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Development of a successful international outreach program: Project Health Cape Verde, a 501c3 nonprofit
Sally Tan, BS1, Alexander Cole, MD2, Briony Warda, MD2, William Dewolf, MD3, Anurag K. Das, MD3, Michael Kearney, MD3.
1Harvard Medical School, Boston, MA, USA, 2Brigham and Women's Hospital, Boston, MA, USA, 3BIDMC, Boston, MA, USA.

Background
We present a model for a successful international outreach program developed at our institution over the last six years. We discuss the factors, some unique to our local circumstances, that helped initiate the program and how others may learn from our experience and start similar but unique rewarding experiences. Cape Verde is an island nation 350 miles from the West African coast. Since the country has only one urologist serving its entire population of half a million, the well to do get their care in Portugal and America while others have a difficult time receiving appropriate urologic care. A large immigrant community of Cape Verdeans exists in Massachusetts and their discussion of the lack of urologic care in Cape Verde led to our outreach program. Over time Project Health CV a 501c3 nonprofit has grown and addressed four objectives:
1)
Expand access to urologic care
2)
Train local providers in the treatment and prevention of urologic diseases
3)
Establish a research platform to develop best-practices in urologic care for resource-limited settings
4)
Expose surgical trainees to providing care in the global health setting
Methods
Starting with an initial visit to provide urologic care, an expanding team now including urologists, gynecologists, general surgeons, anesthesiologists and medical interpreters from Beth Israel Deaconess Medical Center (BIDMC) in Boston, MA provided clinical care and training at two hospitals in Cape Verde on 8 visits from 2010-2015. Interviews were conducted with 9 clinical staff to elicit health delivery barriers specific to this setting. Surgical case logs were maintained to measure clinical productivity and training was performed for local providers in basic urologic care.
Results
Since 2010, BIDMC surgeons in partnership with Cape Verdean physicians have treated a total of 1654 patients and completed 77 operations, including the nation’s first transurethral resection of the prostate.
Three Cape Verdean surgeons have been trained in 15 procedures, and 3 of them have completed a surgical training course at BIDMC. Likewise, 14 surgeons from BIDMC have volunteered in Cape Verde and gained valuable training in operating within a resource-limited setting.
During this time, outpatient urological visits in Cape Verde have increased by 56% from 2009-2013. The number of urological surgeries performed each year has decreased by 27% due to the focus on training local physicians
Project Health CV recently launched a new research platform to address on-going issues of access, affordability, and quality in Cape Verde addressing issues such as task-sharing, maintaining complex urologic equipment, and educating primary care physicians.
Conclusions
Project Health CV demonstrates how through creation of a 501c3 non-profit, members of an academic medical center can provide subspecialty surgical care in a resource-limited setting and simultaneously train local providers to sustain this type of care. Our outreach program provides valuable care and also fosters cooperation and goodwill between immigrant Cape Verdeans in the US and our AMC. Future efforts will expand urological training in Cape Verde, invest in urology infrastructure, and increase public health awareness about urological problems.


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