Mission Global Health: A Conversation with Adam Silverman, MD Adam Silverman, MD is an emergency medicine and critical care specialist at Connecticut Children’s. He has also recently been named the director of the Center for Global Health at Connecticut Children’s Medical Center. Together, both he and newly appointed associate director Karen Callahan BSA, BSN, MHS, RN, CPN will aim to build upon the mission of the Global Health Initiative. Though the Center for Global Health is a new entity at the Medical Center, improving health outcomes for children around the world has always been a core mission of Connecticut Children’s. What once began as a volunteering opportunity for physicians and medical staff has evolved throughout the years into something much greater. The establishment of the Global Health Initiative brought to fruition an abundance of ongoing activities and resources, including the annual Global Healthcare Fair, Global Health Film Festival and a wide variety of program support. As interest grew, so did the need for a designated center…the Center for Global Health. Becoming the Center for Global Health “We have a responsibility to our families, our communities, our country and the world. We have unique skills that are unmatched outside of this country,” said Dr. Silverman. “The inequality in healthcare for children that exists in the world is a tragedy and we can all do something about it.” Dr. Silverman focuses his time on investigating how critically ill children are cared for in the emergency department as well as improving the coordination of care amongst various providers. In addition, Dr. Silverman provides care to children in Haiti and develops methods of increasing hospital staff participation in global healthcare endeavors. After Haiti was devastated by a massive earthquake in 2010, Adam Silverman, MD, flew to the impoverished nation to help. Since then, he has gone on over 10 medical missions to Haiti and organized several more. He and others from Connecticut Children’s have volunteered with Project Medishare at Hospital Bernard Mevs in the Haitian capital of Port Au Prince and have volunteered with Konbit Sante to support improvements in newborn and pediatric care at Justinien University Hospital in Cap-Haitian. Having an ongoing relationship makes all the difference. “They know us, they know Connecticut Children’s, our level of expertise and the spirit in which we come, so we can be much more effective with these partnering organizations and the Haitian doctors and nurses relative to someone who comes only once,” Dr. Silverman says. The Need is Great Dr. Silverman says that clinicians traveling to Haiti for the first time can expect a significant culture shock. “Port Au Prince is only 90 minutes from Miami, but it is one of the most underserved places in the world,” he says. “The difference in the lives of those people from those in the United States is just astounding.” While Hospital Bernard Mevs serves both adults and children, Dr. Silverman and others from Connecticut Children’s provide mostly pediatric care. Perinatal infections are quite common, so many children have hydrocephalus, and there is a dearth of neurosurgeons to treat it. Respiratory illnesses, infections and major and minor trauma are also common. Many infants are born at home or in tents, and mothers and babies often have fevers. There are no laboratory facilities to do cultures, so visiting clinicians treat infection with whatever antibiotics are available and hope it will be effective. Access to radiology studies is limited. There is a CT scanner that sometimes works, but there are no on-site radiologists. “We have limited support there compared to Connecticut Children’s, but many people find it inspiring and liberating to realize how effective they can be without state-of-the-art equipment and facilities,” Dr. Silverman says. “We can actually provide pretty good care with a lot less.” Ongoing Care As a volunteer with Konbit Sante providing medical expertise at Justinien University Hospital (JUH), Dr. Silverman is part of a collaborative program that takes an in-depth look at newborn and infant care and works with the residents and staff to improve outcomes. In fact, 2 years ago, Dr. Silverman and Vic Herson, MD and a team of Connecticut Children’s volunteers trained staff members in newborn resuscitations and then more recently trained that same staff how to be newborn resuscitation instructors so that the process would become self-perpetuating. But here’s the truly incredible thing in this age of technology: their involvement doesn’t end when their flight returns to Connecticut. Every month, Dr. Silverman and his colleagues at Connecticut Children’s work with Konbit Sante to review clinical cases with the hopes of improving care and providing monthly video-based conferences to staff and residents on the care of infants at that facility. “It truly is addicting. It actually makes me better at my job here,” said Dr. Silverman. “I find myself more patient, more compassionate, and more understanding of the context of my patient’s lives.” A Global Responsibility While rewarding, Dr. Silverman admits it’s not always easy. “Seeing children die from relatively straightforward medical issues that would be survivable across the border in the Dominican Republic or here in the United States is extremely tough. The thing is, almost everyone down there knows it. The doctors and nurses are educated, thoughtful and dedicated but between a lack of resources, lack of general education about when to seek medical help and poor infrastructure it can become very difficult for them to continue to strive for the outcomes they know their patient’s deserve.” April 2016 will be Dr. Silverman’s 15th trip to Haiti. When asked how many children he has helped, Dr. Silverman admits he has lost track. Even so, he’s the first to point out that 20 days a year is not enough time to make a big enough difference. Instead, he says the difference he’s making in the world is better measured in the doctors and nurses he has helped train, so that they can train those who are helping children in Haiti year round.