Associate Professor of Anesthesia, Harvard Medical School

I am a pediatric anesthesiologist in full time clinical practice. My area of clinical expertise and innovation is in the field of global health, where I have worked to address the massive worldwide disparities in surgical and anesthetic care.

Area of Excellence: Global Health

Inadequate anesthetic capacity in low-income countries contributes to a global public health crisis of limited surgical treatment, obstetric management and critical care for billions of the poorest people around the world. As the head of the Global Health Division of the MGH Department of Anesthesia, I established a collaboration with Department of Anesthesia and Critical Care at Mbarara Hospital, a rural teaching hospital in south-western Uganda. This academic partnership has created novel techniques to develop anesthetic care in low-income countries with limited health care infrastructure.

Since 2011, I have assisted in expanding both basic anesthetic training capacity and more advanced professional development in Uganda. I helped promote the development of anesthetic residency training program through an innovative anesthesia distance education program between the MGH and Mbarara Hospital (J Clin Anes 2015). This initiative, the first of its kind, allowed for the delivery of educational resources from a high-resource program to a setting with limited educational capacity.   

I promoted the professionalization of Ugandan anesthesiologists by introducing a novel method of pain control, ultrasound-guided regional anesthesia, to East Africa. I arranged a workshop to teach East African anesthesiologists the technique (ASRA News 2015), and then worked with American and Ugandan colleagues to mentor clinical research in Uganda (Lancet 2015). This development and mentoring culminated in a Ugandan first- and senior-authored research publication, the first peer-reviewed clinical publication from this department (Anaesthesia 2019).

In parallel with this work, I developed a model of measuring surgical and anesthetic outcomes at a hospital level. I designed, built and implemented an electronic hospital outcomes database to capture all mortality outcomes from surgical, obstetric and anesthetic care (N Engl J Med 2012; WJS 2016, 2017, 2018, 2020; Surgery 2017; SAJAA 2022). This database identified four metrics that can be used to assess the effectiveness of treatment interventions and guide the allocation of resources. (Anes Analg 2021) Designed and implemented in a representative African hospital using locally available resources, this method of measuring surgical and anesthetic delivery is reproducible across the many small teaching hospitals that can drive expansion of treatment capacity in low-income countries.

This body of work therefore has developed models of international collaboration between anesthetic training programs, defined and promoted the role of anesthesiologist in the delivery of care in low-income countries, and produced a method of outcome measurement to promote the delivery of effective care.

Supporting Activity: Clinical Expertise in Oxygen Delivery

I have additional prominent interests in the physiology of oxygen delivery. My interest in oxygen transport involved work on the peri-operative management of sickle cell disease, a prominent problem in pediatric anesthesia. Reasoning from clinical observations of peri-operative patients (J Neurosurg Anesthesiol 2000, Can J Anaesth 2003) I developed a novel pathophysiological model, defining the disease as a problem of chronic vascular dysfunction rather than acute erythrocyte deformation (Anesthesiology 2004, Br J Anaesth 2005). I surveyed anesthetic management (Pedi Anes 2011), described the peri-operative epidemiology of children (Anes Analg 2013), outlined various clinical details of the disease (N Engl J Med 2009, J Neurosurg Anesthesiol 2010), and published numerous textbook chapters. This accumulated work promotes the abandonment of ineffective management based on the avoidance of sickling, in favor of the development of new approaches aimed at limiting vascular damage.

My interest in oxygen use is also reflected in high-altitude physiology. After leading an expedition to the north side of Mount Everest, I examined the epidemiology of high-altitude deaths on Everest (BMJ 2008). This research revealed that most climbers died at extreme altitude during descent from the summit, many with severe symptoms suggestive of high-altitude cerebral edema. This paper provided guidance for prevention and early identification of this disease, allowing for safer climbs at extreme altitudes.

Teaching:

While focused on addressing educational inequities through Global Health, I remain actively involved in the teaching of clinical anesthesia at the MGH. I served for many years as the Director of Resident Education in Pediatric Anesthesia, was a member of the Anesthesia Department’s Educational Committee, and worked as a clinical tutor, responsible for initiating incoming residents into anesthetic practice. I initiated a series of small group pediatric anesthesia lectures, delivered multiple lectures and case conferences, and published several textbook chapters and peer-reviewed clinical reports.

My teaching has included work in low-income settings. I arranged for provision of a hospital anesthesia library to Mbarara (2011-12), helped in the development in Uganda of an interactive pediatric anesthesia education course (SAFE Paediatrics Course) that is now taught worldwide, and supervised multiple resident exchanges between MGH/Harvard and Uganda (2011-2020).

Summary:
I have endeavored to provide excellent clinical care, administrative overstay and teaching while also conducting research in my area of clinical expertise. I have mentored residents in clinical practice and global heath, trainees from both Harvard and from low-income countries. I have lectured at multiple venues locally, nationally and internationally. I have authored over 75 publications, including 50 first-, senior- or co-authored publications. Through the combination of direct teaching, lectures and extensive publications, I have sought to reduce the global disparities in clinical care.