Friday, September 16, 2016

Global Glimpse: MGH around the world

The power of knowledge: MGHers elevate clinical care in Bangladesh

“When in distress, every man becomes our neighbor.” Those words were penned by MGH founders more than two centuries ago, yet they continue to ring true today. Clinicians, researchers, students and staff travel the world to provide care, comfort and education to those in need. In recognition and celebration of the founding of the MGH Center for Global Health 10 years ago, MGH Hotline will run a series of articles highlighting the people and efforts that improve and enhance the lives of so many across the globe. This look at the past and future of Bangladesh is the first in the series.

The Korali slum

It starts with a cup of coffee.

While waiting for it to cool, Bimalangshu Ranjan Dey, MD, of the MGH Cancer Center, begins where his story began – his birthplace of Bangladesh. Dey left the country when he was 18, but he always believed that one day he would return to use his skills and passion to improve the health and well-being of the people of Bangladesh.

“I had this dream of elevating clinical care in the area,” Dey says. “I’ve been given many gifts in my life and I wanted to give something in return.”

So he has returned – time and time again – to collaborate on multiple programs aimed at providing cancer care to those who so greatly need it. What started as a hope to help has become a brick and mortar reality, in partnership with the Bangladesh Ministry of Health & Family Welfare toward a shared vision to expand access to modern cancer care.

It started nearly eight years ago with the development of a cervical cancer screening protocol in the Korail slum of Dhaka, in collaboration with AK Khan Healthcare Trust, an area nonprofit organization. “Cervical cancer is the No. 2 killer of women in Bangladesh – second only to breast cancer – so it is having a massive impact on society,” Dey says. “There are no national registries, so the incidence is unknown. From limited data at teaching hospitals, however, 80 percent are believed to be advanced stage and more than 80 percent will die within five years.”

This is in stark contrast to studies in the U.S. which project only 12,990 cases of cervical cancer in 2016 – the majority of which will be detected in their early stages.

The challenges of implementing the program were immense. There is no reliable clean water supply for basic sanitation, and no centralized health services to introduce or educate about basic hygiene measures. Yet, in 2010, under the leadership of Annekathryn Goodman, MD, director of the MGH Gynecology Oncology Fellowship Program, the hospital helped to create a community-based comprehensive cervical cancer screening and treatment program, which to date has treated an estimated 300 underprivileged women in the Korail slum. 


Jenna Moran, NP, of Lunder 10, and Dey examine a young patient who could benefit from allogeneic stem cell transplantation.

A first for the country

Building on the successful collaborations to address cervical cancer, another milestone was marked in March 2014 when the first bone marrow transplantation unit in the country was opened at the Dhaka Medical College and Hospital, the largest public referral hospital in Bangladesh. Dey says support from the leadership of the MGH Cancer Center and clinical colleagues in the MGH Bone Marrow Transplantation Unit, along with the close collaboration of physicians and nurses in Bangladesh, were essential in bringing the project to fruition.

“In advance of our first transplant, 40 MGH staff spent more than 150 weeks in Bangladesh providing clinical mentorship to the unit and teaching in an advanced nursing program,” Dey says. “It was an amazing partnership between the MGH, AK Khan Healthcare Trust, the Ministry of Health and the local physicians. To build this type of program in such a resource-limited country is virtually unprecedented.”

Since its inception, 23 patients have successfully been treated in the new bone marrow transplantation unit and the group hopes to be able to provide allogeneic (donor-derived) transplants in the coming years. “I can’t stress enough how hardworking and dedicated Dr. Dey is,” says Goodman, who has taken a lead role in the development of a Women’s Cancer Care Program at the Dhaka Medical College and Hospital. “What he has done is extraordinary. He has shown the local clinicians that when you have a sterile environment, learn these special techniques and work together in an interdisciplinary team, you can build a successful treatment program. He is an inspiration to others, and we hope that his dedication to education continues to translate to other areas in Bangladesh.”

Training and support

Goodman demonstrates advanced surgical techniques to treat cervical cancer.

“How are we going to make a difference in this sea of need?”

That’s the thought that stood out for Anne-Marie Barron, PhD, MGH clinical nurse specialist who also serves as associate dean at Simmons College School of Nursing and Health Sciences, during her first trip to Bangladesh in 2009. She had worked with Dey for years in the MGH Hematology/Oncology Unit, and readily agreed when he approached her to travel to Dhaka and share her expertise in nursing education. “He said, ‘Come, help us. If nursing education and nursing practice are not elevated, the quality of care will never rise. Your contributions will enhance their skills and confidence,’” Barron recalls.

Seeing hospital conditions firsthand was heartbreaking, Barron says. There were 1,600 full beds, but twice as many patients could be found lying on straw mats in the hospital hallways waiting for a bed to open, as the hospital turns no patients away. Further complicating the congestion were family members who clogged the hallways to care for their loved ones until they could be seen by a professional.

“That was my first experience with global health and it was amazing,” says Barron. “I think there are lots of people who go to places in developing countries and they get overwhelmed and find it difficult to go back. We keep returning and we’ve established a real credibility with the people there. They know we are going to return and continue to help.” 

"As with all of MGH’s partnerships around the world, the projects in Bangladesh extend the global reach of the hospital to improve health for vulnerable communities through patient care, clinical education and scientific discovery,” says Jason Harlow, associate director for Global Programs at MGH Global Health. “What we might take for granted in Boston – empowered nurses delivering patient-centered medicine in multidisciplinary teams – is still relatively rare in places like Bangladesh. Beyond the transfer of technical skills by Dr. Dey and his remarkable colleagues in the MGH Cancer Center, I am excited to see the MGH as a driving force to advance a culture of care for the people of Bangladesh. Most gratifying is to see this collaboration supported directly by the government. I think this shows a strong political commitment to the long-term sustainability to these efforts.”

Dey is quick to point out that education, particularly within the field of nursing, is a key component to the success of the program. “Nurses play a central role in delivering health care around the world, and it is imperative that we prioritize their role within the comprehensive care team,” he says.

Dozens of MGH nurses have traveled to Dhaka – some multiple times – spending anywhere from one to six weeks on the ground to share their knowledge, create curricula and reinforce foundational nursing skills. “It’s really incredible,” says Barron, who took her 10th trip to Bangladesh in June. “The nurses who have been practicing for awhile – it’s really wonderful to see the level of confidence they have. I feel like we are recognizing the long arc of a joy-filled career in nursing. You can see the power of knowledge unfolding before your eyes.”

A look at the future

“Building a bone marrow transplant program from the ground up – especially in a resource-limited environment – is a daunting task but Dr. Dey has marshalled the necessary resources and staff, inspired many team members at the MGH to provide their expertise in the training of that staff and has shown that anything is possible in the name of innovation and advancement of modern health care,” says Thomas Spitzer, MD, of the Bone Marrow Transplant Program.

Dey is quick to point out that the dedication of staff here and abroad is the key to building successful programs. “Recognition goes to everybody,” Dey says. “I couldn’t do this without the help of so many at the MGH, and I take it as a privilege to be a small part of a place like the MGH that wants to be a part of these big, big projects.”

In the future, Dey says, he will continue to strengthen and expand the clinical efforts in Bangladesh and will continue to ask MGH clinicians and colleagues for their support and expertise. “Good things happen like that,” he says. “It’s that easy. This family grew over a cup of coffee or tea.”

Dey’s cup of coffee is now empty – but his plate of projects and unbridled optimism is full.

He smiles. “Do you want to go to Bangladesh?” 

Read more articles from the 09/16/16 Hotline issue.

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