Global Health Diaries
Our work doesn’t stop at the walls of the medical center. Across the globe, members of Columbia Anesthesiology partner with colleagues to care for patients, teach, learn, and contribute to health systems in diverse and challenging settings.
Our brief dispatches offer perspective on global health in practice.
Sierra Leone...Dr. Anjan Saha
Neonate with tetanus in a hospital on a remote island off of the coast of Sierra Leone. Baby rigid, periodic relaxation from spasms, only on nasal cannula. No amnestic agents, muscle relaxants, laryngoscopes, ETTs, ventilators, BVMs, or antitoxin available. The hospital is 40 mins from mainland, and 6 hours total transit time at minimum from nearest hospital with its last vial of antitoxin. Baby still gets antitoxin, and supplying hospital has its stock replenished. How? Talk to a global anesthesiologist near you.
Building Sustainable Cleft Care in Guyana...Dr. Richard Raker
In 2018, I traveled with representatives from Smile Train a leading global charity supporting comprehensive cleft care to Georgetown, Guyana, where we assessed whether the Georgetown Public Hospital Corporation (GPHC) was ready to move beyond visiting surgical missions and develop a sustainable, locally led cleft program. From the outset, our goal was not to provide episodic care, but to help build durable systems that would remain long after we left.
We began with a comprehensive safety and infrastructure review aligned with international surgical and anesthesia standards. We met with hospital leadership, the Ministry of Health, surgeons, anesthesiologists, pediatricians, and nurses and local business leaders to understand their strengths, challenges, and vision. It was clear that the clinical talent and institutional, governmental and local commitments were already present; what was needed was structured mentorship, standardized systems, and ongoing quality oversight.
My primary role focused on anesthesia systems strengthening. During mentoring visits, I worked side-by-side with the Guyanese anesthesia team to enhance pediatric airway management, refine intraoperative monitoring, strengthen postoperative recovery protocols, and reinforce safety checklists. The emphasis was always on partnership and skills transfer, not substitution.
We also helped implement structured intake pathways and digital patient tracking through the Smile Train Express (STX) platform to ensure continuity and long-term follow-up. Case review and complication monitoring were embedded early to support continuous improvement.
By 2023, cleft surgeries were being performed independently by the local team. Between 2019 and 2025, 113 patients underwent surgery for 161 cleft-related conditions, delivered under standardized safety protocols and supported by multidisciplinary follow-up. Overtime, speech therapy, nutritional support, orthodontia and dental care will be added.
For me, this experience reaffirmed that sustainable global surgery is not about short-term missions—it is about trust, training, safety alignment, and building systems that empower local clinicians to lead.
Lessons in Anesthesia Education: Reflections from Vietnam...Dr. Jordan Francke
In January 2024, I had the honor of being one of five nationally recognized residents to receive the Society for Education in Anesthesia’s “Health Volunteers Overseas Traveling Fellowship.” This opportunity supported a four-week medical education rotation at Huế University of Medicine and Pharmacy (HUMP) in Huế, Vietnam.
As I prepared for the trip, I was faced with a mixture of excitement but also apprehension about teaching in this resource-limited setting: I feared I was not adequately prepared to teach complex topics to my peers abroad, or that incorrect assumptions about what medications, equipment, and resources they might have could potentially offend them. Upon arrival, any concerns I had quickly melted away. I was warmly welcomed by 24 anesthesiology residents whose clinical practices, medications, and monitoring standards in many ways mirrored those of my home institution. Twice weekly, I delivered lectures (often on obstetric anesthesia and systems of perioperative care in the U.S.) while HUMP faculty interpreted. The cross-cultural cooperation transformed sessions into dynamic, case-based, and highly interactive assemblies that underscored the truly bi-directional nature of this exchange.
Despite meaningful differences in the availability of resources like medical air and infusion pumps, what struck me most was HUMP’s remarkable strength in regional anesthesia. With only a single ultrasound machine, residents routinely performed a wide range of single-shot nerve blocks and spinal anesthetics for awake patients. Their level of technical versatility in many ways exceeded my own residency experience in the United States. Outside the lecture hall and operating rooms, I was deeply influenced by the team’s humility, ingenuity, and disciplined stewardship of medications and supplies, particularly in the context of drug shortages and limited equipment. I returned home with a renewed appreciation for the technologies I take for granted, a commitment to more judicious resource use, and a desire to build future partnerships so HUMP residents can visit my institution and experience our approach to anesthetic care firsthand.
A Long View on Global Health: Building Cardiac Care that Lasts...Dr. William Schechter
Conceived in 1994, Heart Care International is a 501(3c)(3) charitable organization incorporated in the State of Connecticut. Our mission is to diagnose children with congenital or acquired heart disease and offer medical and/or surgical care in their home country. Once invited, we commit our team to a minimum of five years in the host country with the goal of building both capacity and sustainability. For more than thirty years we have worked in multiple countries in Central America, South America, and the Caribbean. We started in Guatemala, then El Salvador, the Dominican Republic, Peru, and most recently, in an impoverished region of Mexico, the state of Chiapas.
The reality of Heart Care is that we have never abandoned any of our host countries. We remain available and continue to support each country with short-term trips, engage in hands-on teaching in the operating rooms, at the bedside, and in the intensive care units. We participate both in-person and by live web-based conferences such as catheterization conferences, Grand Rounds, surgical and interventional planning consultations, and where local bandwidth exists, we have even developed the capability of providing expert live interpretation of echocardiograms during surgical procedures.
We have participated in the care of well over 5000 patients including screenings, medical care, interventional procedures and surgeries, with a goal of creating self-sustaining programs in communities that are in need, which has, in good measure, been achieved. We have donated cardiopulmonary bypass machines, echocardiography equipment, medications and myriad other supplies, and have relied on philanthropy to bring this to fruition.
It all began at Columbia University Medical Center in the early 1990s.
Our organization has always been composed of surgeons, anesthesiologists, cardiologists, intensivists, biotechnicians, and nurses who are board certified in their field of expertise and do this type of work for children every day. Occasionally, we invite highly qualified trainees with teaching and language skills that they are willing to share. Now, our faculty represents some of the most prestigious programs in the country and indeed the world. We adhere to the same high standards of care that are established by professional organizations in the United States, Canada and the UK. These volunteers have helped build this organization by hard work and commitment, almost all by using vacation days. The organization was founded by a Columbia surgeon, Dr. Robert Michler, who later went on to become Chief of Cardiovascular Surgery at Montefiore Hospital. In the early days, staffing was enthusiastically 100% Columbia true blue. Now, some of our staffing consists of specialists from our early locations who offer unique perspective and are helping our newer programs get off the ground.
I have served as vice chair, board member, anesthesia and critical care team captain since its inception and now serve on the medical advisory board of the organization. I am proud to say that many in our cadre of early volunteers are still active and participate in trips. They are currently practitioners at some of the leading congenital programs in the USA and some have risen to directors and chiefs of service. Our most recent recruit from our Department of Anesthesiology is Dr. Max Feinstein, and several of our stellar pediatric cardiac anesthesia and congenital surgery colleagues have expressed interest in joining us in the near future. We have published our experiences in several peer-reviewed journals, including Pediatric Anesthesia, and presented our “lessons learned” and outcomes data at international meetings, including the First Global Forum on Humanitarian Medicine: Congenital Cardiac Surgery, Pediatric Critical Care and Disaster Medicine in Developing Countries, in which we participated by invitation of the Secretary General of the World Health Organization in Geneva.
I invite you to visit our website at heartcareintl.org. If you are interested in discussing involvement, feel free to contact me at ws5@cumc.columbia.edu.
Photo: In the accompanying photo, I am assisted by Carlos Cusi, former Columbia anesthesia technician extraordinaire, the hands are those of Dr. Olinda Flores, a talented local anesthesiologist who worked with us on every trip to Peru (circa 2014).