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BROCKTON – Mary MacGregor developed Type 2 Diabetes during a pregnancy three decades ago and it never went away.

Years later, circulatory problems caused MacGregor, 69, of Brockton, to lose the toes on her right foot.

Recently, as she sat in an office in Brockton, Dr. Barry Rosenblum examined and cleaned that foot. MacGregor has also developed a type of nerve damage called neuropathy, which means she cannot not feel the limb. Because of that, she uses a custom-made pad to protect a wound on the bottom of her foot.

But, for all the trouble her diabetes has put MacGregor through, she is grateful. If not for the treatment available in the United States, MacGregor might have lost her entire leg.

“It probably would have just spread,” she said.

MacGregor’s gratitude came into sharp relief this month when, during her regular checkup, Dr. Rosenblum was shadowed by a Cape Verdean counterpart, Dr. Danielson Veiga.

Dr. Veiga visited Brockton recently through a program organized by Signature Healthcare Brockton Hospital and Dr. Rosenblum, a foot surgeon at Beth Israel Deaconess Medical Center. Dr. Veiga’s goal is to learn techniques that will help him save the limbs of people with diabetes in Cape Verde.

“It’s not easy to manage diabetic problems,” Dr. Veiga said. “People live in remote areas. They have to pay a lot of transportation costs to see a doctor.”

Dr. Veiga estimated that of those people in Cape Verde who develop serious “diabetic foot” – problems with blood flow and infections that fester – some 30 to 35 percent will undergo amputation. Doctors in the U.S. are able to save limbs at a far better rate, Dr. Rosenblum said.

Last November, Dr. Rosenblum and some of his colleagues traveled to Cape Verde to create a diabetic limb salvage unit at a hospital in Praia, the nation’s capital. The city, slightly larger than Brockton, is on the island of Santiago, one of 10 islands that make up the country off the coast of West Africa.

New England is home to hundreds of thousands of Cape Verdean immigrants, with Brockton in the center of a population line that stretches from Boston to New Bedford. The country’s president and three of its mayors visited Brockton last summer.

While in Cape Verde, Dr. Rosenblum and fellow surgeons taught Cape Verdean doctors surgical techniques to avoid amputations and help heal wounds faster. They are planning follow-up visits as well.

Meanwhile, Dr. Veiga, a surgeon trained in Russia and China, is learning vascular surgery, which allows doctors to pinpoint and fix diabetic circulatory problems without removing a limb. Right now, such techniques do not exist in Cape Verde.

 

Doctors instead send diabetic patients requiring vascular surgery to Portugal or Brazil. But with a financial crisis in Portugal, opportunities for Cape Verdeans have been limited.

Dr. Veiga said now the decision to send someone for surgery often depends not on medical considerations, but on whether they have enough money

November 2010 Urology Team

Michael Kearney,MD

Ravi Kacker,MD

William McKedermot,MD

Joao M Tavares,MD

Carla Iozza

Luis DaCosta

Bubacar Balde

Luis DaSilva Lopes: Nobidade TV

Napoleao Teixeira

 

November 2011 Urology & Gastroenterology Team

Michael Kearney,MD

Peter Chang,MD

Eurizandra Pinto

Alphonso, Brown

Luis DaCosta

Ernestina DaMoura-Moreira

Luis DaSilva Lopes: Nobidade TV

 

March 2013 Urology & Urogynecology Team

Michael Kearney,MD

Michael Sweeney,MD

Peter Chang,MD

Roger Lefevre,MD

Maria DaMoura,RN

Tatiana Vicente,RN

Ana M. Tavares,CNA

Josephine Duarte

Carla Iozza

Ernestina DaMoura-Moreira

Luis DaSilva Lopes: Nobidade TV

 

March 2014 Urology, Urogynecology & Anesthesia Team

Michael Kearney,MD

Peter Chang,MD

Michael Sweeney,MD

Roger Lefevre,MD

Amos Adelowe,MD

Analesa,Baraka,RNP

Ann Gisinger

Arpana Brachireddy,CRNA

Kathleen Avelino

Josephine Duarte

Ana M. Tavares,CNA

Luis DaCosta

Isidra Lima

Luis DaSilva Lopes: Nobidade TV

 

November 2014 Vascular Surgery Team

David Campbel,MD

Barry Rosenblum,MD

Carla Iozza

 

December 2014 Trauma Surgery Team

Stephen Odom,MD

Raykar Nakul,MD

Ernestina DaMoura-Moreira

 

May 2015 Urology & Urogynecology Team

Michael Kearney,MD

Michael Sweeney,MD

Roger Lefevre,MD

Amos Adelowe,MD

Analesa Baraka,RNP

Sybil Dessie,MD

Luis DaCosta

Carla Iozza

Josephine Duarte

Isidra Lima

Ana M. Tavares,CNA

Ernestina DaMoura-Moreira

Anaide DeSousa,CNA

Ivone Joia,CNA

Luis DaSilva Lopes: Nobidade TV

 

October 2015 The Lancet Commision & Cape Verde: A powerful Partnership in Health Systems Strenghtening

Raykar Nakul,MD MPH

Saurabh Saluja,MD MPP

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BIDMC is no stranger to Cape Verde, as a group of physicians, surgeons and translators have been making trips to provide care for the past few years. In fact, later this month, a group of BIDMC physicians and translators will travel to Cape Verde for another medical mission trip.

For me, however, this trip was my first. We were mainly based in the capital city of Praia and worked at Augustinho Neto Hospital (ANH), which serves as one of the two tertiary hospitals in the country. One of the reasons for this trip was to research, explore and build the foundation for future visits. Ernestina Damoura-Moreira, BIDMC Interpreter Services, accompanied us, as did Dr. Odom’s wife, Alexandra, who is a librarian by training and was vital to our research and data collection efforts.

We were focused on conducting an initial baseline assessment on research tools developed by The Lancet Commission on Global Surgery, as well as a trauma assessment modified by Dr. Odom. I worked with Ernestina and Alexandra to also perform qualitative interviews of the core staff of ANH and with individuals from the Ministry of Health.

Hospital staff eagerly welcomed us, as they have been looking for a general surgery team to help with laparoscopy and trauma surgeries. I had the opportunity to assist in several operations performed by Dr. Odom and the Cape Verdean surgeons. This was an amazing experience, as the Cape Verdean surgeons I worked with were highly skilled, and it was a pleasure to learn from them. Working in a low-resource environment, they are forced to have a broad skill set. I watched a young Cape Verdean surgeon perform the most beautiful non-mesh hernia repair I have ever seen.

For the past two years back here in Boston, I have been part of a research group looking at the state of global surgical care. I must say, ANH is a great representation of a hospital in a lower-middle income country. The infrastructure is there, and staff is highly trained. The work ahead of us remains in getting all these parts to work together more efficiently.

 

Dr. Odom is developing a trauma course in partnership with the Cape Verdean surgical team for all the surgeons in Cape Verde (not just at ANH), and we’ll be proceeding with a full-systems assessment to establish a baseline for future work. Also on the docket is the strategic development of laparoscopic skills training.

I am privileged to work at this institution and with colleagues such as Dr. Odom, Dr. Michael Kearney and Ernestina, who believe in true partnership and collaboration. The Cape Verdean Minister of Health said this: “We want a strong commitment that will continue. We’ve had many missions where they would come, do a little something, and then it would die.”

We hope to use the next several months to expand upon an action plan for system assessments in Cape Verde, in collaboration with The Lancet Commission on Global Surgery and the Ministry of Health of Cape Verde. We’ll return later this year after we’ve developed a plan for building the capacity for trauma and laparoscopic surgery in the country, alongside Cape Verdean surgeons.

The entire experience was wonderful. Ernestina is native to Cape Verde and well connected in the country by her sister, a former Congresswoman. They helped us explore the local area during our visit, too. But fun aspects (amazing food and beautiful beaches) aside, I really enjoyed being in an environment where the surgeons were committed to providing the best care for their patients, despite shortfalls in their infrastructure. I look forward to my next trip, and I’m excited to be a part of something so great.


Nakul Raykar, MD, Surgery Resident

Santiago Island, Cape Verde

 

 

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