“Neurologists can triage better than anybody,” says Anthony Alessi, MD, a Connecticut neurologist and author of Lift Up Your Hearts: Healing Haiti, Land of Hardship. After the January 12, 2010, earthquake, he and 15 medical colleagues flew to Haiti with the Haitian Health Foundation. “In my role as a neurologist, the assessment and treatment of brain and spinal trauma was paramount,” he says in his book. “I also assumed the role of coordinating the transfer of patients between the hospital ship USNS Comfort and St. Damien’s [Hospital].”
Alessi shared his experiences as a volunteer in Haiti, both before and after the earthquake, with colleagues at the most recent meeting of the American Academy of Neurology (AAN). Alessi first went on a medical mission to Haiti with his daughter in 2008. “What I thought was going to be a father-daughter bonding experience became a father-daughter life-changing experience.”
Even before the earthquake, Haiti was a country with poor infrastructure and extreme poverty. A place where people die from many treatable diseases like malaria and tuberculosis. “I was shocked the day I saw a patient succumbing to tetanus, knowing this death was totally avoidable,” Alessi says.
When he went back to Haiti six months after the earthquake, much of the trauma had been addressed, and he says, “I primarily worked at Kay St. Germaine, a rehabilitation hospital for children with neurological disorders adjacent to St. Damien’s.” There, he treated children with conditions like cerebral palsy, Down syndrome, and epilepsy. These conditions were so poorly understood, says Alessi that the parents of these children often asked, “When will my child be better?” He spent a lot of time educating parents.
“There is a need for neurologists unlike other groups,” says Elaine Jones, MD, a private-practice neurologist in Rhode Island, who teamed up with Alessi at the AAN meeting to share her experience volunteering in Haiti. Like Alessi, she also wrote about the country after the earthquake. In 2012, Jones described the medical conditions brought on by poverty, poor nutrition and sanitation. “Patients came from towns as far as two hours away for evaluations. Many had progressive neurological symptoms but had never had a neurological exam.”
Jones says she spent a lot of her time teaching Haitian doctors how to do neurology, “The focus is to train the people there, so they eventually don’t need us.” And this need for neurologists does not only apply to Haiti or times of disaster. There is a severe lack of neurologists, neurology training, and neurology research in many poor countries.
“There is so much need for neurologists in places like Panama and Honduras,” says Jones. Likewise, neurologist Sidney H. Rosenberg talks about the opportunities he discovered in the developing world in this article, and neurologist Soma Sahai-Srivastava talks about the needs in Cambodia in this article.
Low and middle income countries (LMICs) “are disproportionately affected by neurologic disorders compared to high-income populations,” say authors Fleisher and Mateen in a 2014 article published in Neurology Clinical Practice. They point out, in particular, a high disease burden in the areas of stroke and epilepsy. This combined with “limited diagnostic and treatment infrastructure, and a paucity of trained providers has produced a dramatic need for neurologic expertise in LMICs.”
Despite the great need and benefit brought by neurologists who volunteer overseas, Fleisher and Mateen say the scope of the need is largely underappreciated, and even neurologists, themselves tend to be “skeptical about their value in resource-limited settings.” In their talks at the 2017 AAN meeting, Alessi and Jones, emphasized the value brought by neurologists. They also talked about how much they received from their experiences.
“You learn that there is a lot you can do, but you also learn that there are things we are doing here that we may not need to,“ says Jones. In her 2012 article she recalls:
When there is no access to an MRI in the entire country, physicians must rely on detailed history and examination skills. As I provided care, I found myself recalling basic training of anatomy and thinking about pathophysiology. It was a relief to not have to worry about getting paid, checking the right boxes on forms, or testing to protect against lawsuits. I was able to start to focus on the patient again.
If you are interested in volunteering overseas, Fleisher and Mateen recommend you start by exploring universities near you or hospitals with which you already have an affiliation. In their paper, they also provide a list of neurology specific organizations that have a global interest.