Global Musculoskeletal Health Equity Division

About GHMED

The HSS Global Musculoskeletal Health Equity Division (GMHED) is a division of HSS Global Partnerships founded in 2021 by Swetha Pakala and Mark Brouillette to provide humanitarian services in places where the need for musculoskeletal care is great and access to safe high-quality care is lacking.   

In 2012, Swetha Pakala, MD founded the Global Health Initiative (GHI) within the Department of Anesthesiology, Critical Care & Pain Management. The focus of this program was to address the need for improved anesthetic capacity in low-resource settings by supporting regional anesthesia training. GHI’s first program was conducted at the Hospital for Traumatology and Orthopedics in Ho Chi Minh City, Vietnam. The program later expanded its work to sites in Uganda, Ghana and India. 

In 2017, GHI launched GRACE (Global Regional Anesthesia Curricular Engagement), which was a novel training model for resource-limited settings. GRACE enabled us to create teaching curricula using a systematic framework based on a partner site’s specific needs. It also offered a platform with which to measure intervention outcomes. 

Thanks to the support of HSS Global Partnerships, in 2021 global health efforts were expanded to consider all of the relevant service lines under the HSS musculoskeletal health care umbrella. A multidisciplinary program like this has the potential to increase the positive impact on providers and patients in resource-limited settings.  To date, we are enthusiastic to have HSS Orthopedic Surgery (Trauma, Spine and Sports), Anesthesiology and Pharmacy Departments on board for the GMHED launch in Ghana this year.  

Our Mission

The GMHED mission is to improve musculoskeletal education, research and practice at our partner institutions in resource-limited settings at home and abroad by supporting clinical training programs and building local research infrastructure 

Our vision and guiding principles are to develop and deploy evidence-based, adaptable methods to assess the musculoskeletal health care needs of hospitals in low-resource settings and evaluate the impact of global health initiatives aimed to address gaps in training, research and care while observing the following principles: 

• Assist partners on their terms, i.e. prioritize local agendas and timelines over our own, and, when possible, integrate our efforts into preexisting programs rather than impart new ones. 
• Put collaboration ownership into our partners’ hands and allow local leaders to decide how resources can best be used to help their providers and patients. 
• Build self-sustaining programs that can eventually be maintained locally without outside assistance.
• Periodically evaluate our programs’ success in order to use the results to inform improvements, publish useful findings and demonstrate progress to HSS and outside sponsors. 
• Use sound scientific principles and methodology to assess needs and evaluate programs. 
• Increase public recognition of the global musculoskeletal disease burden and inequities that exist in resource-poor settings in regards to access to treatment that is timely, affordable and high-quality. 
• Share knowledge and resources freely for the betterment of the global health community. 

Our Team

Leadership

Swetha Pakala, MD
Co-Chair

Swetha Pakala, MD

Co-Chair

Dr. Pakala is a board-certified anesthesiologist at HSS and a Clinical Assistant Professor of Anesthesiology at Weill Cornell Medicine. She is a well-recognized expert in the use of regional anesthesia in international health and resource limited settings. For her work as her department’s Global Health Initiative Co-Chair, Dr. Pakala was the first recipient of the Leon Root, MD Community Service Award in 2019. This award recognizes the outstanding leadership of those making significant contributions to the community through initiatives that improve the care of vulnerable and underserved populations. Since joining HSS in 2012, Dr. Pakala has been involved in several public health initiatives, short-term surgical missions, and sustainable teaching efforts in countries around the world including Vietnam, Uganda, India and Ghana. She completed her medical school and residency training at the University of California, San Francisco and received further specialization in Regional Anesthesiology and Acute Pain Medicine at HSS.

View Dr. Pakala's profile

Mark Brouillette, MD
Co-Chair

Mark Brouillette, MD

Co-Chair

Dr. Brouillette is an anesthesiologist within the Department of Anesthesiology, Critical Care & Pain Management. He completed medical school at University of Colorado and residency at University of Kansas prior to undertaking specialized training in Regional Anesthesiology & Acute Pain Medicine at HSS in 2017/2018. Dr. Brouillette began global health work in Ghana in 2008 and has been active teaching and researching there ever since. At HSS, he is the Co-Chair of the department’s Global Health Initiative. He is also a teacher for the World Federation of Societies of Anaesthesiologists Fellowship program in Ghana and serves as Vice Chair for the American Society of Regional Anesthesia’s Global Health Special Interest Group.

View Dr. Brouilette's profile

Physician and Surgeon Leads

Sariah Khormaee, MD, PhD
Spine Surgery Champion

Sariah Khormaee, MD, PhD

Spine Surgery Champion

Dr. Khormaee is an adult and pediatric spine surgeon with a long-standing history of advancing global spine care, research and education. She has traveled extensively to develop sustainable collaborations with spine specialists, including in Myanmar and Vietnam. In addition to her academic efforts to understand spine care inequalities, she works with several nonprofits to improve delivery of spine care with a special focus on implant availability. Dr. Khormaee graduated from the University of Washington as President’s Medalist / Valedictorian. She completed her Medical Degree at Harvard Medical School-MIT Health Sciences Technology with Honors. She earned her PhD from Cambridge University in Chemical Engineering and Biotechnology. Dr. Khormaee completed her residency at Hospital for Special Surgery and completed a specialized spine fellowship at Stanford University.

View Dr. Khormaee's profile

Andrew Grose, MD, MSc
Trauma Surgery Champion

Andrew Grose, MD, MSc

Trauma Surgery Champion

Dr. Andrew Grose is an orthopedic surgeon specializing in the treatment of simple and complex fractures of the pelvis and extremities, as well as joint replacement of the hip and knee. He completed two fellowships at Hospital for Special Surgery, the first in adult reconstruction/joint replacement and the second in orthopedic trauma. For the past 12 years he has worked at level 1 trauma centers in close coordination with neurosurgeons, plastic surgeons, acute care trauma surgeons, chaplains and psychiatrists to restore patients following severe trauma. In addition to treating acute fractures, he also cares for patients referred to him for infection, nonunion, and malunion following trauma, and does both primary and revision hip and knee replacement surgery. Since 2011, Dr. Grose has studied and worked extensively in the field of patient safety. He was the recipient of an American Hospital Association-National Patient Safety Foundation Comprehensive Patient Safety Leadership Fellowship, and subsequently earned a Masters degree in Human Factors and System Safety. His area of interest is the direct observation of individuals and teams at work to promote both self-improvement and uncover system concerns that can be corrected to improve quality and safety.

View Dr. Grose's profile

Benjamin Nwachukwu, MD, MBA
Sports Surgery Champion

Benjamin Nwachukwu, MD, MBA

Sports Surgery Champion

Dr. Benedict Nwachukwu is an orthopedic surgeon and specialist in hip, knee and shoulder surgery at HSS. Dr. Nwachukwu is the Co-Director of Clinical Research for the Sports Medicine Institute at HSS. He is also an Assistant Professor of Orthopedic Surgery at Weill Cornell Medical College. Dr. Nwachukwu attended college at Columbia University and he obtained his MD from Harvard Medical School. He also obtained an MBA from Harvard Business School while a medical student. Dr. Nwachukwu completed his orthopedic surgery residency at HSS and his sports medicine fellowship training at the world renowned Rush University. Dr. Nwachukwu currently has over 130 published peer reviewed publications. His research has been nationally recognized throughout his career. As a medical student, Dr. Nwachukwu was given the Janee and Paul Friedmann, MD '59 Surgery prize – awarded to the top student going into a surgical specialty and he graduated cum laude for excellence in orthopaedic research. As a surgical resident, Dr. Nwachukwu was awarded the Lewis Clark Wagner, MD, Chief Resident Award for Excellence in Orthopaedic Clinical Research. He has also been awarded numerous professional society awards and he has been awarded various research grants to support his advancement of orthopedic science.

View Dr. Nwachukwu's profile

Champions

Niharika Thakkar, PhD
Research Champion 

Niharika Thakkar, PhD

Research Champion

Niharika was born in India, and completed her schooling and junior college degree in Science from Bombay (now Mumbai). By 2009, Niharika graduated with a major in Psychology, and a minor in English literature, from Fergusson College, Pune. She earned her Master’s Degree in Clinical Psychology in 2011, ranking first at Fergusson College in the final semester. As part of her Masters, she completed a clinical internship and wrote her thesis in Graphology and Personality. At college, she excelled in academics and shined through when she was awarded the “most deserving candidate of the year” scholarship in her final year in 2011. Thereafter, until 2015, she worked in India as a clinical Psychologist at a hospital, headed the Psychology Department at a Rehabilitation Center, as a post-graduate teacher of Psychology, as well as ran her independent clinic in collaboration with Psychiatrists. In March 2015, she moved to USA, and also started her PhD journey in “Bullying and Victimization among Adolescents in India”, at the Department of Social and Behavioral Sciences at Leiden University, The Netherlands. Alongside her PhD, Niharika was involved in a National Science Foundation (NSA)-funded research project that focused on the conceptual understanding of key algebra concepts at the City University of New York. She later moved on to work as a Research Associate at the Center for Family Services, in greater New York. In July 2020, she founded PsychLine.in, an online mental health organization that aims to provide good-quality care and education to all in India. Niharika completed her doctorate in 2022, and has several international publications to her name. She was also recently invited by Elgar Publishing (UK) to contribute a book chapter to the Global Handbook of Bullying and Violence. Niharika is an internationally rated Chess player, loves to travel, and is a hopeless dog lover. She has a rabid social conscience, and wishes to pursue her purpose in creating global mental, emotional, and social health awareness.

Jawad N. Saleh, B.S., Pharm.D., BCPS, BCCCP
Pharmacy Champion 

Jawad N. Saleh, B.S., Pharm.D., BCPS, BCCCP

Pharmacy Champion

Dr. Jawad N. Saleh, B.S.Pharm., PharmD, BCPS, BCCCP is a registered pharmacist who is dual board-certified in Pharmacotherapy and Critical Care. He currently serves as the Manager of Clinical Services and Critical Care Specialist for the Pharmacy Department at the Hospital for Special Surgery. He is an Assistant Clinical Professor for the St. John’s University College of Pharmacy and Health Sciences and acts as a mentor for future pharmacists. Dr. Saleh received his Bachelor’s of Science in Pharmacy and his non-traditional post Doctor of Pharmacy degree from St. John’s University in Queens, New York. He is currently enrolled in the Harvard Medical School Master in Clinical Service Operations program with a strong focus to optimize efficiency and improve patient outcomes. Dr. Saleh created and implemented the first pharmacy clinical program at the Hospital for Special surgery. He authored and co-authored publications and presentations regarding perioperative impacts on patient care. He has presented numerous topics on both a national and regional level at organizations such as ASHP, FAH, UGM and Becker’s Healthcare. He also sits on several advisory boards to facilitate and improve innovative products coming to market. As the Pharmacy Champion on the Global Musculoskeletal Health Equity Division (GMHED) at HSS, Dr. Saleh utilizes evidence-based pharmacy best practices to improve musculoskeletal care in resource limited settings at home and abroad. Dr. Saleh is the secretary for the Pharmacy and Therapeutics Committee and co-chairs both the Antimicrobial Stewardship Committee and the Hematology Workgroup. He is the co-founder and co-chair of the hospitals Opioid Stewardship Committee and worked on countless quality initiatives within the organization. He currently holds a position on the Diversity, Equity and Inclusion leadership council and is a contributing member of numerous committees within the Hospital for Special Surgery.

Email:salehj@hss.edu

Linkedin

GMHED Partners

Ghana 

The Republic of Ghana has a population of 31 million and is situated along the Gulf of Guinea in West Africa. Ghana is a multinational state that gained independence from the British in 1957. The government is a unitary constitutional democracy, and English has been adopted as the common language. With respect to musculoskeletal disease, the burden of trauma, chronic degenerative states and congenital deformities is high, but much of the infrastructure and workforce needed to care for these conditions is lacking. GMHED currently collaborates with the two largest teaching hospitals in Ghana. Our programs there focus on increasing the orthopedic surgery and anesthesiology workforce by training local doctors and conducting research. 

• Komfo Anokye Teaching Hospital (KATH): Kumasi, Ghana  
  HSS and KATH began working together in 2017, though Dr. Brouillette has led several US academic centers’ global health programs with the KATH Directorate of Trauma and Orthopaedics and Directorate of Anaesthesia & Intensive Care. KATH is a 1,200-bed academic center built in 1952 and located in the city of Kumasi. KATH is the primary referral center for the northern two-thirds of Ghana and the teaching institution for the Kwame Nkrumah University of Science and Technology Medical School. More than 10,000 surgeries are performed at KATH annually; 16% for musculoskeletal conditions, many of which are road traffic injuries. KATH offers postgraduate medical training in most disciplines, including Trauma & Orthopaedics and Anaesthesia & Intensive Care. Subspecialty fellowship training in Regional Aneaesthesia and Interventional Pain Management is now available.

• Korle Bu Teaching Hospital (KBTH): Accra, Ghana  
  HSS began collaborating with KBTH in 2020. KBTH is a 2,000-bed academic center built in 1923 and located in the capital city of Accra. KBTH is the oldest and largest referral center for the country and also sees patients referred from its West African neighbors. KBTH houses the University of Ghana Medical School and offers postgraduate training in 14 medical disciplines, including Trauma & Orthopaedics and Anaesthesia & Intensive Care.  

  

  Korle Bu Teaching Hospital anesthesiologists Dr. Alex Akowuah
  and Dr. Kofi Mensah and HSS anesthesiologist Dr. Mark Brouillette
  launch the KBTH-HSS collaboration in January 2020.

   

India

India, officially called the Republic of India, is the seventh largest country by area, the second most populous country and the largest democracy in the world. It is a pluralistic, multilingual, and multi-ethnic society. India has become a fast-growing major economy and a global hub for information technology services. Despite the economic advances, India is also overwhelmed by unyielding poverty, both urban and rural. Additionally, religious and caste-related prejudice permeates many sectors of society. In poverty-plagued communities, healthcare resources and workforce are dire, which leads to a high burden of disease. Musculoskeletal disease, particularly trauma, comprises a large proportion of unmet need.

Osmania General Hospital (OGH): Hyderabad, India  
HSS and OGH began working together in 2019 when the HSS anesthesia Global Health Initiative (GHI) introduced the GRACE training model to the OGH department of anesthesiology. OGH is the second largest government hospital in South India and provides free medical care to the indigent population of Hyderabad and the surrounding areas. OGH houses 1,000 beds within three specialty buildings, has 62 operating rooms of various specialties and performs roughly 62,000 surgeries per year. OGH offers the premier anesthesiology residency training program in South India, with approximately 90 new residents annually. Although physician anesthesiologists have been performing regional anesthesia techniques for several years, there is a large variability in skill and success rates among practitioners. The OGH faculty therefore sought to collaborate with GHI to improve their knowledge and skill level. 

Global Initiatives

The GMHED initiatives are the blueprints that guide how we approach global health work. They are the recipes we use to support our partners’ educational and research programs. The idea is that we, or any global health group, can follow an initiative’s prescribed steps, in any resource-limited setting, and end up with a sustainable intervention that is tailored to the unique needs of the local hospital or health care network and that can be examined periodically for changes associated with the intervention’s implementation, thereby informing program improvements and gauging success. 

Global Regional Anesthesia Curricular Engagement (GRACE)

GRACE is a framework to design and measure the impact of a regional anesthesia training program. It was first piloted at the Komfo Anokye Teaching Hospital (KATH) in Kumasi, Ghana in 2017. The first step is to conduct a needs assessment. Since no validated assessment could be found in this field, we devised and ran an original one. The results of the needs assessment are then summarized for the host and visiting teams who created a novel curriculum with the help of an expert panel’s consensus recommendations.

At predetermined intervals, the four-part Kirkpatrick method is used to evaluate changes in 1) trainee satisfaction (survey), 2) knowledge (written examination), 3) clinical skill (observed structured clinical examination) and 4) changes in regional anesthesia utilization and patient outcomes (audit). View the detailed GRACE methods used at KATH published in 2020.

GRACE schematic

 

Regional Anesthesiology Fellowship

The HSS Regional Anesthesiology & Acute Pain Medicine Fellowship offers 1-2 Fellows per year the opportunity to take part in the Global Health Track. Dr. Brouillette and Dr. Pakala serve as the Fellow’s mentors and help them gain an in depth understanding of existing global musculoskeletal health care disparities as well as the traditional versus modern strategies used to address health care inequities. Fellows will also have the chance to design and execute an academic project at one of our GMHED sites or at a low-resource institution of their choosing at home or abroad, travel safety guidelines permitting. This is typically concise education or research-focus protocol that can be completed and disseminated in the fellowship year. Up to four weeks of travel is sponsored depending on the project specifications. 

Fellows will graduate from our track with an enhanced appreciation for the unmet orthopedic needs worldwide, evidence-based tools to join or build new global health initiatives in their future careers, enhance fluency in multidisciplinary and cross-cultural communication and collaboration and the knowledge and skill set to perform a variety of regional techniques such as transarterial and paresthesia-seeking approaches to the brachial plexus block, ultrasound-guided suprainguinal fascia iliaca and pericapsular nerve group blocks for hip analgesia, nerve stimulator-guided femoral and proximal thigh (anterior and posterior) sciatic nerve blocks for lower extremity operations and the landmark-based ankle block for foot surgery. 

KATH anesthesiologist Dr. Anastasia Ohene and
2017/2018 RAAPM Fellow Dr. Patrick Laughlin
take part in a clinical skills examination

Publications & Resources

Division Publications

• Topics, Skills, and Cases for an Undergraduate Musculoskeletal Curriculum in Southern Africa: A Consensus from Local and International Experts. Held MFG, Laubscher M, Graham SM, Kruger N, Njisane P, Njisane V, Dunn RN; Learning Innovation via Orthopaedic Networks (LION) Group (S Khormaee) .J Bone Joint Surg Am. 2020 Feb 5;102(3):e10. doi: 10.2106/JBJS.19.00664.PMID: 31596812
• Motivations and impact of international rotations in low- and middle-income countries for orthopaedic surgery residents: Are we on the same page? Roberts HJ, Albright PD, Shearer DW, Won N, MacKechnie MC, Richard Coughlin R, Miclau T 3rd, Morshed S, Sabharwal S; COACT Resident Rotation Study Group (S Khormaee) .Am J Surg. 2021 Feb;221(2):245-253. doi: 10.1016/j.amjsurg.2020.08.046. Epub 2020 Sep 12.
• Consortium of Orthopaedic Academic Traumatologists: A Model for Collaboration in Orthopaedic Surgery. Miclau T, MacKechnie MC, Shearer DW; COACT group (S Khormaee). J Orthop Trauma. 2018 Oct;32 Suppl 7:S3-S7. doi: 10.1097/BOT.0000000000001288.
• Field evaluation of a prototype paper-based point-of-care fingerstick transaminase test. Pollock NR, McGray S, Colby DJ, Noubary F, Nguyen H, Nguyen TA, Khormaee S, Jain S, Hawkins K, Kumar S, Rolland JP, Beattie PD, Chau NV, Quang VM, Barfield C, Tietje K, Steele M, Weigl BH.PLoS One. 2013 Sep 30;8(9):e75616. doi: 10.1371/journal.pone.0075616. eCollection 2013.PMID: 24098705
• Brouillette MA, Kaiser SP, Konadu P, Kumah-Ametepey RA, Aidoo AJ, Coughlin RC. Orthopedic surgery in the developing world: workforce and operative volumes in Ghana compared to those in the United States. World J Surg. 2014;38(4):849-857. doi:10.1007/s00268-013-2314-0 
• Brouillette MA, Aidoo AJ, Hondras MA, et al. Anesthesia Capacity in Ghana: A Teaching Hospital's Resources, and the National Workforce and Education. Anesth Analg. 2017;125(6):2063-2071. doi:10.1213/ANE.0000000000002487 
• Brouillette MA, Aidoo AJ, Hondras MA, et al. Regional anesthesia training model for resource-limited settings: a prospective single-center observational study with pre-post evaluations. Reg Anesth Pain Med. 2020;45(7):528-535. doi:10.1136/rapm-2020-101550

Global Health Resources

GRACE Tools: View GRACE article