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AANS Neurosurgeon | Volume 28, Number 3, 2019

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Project Shunt: Dr. Karin Muraszko’s Global Legacy

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Within the global neurosurgical community, Karin M. Muraszko, MD, FAANS, is a source of inspiration as a leader who emphasizes outstanding patient care. In addition, during her tenure at the University of Michigan, Dr. Muraszko developed and led Project Shunt, medical work in Guatemala that provides neurosurgical education and treatment.

The Beginning

In 1996, Dr. Muraszko was approached by the Michigan chapter of Healing the Children. Their goal was to determine the optimal way to treat the high rates of myelomeningocele in Guatemala. At the time, Dr. Muraszko was the only pediatric neurosurgeon at the University of Michigan. While she felt compelled and excited to be involved, she wanted to ensure that this program was done properly. The volume of children requiring treatment necessitated that the interventions be performed in Guatemala, rather than treating the patients in the U.S. To do this, she defined two parameters:

1) What procedures could be performed with limited resources

2) What facilities could be utilized

She and her team planned their first exploratory trip in 1997.

When Dr. Muraszko first arrived in Guatemala, her team was provided a single room with a sink that had occasional water and one overhead light to serve as their “OR”. She determined that it would be best to first focus on treating pediatric patients with tethered cords. There was a large demand for this operation and it was a procedure that she felt comfortable doing with their limited resources. For Dr. Muraszko, this was simply a starting point.

Care Expanded

To provide the full scope of procedures that the Guatemalan pediatric population needed, Dr. Muraszko’s team would need to bring additional medical and surgical equipment. To do this, she partnered with Delta Airlines to aid in the transportation and a local radiology group donated a portable MRI machine, which allowed the team to acquire a few slices – enough for diagnosis and surgical treatment needed. With the resources secured, the team developed what they felt was a sustainable model for providing one week of high quality pediatric neurosurgical care:

  • See 75-100 patients in clinic on Sunday;
  • Operate Monday through Thursday; and
  • Reserve Friday for follow-up and last-minute procedures.

Sustainability

In 2020, 23 years since the initial exploratory trip, Project Shunt continues to travel annually to Guatemala. In recognition of the need for sustainable local neurosurgical care, independent of Dr. Muraszko and her team, she has widened the scope of Project Shunt to provide training to local surgeons and providers. Dr. Muraszko has now performed over 400 spinal operations with Guatemalan general surgeons; many of these surgeons are now proficient at performing in these cases independently. This has allowed Dr. Muraszko and her team to focus on more complicated procedures, such as endoscopic third ventriculostomies.

Guatemalan nurses, medical students and surgical trainees from four different hospitals participate in the clinics and operating rooms during the one-week trip. This allows local providers to learn the ins and outs of long term neurosurgical patient care and management. Moreover, U.S. residents who have had the opportunity to accompany Dr. Muraszko learn the valuable skill of operating in a resource-limited environment, pushing trainees to become efficient and think more critically about how to solve operative problems.

One of the most important factors Dr. Muraszko attributes to her success is having a strong partnership with the country itself. She recognizes the importance of being aware of and respecting cultural differences in order to earn the trust and support of those they are trying to help. In doing so, she has been able to empower the Guatemalan community to independently manage and care for many neurosurgical patients. Now, as she reflects back on her experiences, she realizes how much she has personally grown from her experiences in Guatemala. While she and her team are exhausted, they are simultaneously overjoyed to be doing their jobs for some of the kindest and warmest people they have ever met.

More information about Project Shunt: https://medicine.umich.edu/dept/neurosurgery/projectshunt

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