Closing the distance
A neurosurgeon uses technology to reduce disparities in medical care and education in remote areas
By Marzieh Ghiasi
Published on November 3, 2011
http://www.mcgilldaily.com/2011/11/closing-the-distance/

Image by Afra Saskia Tucker

“Two worlds, One spirit,” a collection of photography and sculpture by Ivar Mendez, the chairman of the Brain Repair Centre at Dalhousie University, was on display at Musée des Maîtres et Artisans du Québec. His black and white photographs capture the sharp boundary where dark, coniferous forests meet snow-covered mountain slopes in Northern Labrador. This landscape is marked not only by tremendous beauty, but also by human suffering.

Mendez, a trained neurosurgeon, explores humanity’s struggles through art, while seeking to alleviate it through medicine and technology. I sat down with Mendez prior to a discussion on his work on September 24, which was organized by former McGill professor, Dr. Norman Cornett.

In recent years, Mendez has made headlines by facilitating the adoption of remote-presence robots to provide specialist neurological consultation services in remote areas of Canada. Remote-presence robots allow physicians to operate in a clinic thousands of kilometers away, using a video game-like joystick to move a robot throughout. These robots can rotate 360 degrees, and have a monitor that shows a live-feed of the physician. In addition, they are equipped with high-resolution cameras and sound equipment, allowing for real time examination and interaction with patients. Despite the unusual experience of interacting with a robot, Mendez says that patients, family, and staff quickly adapt to this futuristic associate.

In Canada, as well as in Mendez’s native Bolivia, aboriginal populations – often located in remote areas – suffer disproportionately from lack of access to specialist care due to distance and climate. Mendez excitedly speaks about the potential to expand such services and take expertise to where it is needed most.

“To listen to the heartbeat of a baby in the mother’s womb thousands of kilometers away,“ Mendez said. “[to] determine which mothers are at risk.”

He views technologies such as remote-presence robot systems as a means of reducing disparity and providing equal access to medical care, even in remote areas such as the Canadian arctic. These communities, too, are quickly accepting and integrating technologies. Mendez describes a community in Northern Labrador that, after the province proved unwilling to purchase a remote-presence robot, came together to raise funds to do so independently.

Though he has helped found neurosurgical units Asia, Africa, and South America, Mendez’s interest in technology is not limited to the medical field. In another initiative, presently in its second year, children in Inuit communities in Northern Labrador are provided with laptops and put in touch with children from Nova Scotia and the Bolivian Andes.

“These kids can communicate with art, math, and music,” he said. “[This] instills in children the idea that, no matter who we are, our contributions have the same value.”

Mendez also emphasizes the importance of investing in cross-cultural exchanges. He described a school in the north of Canada where, for the first time, two students have entered 12th grade, and will be the first two high school graduates in several years. Communicating with graduating students in Nova Scotia via the laptops motivated these students to continue their education. In this way, the introduction of innovative technologies can provide services to people who lack access, and offer these communities a means for growth.

“The change will come from within,” Mendez said. “We can help provide the environment for the children to one day become the leaders of the future, and change their own communities.”

Today is the 142nd birthday of an amazing Canadian researcher and physician– Dr. Maude Abbott. It’s hard to sum up in a few words just how awesome this lady was. Briefly, she was orphaned as a child and was raised by her grandmother. After graduating high school, she joined one of the first groups of women to enroll and graduate from McGill. Although she was tremendously interested in pursuing medicine, she was not admitted to the McGill medical school which at the time was exclusive to men. So instead, she enrolled in Bishop’s where women were admitted, and later pursued her postgraduate studies in Europe.

When Abbott returned to Montreal, as I outline below, she was able to establish herself as an expert in congenital heart disease. For her work she was awarded an honourary medical degree from McGill and became a professor at the very institution that had some three decades earlier refused to consider her application on the basis of her gender. Being a woman researcher and physician, Abbott faced many challenges in a world where science and medicine were considered to be men’s territory. However, she overcame many of these barriers by the excellence in the quality of her work and her strong character, consequently paving the way for many more women to succeed.

The following is not an autobiographical sketch, but rather looks at a particular artifact of medicine that I had the pleasure of seeing at the McGill Medical Museum earlier this year and how it shaped Maude Abbott’s career.

The Holmes Heart
Rise of Pathological Anatomy in Canada

By Marzieh Ghiasi (Mar 2011)

athological anatomy, the study of altered or abnormal anatomy, is a field that in its early stages relied heavily on the collection and study of specimens. The ‘Holmes Heart’ is one of such specimens. Stored today at the McGill Medical Museum, it gave early modern physicians an understanding of the human body and its pathologies.
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While researching the works of Canadian neurosurgeon Wilder Penfield I found a rather moving tribute by him to William Osler, aptly titled “Hero Worship”. By moving tribute, I mean fangirling over an extraordinary physician, writer, etc. which leads me to wonder if Dr. Penfield were alive, would he want my Sir William Osler: A ‘Stach Through History desktop wallpaper? Sadly this delightful article is not under public domain but can be found in the Archives of Internal Medicine for those who have institutional access.

Sir William Osler devoted his mind to medical education, to the study of clinical problems and to the lore of medical history. In all those fields he was a distinguished leader, and yet it is not altogether because of these qualities of the intellect that Osler Societies have sprung up in so many parts of the English-speaking world, chiefly composed of students or of young physicians. The unique quality of this man had to do with the “heart.”

I would have you see him, through the eyes of the previously quoted undergraduate, as “the least sentimental, the most helpful, most lovable,” teacher of medicine. He belongs to medical students of all time, as Lincoln belongs to common men everywhere, a man who grew to be what he was by dint of hard work, and in whose footsteps any under-graduate may dare to “hope and dream” that he may follow.

Penfield, W. (1949). “Hero Worship.” Archives of Internal Medicine 84(1): 104-109.

Today I had the chance to visit Musée des Hospitalières de l’Hôtel-Dieu de Montréal located on Avenue des Pins Ouest between Avenue du Parc and Rue Saint-Urbain. I’d passed by the complex many times in the past couple of years since I lived right around the corner, but I’d never actually visited the museum.

Hôtel-Dieu de Montréal (Source)

“Hôtel-dieu” means “hostel of God” and is an old term in French for hospitals. The term refers to the origin and history of French hospitals as religious institutions and Hôtel-Dieu de Montréal is no different. It is the oldest hospital in Montreal, founded in 1642 by Jeanne Mance. There is actually a street called Rue Jeanne-Mance and I’d always assumed it bore the name of one of Catholic saints, as many streets in Montreal do. So it was news for me to find out (1) Jeanne Mance was a lady (2) and wasn’t a religious figure.

Jeanne Mance, founder of
Hôtel-Dieu de Montréal
*Click image for full view
(source)

Jeanne Mance was a laywoman born to a bourgeois family in France. When she came to New France, with an endowment from a French benefactress Angélique Bullion, she founded Hôtel-Dieu de Montréal. The hospital was staffed by nuns from the order of Religious Hospitallers of St. Joseph (RHSJ) which had been founded six years prior.

Today part of the old hospital has been converted to a museum that sits in two parts. The first floor is the entrance, the second contains artifacts and documents describing the founding of the hospital and the nuns’ convent, and the third displays artifacts from the hospital.

I found the second floor particularly interesting because I had a chance to speak with a guide, a kind old lady who described for me in detail the nuns’ lives from the 1600s onward. It was obvious that the nuns in the convent led solitary and cloistered lives and one might wonder, as I did, what the appeal would be. As my guide recounted, young women were compelled to join the order for many different reasons, but there existed some common narratives in their experiences. Up to mid-19th century, families in New France were encouraged to have large families in order to keep the settlements going strong. Many women who joined the religious orders came from large families where they were the first children, and were expected to be responsible for many younger children. Understandably, after the experience, some young women found life as laywoman unappealing.

Large families also meant that many families were very poor and could not afford an education for the children. For young women, joining the order meant receiving support from a spiritual family and an education. In spirit of sisterhood, nuns would teach each other to write, work with numbers, and skills that would be more difficult for laywomen to acquire. One of the documents in the museum described a 13-year old who had joined the order and had later gone on to become a very successful mother superior. While it might seem unreasonable that a 13-year old could understand or be capable of making such a decision, the chances of a young woman being able to accomplish much outside this context were very small. Also at that time, women were considered to be subjugated to their husbands and devoid of their own identity and person-hood after they married. The nuns, however, were able to retain authority within society and commanded respect for their accomplishments. So while the nuns may have been cloistered from society, in some ways they were much more present and able to contribute to society than laywomen.

Not all nuns were in convents, however, and some orders were actually completely immersed in society. There were orders to help the blind, to help orphans, to help those with leprosy and in general help the needy when no one else was. In Montreal, the convent and the hospital were separate. However, as my guide described the nuns at Hôtel-Dieu de Montréal lived a kind of a double life reflective of their motto “silence and charity”. In the convent they dealt with religious duties, while in the hospital they worked as nurses, tending to the needs of the sick and helping their families cope.

Hôtel-Dieu infirmary (Source)

The medical artifacts on the third floor are quite interesting and make up a large part of the 20,000 artifacts that the museum has preserved. These included instruments such as early microscopes (with intact slides!), glass syringes, wooden wheelchairs, and pictures of the hospital. Aside from the historical medical equiptment, I enjoyed looking at pictures of the nurses, noticing their transformation through the years. Up to 1935 the nurses in Hôtel-Dieu wore head-covering similar to coifs. Apparently, the coif with an extended veil in the back sometimes got in the way so they changed their nuns’ coifs to nursing caps. For most of Hôtel-Dieu de Montréal’s history only nuns were allowed to be nurses in the infirmary; however, after 1901 they began to train laynurses. These young women would train and work at the hospital alongside the nuns and stay with the nuns for a small fee.

In 1970s, following Quebec’s Révolution tranquille (Quiet Revolution), all the hospitals in Quebec were transferred to the government to be run by the secular apparatus. Therefore, while the Hôtel-Dieu hospital exists as a teaching hospital for Université de Montréal, the nurses are no longer associated with any religious orders. What remains of Hôtel-Dieu de Montréal’s 300-year history is the museum and the nuns who live in another part of the complex. Today they run an affordable hostel for families of patients in CHUM/MUHC hospitals who need to stay in the city to accompany their sick family member. The nuns no longer live in a convent, separate from society, and they no longer wear habits but normal clothes. They can only be identified by the pins they wear as part of the order Sisters of St. Joseph (RSJ).

http://www.mcgilldaily.com/articles/20738

Diagnosis gone digital
By Marzieh Ghiasi
Monday, October 5th, 2009

Almost every field has adopted digital technology, and medicine is no exception. However, the transformation of health informatics in the past decade has not simply been a change in tools of the trade, but a change in the very way knowledge is acquired and applied.

13th century Anatomical Illustration | Source

As a discipline that brings together health care and information science, health informatics is involved in setting up resources like search engines that doctors can use to retrieve clinical data. These tools can be grouped into two categories – information retrieval systems (IRS) and clinical decision support systems (CDSS).

Pierre Pluye, a physician and associate professor in the Department of Family Medicine at McGill University, investigates these electronic resources. He explained how IRS provide a way to filter the staggering amount of available information down to only the most relevant.

“There are 19 million abstracts on Medline [an online biomedical database]. Physicians do not have time [to read every single one]… because basically you would have to read 24 hours a day, seven days a week just to keep updated,” said Pluye.

CDSS differ from IRS in that they provide patient-specific information. Clinicians can use calculator-type programs that look at a patient’s history to determine their likelihood of contracting diseases or experiencing medical complications.
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