nearly six months,” Murali-Ganesh says. “We’ve developed technology that does this in a real-world setting to improve treatment decisionmaking. Being on the ground here has been invaluable.”