Dr. Nirupama Yechoor: A passion for treating our most vulnerable patients

Nirupama Yechoor, MD, MSc is currently a senior Neuro-ICU fellow at Mass General, and will be assuming a faculty appointment as an Instructor in Neurocritical Care this summer. She is also joining the McCance Center as a research fellow, where she will be pursuing work to better understand and improve outcomes and recovery for people with intracerebral hemorrhage (ICH).

Globally, according to the World Stroke Organization, “stroke disproportionately affects individuals living in resource-poor countries. From 2000 to 2008, the overall stroke incidence rates in low- to middle-income countries exceeded that of incidence rates seen in high-income countries by 20%. Today, two out of every three people who suffer from a stroke live in low- and middle-income countries.” Similarly, a study from the AHA reported that "Those with a lower socioeconomic status have more severe deficits and are less likely to receive evidence-based stroke services.”

Following her Masters in Global Public Health at Duke University, Dr. Yechoor discovered a passion for improving brain health outcomes and addressing global health disparities while working with hospitals in Kampala, Uganda and then with the World Health Organization (WHO) in Geneva.

The McCance Center is very pleased to welcome Dr. Yechoor to her new role as part of the McCance Center clinical-research platform.

Tell me a little about your academic and personal background?

I was born in India, and moved to the US when I was young. Both my parents are physicians, so I naturally gravitated towards science. My curiosity led me to MIT for college, where I fell in love with the brain. I worked in a research lab that investigated the molecular mechanisms of learning and memory. I was amazed at how profoundly a simple protein could influence complex processes, such as behavior and memory.

While my undergraduate experiences ignited a passion for science, I knew I wanted to work with people, not just proteins, which led me to Duke University where I pursued a Masters in Global Public Health. My thesis research focused on HIV-associated neurocognitive impairment in Kampala, Uganda, where roughly 33 neurologists shoulder the burden to treat a population of 33 million. As access to anti-retroviral therapy improved, a new problem surfaced – the incidence of neurocognitive impairment continued to increase. Even if a patient’s HIV was managed, their quality of life could be compromised. I also had the incredible opportunity to work for the WHO in Geneva, where I gained firsthand experience in policy implementation to impact global health, especially for underserved populations.

My undergraduate and graduate experiences finally led me to medicine; I pursued my MD at The Ohio State University, and then did my neurology residency at Wash U (Washington University, St. Louis, MO).

Does the global statistic that two of three people who experience stroke live in low- and middle-income countries, surprise you?

From my on-the-ground experience since graduate school, I’ve certainly come to understand the scope of the problem worldwide, and that neurology remains far behind other specialties in global public health. But during my residency at Wash U, it was probably even more striking to realize the health disparities that exist in our own communities in the US. My hospital served a very diverse patient population, and I realized that even ground-breaking medical therapies and the most excellent clinical care were not addressing the issues of social determinants of health nor the health inequities that persist among so many of our patients.

Having witnessed these significant disparities and how much they apply to critically-ill neurology patients, I pursued a fellowship here at Mass General where I would be able to work with Dr. Jonathan Rosand and Dr. Alessandro Biffi, whose vision is to reach patients who are vulnerable to worse outcomes after stroke because medicine neglects to address health inequities. I’m passionate about their vision to better understand the social determinants of health as aggregate and interrelated factors – including race, housing, employment, education, pre-existing levels of disability, and family circumstances. I want to see how these everyday factors affect outcomes after stroke, and even apply our findings to help improve recovery after all types of brain injuries.

I’m excited to pursue the really difficult questions with regard to recovery following brain injuries, and implement policies and strategies that lead to real change.

Finally, I know you’re interested in caring for patients as part of a family unit, not just as individuals. Tell us a little more about that?

I’m interested in building on the work already going on at the McCance Center to identify barriers to care after stroke – because we know the story actually starts much earlier and is often rooted in family circumstances and history. Specifically, in the ICU we see the impact of a patient’s admission on the whole family. Add to that that the patients’ parents and children may share the same risks, we really need to be treating the whole family. We must focus on how to prevent the need for future interventions