The Department of Surgery at Massachusetts General Hospital conducts global surgery efforts, aimed to improve surgical education and access to advanced surgical care in resource-limited settings.

Advancing Global Surgical Cancer Care in Resource-limited Settings

James Cusack, MD, and Patrick Okao, MD, in the operating room at Inshuti Mu Buzima/Butaro Hospital and Cancer Center in northern Rwanda, August 2013.

James Cusack, MD (left), and Patrick Okao, MD (right), in the operating room at Inshuti Mu Buzima/Butaro Hospital and Cancer Center in northern Rwanda (August 2013).

The Department of Surgery at Massachusetts General Hospital strives to improve health equity in resource-limited settings around the world through a range of surgery initiatives. Clinicians, residents, fellows and staff from the Department of Surgery participate in global medical missions to teach, learn and provide advanced surgical care to patients. Recent efforts have focused on developing and implementing more comprehensive surgical curricula at underserved sites such as Mbarara, Uganda.

Since 2002, James C. Cusack, Jr., MD, FACS, has been involved in global surgery efforts in countries such as China, Bangladesh, Liberia, Kazakhstan, the Philippines, Rwanda, Botswana and Uganda. In fall 2013, he was appointed director of the Mass General Global Surgery Initiative to coordinate the global surgery efforts within the Department of Surgery. “What continues to impress and motivate me is the spirit of collaboration that marks these missions—it is the most rewarding work of my career,” Dr. Cusack says.

Dr. Cusack is engaged with the following Global Surgery Initiatives of the Department of Surgery: 

  • Using Circulating Tumor Cells (CTCs) to Identify Patients at Risk for Breast Cancer in a Resource-limited Environment in Uganda and Botswana
  • Mass General Cancer Center/Mbarara University of Science and Technology Collaboration to Improve Surgical Care and Expand Cancer Care in Mbarara, Uganda
  • Surgical Education and Training in Cancer Care, Inshuti Mu Buzima/Butaro Hospital in Rwanda
  • Surgical Education/Training Project, JFK Hospital and A.M. Dogliotti College of Medicine in Monrovia, Liberia
  • Improving Cancer Care in Astana, Kazakhstan
  • Improving Cancer Care in Dhaka, Bangladesh

Global Surgery Projects

Oncologist-in-training Becky Tibenderana, MD, in oncology clinic at Mbarara University of Science and Technology

Oncologist-in-training Becky Tibenderana, MD, in an oncology clinic at MUST.

Using Circulating Tumor Cells (CTCs) to Identify Patients at Risk for Breast Cancer in a Resource-limited Environment at Mbarara University of Science and Technology (MUST) in Uganda, and Princess Marina Hospital and Gaborone Private Hospital in Botswana (2014)

  • Partner Organizations: In collaboration with Mehmet Toner, PhD, and others at Mass General, Mass General Center for Global Health, Mass General Cancer Center, MUST, National Institutes of Health (pending), and Princess Marina Hospital and Gaborone Private Hospital in Gaborone, Botswana
  • Funding Sponsor: National Institutes of Health (pending)
  • Description: Detecting CTCs has far-reaching implications for both clinical care and cancer biology. Once CTCs are isolated, they can be characterized and used to create a non-invasive tool for detecting early disease, monitoring response and resistance to therapy, and culturing viable cells for further study into the growth, resistance, and metastatic properties of epithelial cancers. In Phase I, working with colleagues at MUST in Mbarara, Uganda, the team plans to evaluate this technology as an early detection tool to diagnose women with breast cancer in a resource-limited setting. In Phase II, we will expand the activities to Gaborone, Botswana
The Mass General team and David Kitya, MD (back right), taught surgical skills to medical students at MUST.

The Mass General team and David Kitya, MD (back right), taught surgical skills to medical students at MUST.

Mass General Cancer Center/Mbarara University of Science and Technology (MUST) Collaboration to Expand Cancer Care in Mbarara, Uganda (March 2014 ongoing)

  • Partner Organizations: Mass General, Mass General Global Surgery Initiative, Mass General Cancer Center, MUST, Uganda Cancer Institute and Shepley Bulfinch Architects
  • Funding Sponsors: Mass General Department of Surgery, Mass General Cancer Center and Mass General Center for Global Health
  • Description: The Mass General Cancer Center sent a multidisciplinary team to the city of Mbarara in southwestern Uganda to explore collaboration with the local university and hospital to build a new national referral cancer center. The invitation was made by MUST Vice Chancellor, Professor Frederick Kayanja, on behalf of his university, the Mbarara Regional Referral Hospital and the Uganda Cancer Institute. The Mass General Cancer Center team comprised James Cusack, MD; Marcia Browne, MD; Thomas Randall, MD; Elizabeth Bigger, MD; and Johanna Riesel, MD. Learn more about this project

Surgical Education and Training in Cancer Care, Inshuti Mu Buzima/Butaro Hospital in Burera District, Rwanda (August 2013)

  • Partner Organizations: Partners In Health, Inshuti Mu Buzima/Butaro Hospital, Dana-Farber Cancer Institute and Human Resources for Health
  • Funding Sponsors: Dana-Farber Cancer Institute, Partners In Health, and Jeff Gordon Children’s Foundation, with additional support from Rwanda’s Human Resources for Health Program and surgical equipment donations from Covidien
  • Description: For a two-week stay, James Cusack, MD, traveled to Rwanda’s national center for cancer care, Inshuti Mu Buzima/Butaro Hospital and Cancer Center, with 400 pounds of surgical supplies donated by the Mass General operating room. Built in 2011 as part of the ongoing collaboration between Partners In Health and the Rwanda Ministry of Health, the Inshuti Mu Buzima/Butaro Hospital and Cancer Center is a 150-bed facility designated the only cancer “Center of Excellence” in the country. The hospital sets the national standard for delivery of advanced cancer care in low- and middle-income countries with teaching and clinical partnerships from an international consortium that includes Harvard Medical School and its affiliates. Dr. Cusack performed surgical operations and trained the hospital’s only general surgeon, Patrick Okao, MD, in the management of cancer, with a focus on breast, colon and gastric cancer
Mass General team led by Thomas Burke, MD, at meeting with President of Liberia, Ellen Johnson Sirleaf in Monrovia, 2008.

Left to right: Robert Dennis, MD, director of JFK Hospital; Ann Prestipino, MPH, senior vice president, Surgical, Anesthesia, Emergency Services and Clinical Business Development at Mass General; Thomas Burke, MD; Ellen Johnson Sirleaf, president of Liberia; Sean Flannery, philanthropist; James Cusack, MD; and Robert Riviello, MD, of Brigham and Women's Hospital, at a meeting in Monrovia, Liberia.

Surgical Education/Training Project, JFK Hospital and A.M. Dogliotti College of Medicine in Monrovia, Liberia (December 2008)

  • Partner Organizations: Mass General, Mass General Division of Global Health and Human Rights, Brigham and Women’s Hospital and the Liberia Ministry of Health
  • Description: A multidisciplinary team from Mass General and Brigham and Women’s Hospital led by Thomas Burke, MD, chief, Division of Global Health and Human Rights, traveled to Liberia to evaluate the reconstruction of the medical school and only tertiary medical center in the country with a focus on surgery, pediatric and psychological care

Improving Cancer Care in Astana, Kazakhstan (December 2008)

  • Partner Organizations: Mass General Cancer Center, Partners International Program and Kazakhstan Ministry of Health
  • Funding Sponsors: Kazakhstan Ministry of Health in Astana
  • Description: A multidisciplinary team from the Mass General Cancer Center traveled to Astana, Kazakhstan, to work with the city’s Department of Health to improve oncology services at the major referral hospital in the capital city. The team comprised Eyal Attar, MD; James Cusack, MD; Paul Busse, MD, PhD; Barbara Cashavelly, RN, and Kevin Vest.
    Learn more about this project

Improving Cancer Care in Dhaka, Bangladesh (Initiated 2006)

  • Collaborators: Ahsania Mission Cancer Hospital, Dhaka, Bangladesh and Grameenphone, Inc.
  • Funding Sponsor: Grameenphone, Inc.
  • Description: Bimal Dey, MD, medical oncologist at Mass General and James Cusack, MD, worked to develop a clinic for cancer care in Dhaka, Bangladesh. Subsequent efforts by A.K. Goodman, MD, of Mass General, led to the establishment of a Human Papillomavirus (HPV) Vaccination Program and Cancer Prevention Awareness Program in Bangladesh

Recent Activities and Presentations

Members of the Harvard University Program in Global Surgery and Social Change at the inaugural meeting of the Lancet Commission on Global Surgery in Boston, January 2014.

Members of the Harvard University Program in Global Surgery and Social Change at the inaugural meeting of the Lancet Commission on Global Surgery in Boston, January 2014. Participants from Mass General included James Cusack, MD; Tiffany Chao, MD; Johanna Riesel, MD; Paul Firth, MBChB; and Vicki Modest, MD.

Since the successful introduction over the past decade of comprehensive programs to treat the common communicable diseases of Africa including HIV, malaria and tuberculosis, deaths related to communicable disease have steadily dropped. Over the same time period, deaths related to cancer have strikingly increased particularly among women with cervical and breast cancer.

In December 2013, the World Health Organization announced that the Global Cancer Burden had risen to 14.1 million new cases and 8.2 million cancer deaths in 2012, with projections that there will be a substantive increase to 19.3 million new cases per year by 2025. More than half of all cancer deaths occur in less developed regions of the world, that are ill-equipped to address this increasing burden of disease.

Dr. Cusack is leading efforts in the Mass General Department of Surgery and Mass General Cancer Center to build capacity in surgery and cancer care in resource-limited settings to address the increasing burden of death related to cancer and surgically treatable disease. Dr. Cusack's recent presentations and meetings include:

  • May 2014: Meeting the Challenge of Cancer in Botswana symposium in Gabarone, Botswana.
    Presentation: “Principles of Surgical Oncology: Operating in a Multidisciplinary Cancer Program”
  • February 2014: Global Oncology Symposium: Global Cancer Care: Challenges and Opportunities in Boston, MA. Presentation: “Surgery within the Context of a Multidisciplinary Cancer Program” 
  • January 2014: Dr. Cusack met with the Lancet Commission on Global Surgery in Boston, MA. The group is charged with advancing the field of global health in collaboration with other experts from a range of medical disciplines. Learn more about the group
  • September 2013: Sixth Annual Meeting of the Alliance for Surgery and Anesthesia Presence (ASAP) in Durham, NC. Presentation: “Providing Multidisciplinary Cancer Care in Rwanda: What is the Standard of Care?”