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Feature October-November 2003
Bringing Hope and Healing to Disabled Children

On the same day in July 2002 that US government officials met with leaders of Afghanistan to pledge to rebuild the medical infrastructure of their war-torn country, Dr. Scott Harrison was already on the scene-laying the foundation stone for a new clinic and surgical center in Kandahar.

The Kandahar clinic is one of the outposts in Harrison's far-flung campaign to bring hope and healing to the physically disabled children of the developing world. His mission is to seek out the poorest countries with the greatest medical needs, and establish and operate teaching hospitals in those locations.

The World Health Organization has estimated that there are as many as 125 million children in the developing world who are physically disabled and amenable to treatment. Yet priorities and resources of government health ministers in these nations are typically focused on diseases such as malaria and gastrointestinal ailments, not the ravages visited on children by hydrocephalus, spina bifida, and club foot.

"Kids with disabilities are way down the list," says Harrison, an orthopedic surgeon and businessman from Pennsylvania. Adding to the problem is that in many cultures, children with physical disabilities or deformities are stigmatized, and in some cases, abandoned, when families who are hard-pressed economically can no longer support them.

"The most effective money spent is in rehabilitation for these children," says Harrison. Treatment is not just a humanitarian issue, "it's an economic matter -- they can go from being a drag on society to being a productive member of society."

Harrison's hospitals provide the infrastructure and treatment to transform this forgotten and discarded generation into healthy, productive citizens. To date, the hospitals he has established in Kenya, Uganda, Malawi, the Dominican Republic, Honduras and Afghanistan have performed nearly 11,000 surgeries and provided medical services to another 40,500 outpatients.

Harrison and his wife Sally Harrison, a registered nurse, were first exposed to the urgent medical needs of disabled children when he was invited to Malawi in 1986 to perform spine surgery and teach orthopedic surgery to the medical professional nationals.

"The volume of patients was both overwhelming and in a strange way, exhilarating. That feeling emanated from the fact that I recognized I was doing so much good in such a relatively short period of time," he recalls. Returning frequently during the 1980s, the Harrisons "could not forget the overwhelming needs of the children."

In 1991, Harrison closed his medical practice and became CEO of Kirschner Medical, an international orthopedic company. A successful merger with another health sciences company permitted the Harrisons to put their time and resources toward the program he developed in response to his experiences in Malawi. The Harrisons founded CURE International in 1996 to bring that program to life, and provided the capital funding for construction of CURE's first hospital in Kijabe, Kenya.

CURE's international headquarters are based in Lemoyne, Pennsylvania, and its European headquarters in the UK. Possible future locations for medical centers include Vietnam, India, and Ethiopia. Harrison's ultimate goal is to place CURE hospitals in each country in the developing world.

Medical professionals who practice and teach at CURE hospitals include US and UK board-certified orthopedic and neurosurgeons, US pediatricians and specialists in physical and rehabilitative medicine, otolaryngologists and maxillofacial surgeons and clinical and specialty nurses. These doctors are all compensated, but their pay is a fraction of what they could make if they remained in their home countries.

In parts of the world where orthopedic surgeons are few or non-existent and national doctors have limited access to training and equipment, CURE has made a priority of transferring healthcare expertise to nationals in each location through intensive training.

The organization also forms strategic alliances with universities and university hospitals whenever possible.

Another hallmark of CURE's hospitals is a holistic approach to healing-tending not just to medical needs, but to social and spiritual needs of young patients and their families. Staff are encouraged to spend time talking to those in their care and getting to know them. A non-denominational faith-based organization, CURE offers a chaplaincy service at each of its medical facilities for individuals who request it. Patients receive culturally sensitive support geared to their own faith or spiritual traditions. Sally Harrison oversees the spiritual counseling services offered in CURE hospitals.

Until 1998, when the first CURE hospital opened in Kenya, there were no children's hospitals in sub-Saharan Africa dedicated to disabled children, and no trained pediatric orthopedic nationals in Kenya. To increase the capacity of Kenyan physicians, CURE has entered into a partnership with COSECSA, the College of Surgeons of East, Central, Southern Africa, to develop a formal training and degree program for national doctors working in CURE hospitals and other medical facilities.

In each country, CURE offers a different treatment focus for children. In Kenya, the focus has been on club foot, which in many cases condemns children to a lifetime of unemployment. The AIC Bethany Crippled Children's Center in Kenya has performed more than 140 surgeries to repair club foot, and within ten years, Harrison estimates that "every child in Kenya who has club foot can be cured."

In Uganda, CURE is focused primarily on the neurosurgical needs of children facing the life-threatening disease of hydrocephalus and neural tube defects. CURE's Children's Hospital in Mbale has established the world's largest study and training program for the effective treatment of hydrocephalus. The hospital has just established its first satellite pediatric neurosurgery clinic at the medical college and regional hospital at Mbarara, four hours southwest of Kampala.

The CURE outpatient clinic that opened in Afghanistan in August is expected to serve thousands of children in the coming year suffering from the effects of landmines, drought and war. When the required funds are available, construction will begin on a new 100-bed hospital, likely to be sited on a 12-acre compound donated by the Afghanistan Ministry of Health. Eye services and prosthesis development-a frequent need in conflict zones-will be offered in partnership with other organizations. Medical needs in Afghanistan are so great that CURE expects to be offering primary care for the next five years.

Comparative chart for cost of procedures
Corrective Procedure/ActivityCost in USCost at CURE hospitals
Clubfoot$5,000$50
Cleft palate$7,500$200
Burn contraction$12,000$100
Hip repair$22,000$400
Hydrocephalus/Spina Bifida repair$40,000$375
Tubercular spinal repair$45,000$1,000
Annual earnings for an orthopedic surgeon$350,000$50,000
Cost to operate a comparable
orthopedic hospital$40+ million$550,000
Cost per bed to build a comparable orthopedic hospital$1 million$25,000
Source: CURE International (September 2003)
CURE provides state-of-the-art healthcare for a fraction of what these services would cost in the developed world. For example, the average cost of surgery to correct hydrocephalus in the United States is $40,000, while treatment at a CURE hospital runs $375. Hip repairs that cost up to $22,000 in the US can be done for a mere $400 at CURE facilities. The cost per bed to build a comparable orthopedic hospital is $1 million in the US, compared to $25,000 in the regions where Harrison operates.

Given the scope of his ambitions for CURE, Harrison is actively seeking support beyond his current base of donors. One option CURE is exploring to help subsidize care for needy children is marketing sophisticated orthopedic procedures such as total hip and total knee replacements and sports medicine techniques to wealthy patients, from within the borders of the countries where CURE operates, or even from outside these regions.

CURE'S work has been leveraged by a variety of partnerships: USAID has assisted the hospital in Uganda by providing a CT scanner and other sophisticated neurosurgical equipment, hospitals throughout the US have donated excess medical equipment, and American pharmaceutical firms have provided free medicines.

The presence of Harrison's hospitals in regions with few resources has worked at a number of levels to add value to the health care infrastructure of those countries.

By raising awareness and insisting on adherence to best clinical and ethical practices in each of its facilities, "we are raising the bar and showing the local health care community that the bar can be raised and it will work."

To keep trained nationals in their communities and fight the "brain drain" that saps the developing world of its most promising medical talent, CURE offers practitioners competitive salaries that can help keep them on board and in their own communities. And the accreditation that CURE helps them obtain is recognized in their own countries but not easily transferable to the US or Europe.

As the reputation of CURE's hospitals begins to radiate out in their host communities, the success of the program's work begins to leverage on itself. "Eventually, we become the spokesperson for disabled children in a country," Harrison says.

The dynamic tension inherent in working in some of the world's poorest communities requires "knowing what is possible versus accepting what happens. The fringe benefits of being in countries where the outlook is so bleak is that you're starting from zero. Everyone takes such joy in succeeding."

The system of hospitals created by Harrison fills a much-needed niche. When he founded his organization, he said he was surprised to learn that no one else had beat him to it.

"These children represent not only an untapped resource to their country if treated, but more important…is the fact that the value a society places on those children who are the least among them are societies that ennoble themselves, as well as being a blessing to these children who are worthy of our care, common respect and love."


 
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