If Aikaterina Siganou, 46, had re-mained in Greece, doctors esti- mated her chances of surviving her brain tumor at one percent. Instead, she traveled halfway around the world to Morgantown and West Virginia University Hospitals. After a seven-week stay, she flew home with 95 percent of the tumor gone.

West Virginia University Hospitals (WVUH) has earned a reputation in West Virginia, the United States, and increasingly around the world, as an excellent health-care provider. The superior medical technology and techniques available attract patients from far beyond our borders. In 2003, WVUH treated patients from every county in West Virginia, 49 U.S. states and the District of Columbia, and from many different nations-including Italy, Belarus, Honduras, Greece, and Israel.

Breakthrough Procedures
Patients are drawn to WVU by the technology and the level of patient care. However, it is the reputations of the doctors that impress their physicians.

"In Greece, we just don't have the equipment that she needs to live," said Aikaterina Siganou's daughter, Nadia, who accompanied her mother on the trip. "Our doctor in Greece told us we could choose between two doctors: one in Germany and one here. We preferred WVU because we heard that it is the best in the world. Our doctor knew Dr. Fukushima. He told us that he's the best."

According to Nadia, the difference in her mother as a result of the surgery is remarkable. Plagued by headaches, Aikaterina was barely able to walk or stand. During the 14-hour flight from Greece to Pittsburgh, Pennsylvania, she lost her ability to speak. "She was essentially a quadriplegic by the end of the flight," said Dawn Molnar, international patient coordinator.

The star of WVUH's neurosurgery team is Takanori Fukushima, MD, an internationally renowned neurosurgeon. He is so renowned, in fact, that both the procedure he developed and the delicate instruments used to perform it bear his name. Called keyhole surgery, or the Fukushima dime operation, the procedure involves a five-millimeter incision at the base of the skull instead of the large, open-brain procedures that were used previously.

Skull-base surgery is one of the most challenging procedures a neurosurgeon can perform. The skull base is the bone surface that the brain rests on. This area contains the major blood vessels that supply the brain, as well as the pituitary gland, the brainstem, and the cerebellum. The brainstem is the connection between the brain and the spinal cord, and contains the beginning of the nerves involved in controlling breathing, blood pressure, eye movement, and more. The cerebellum is responsible for coordination and balance.

Dr. Fukushima spends about a week per month at WVU, dividing the rest of his time between the Carolina Neuroscience Institute in Raleigh, North Carolina, where he is the director, Duke University Medical Center, where he is also a professor of neurosurgery, and other hospitals around the world.

Each member of the neurosurgery team has his or her own specialties within neurosurgery, and their expertise is also recognized. Julian Bailes, MD, is the chair of the neurosurgery department, and specializes in cerebrovascular surgery, sports injuries, and telemedicine. John Collins, MD, is the chief of the pediatric neurosurgery section. Warren Boling, MD, heads the epilepsy surgery program.

Finding a Kosher Chicken
While most international patients so far have sought the expertise of the neurosurgery team, WVU has a growing international reputation in several fields. Cancer treatment, heart surgery, eye care, and advanced medical imaging are helping to attract patients from around the world.

Dawn Molnar, the international patient coordinator, works hard to meet the needs of all patients—and their families. "I do a lot of independent research," Molnar explains. "In addition to meeting their medical needs, we strive to meet cultural and religious needs as well."

According to Molnar, about one-third of the patients who have come to the hospital from out of the country arrive from Israel. "I know where to get a whole kosher chicken, and there are companies that will ship a week's worth of kosher meals here packed in dry ice," she continued. "From sundown on Friday until sundown on Saturday, Orthodox Jews cannot ride in an elevator, use an automatic door, or even carry keys or money. It takes a lot of preparation to be in a state-of-the-art health-care facility like this without breaking the Sabbath. The main doors of the hospital are triggered by an electric eye, and the most direct route to the living area of Rosenbaum Family House is via elevator. We actually do a walk-through of how they can get to the hospital from the Family House without violating their customs."

"Meeting all of the patients' needs is a true team effort," Molnar adds. "All of the hospital departments, from nursing to nutrition and environmental services, have to work together so we can discharge a healthy, satisfied patient."

International Connections
It's not just patients who are traveling to WVU from across the globe. In October 2003, WVU hosted two international conferences, attracting approximately 50 physicians from several countries.

"Conferences like these give international experts the opportunity to learn from each other," Molnar said. "They also give physicians the chance to see what we have to offer their patients."

A case in point is Panoraia Balatsa, from Karpenisi, Greece. The physician who referred her to both WVU and Dr. Fukushima attended the October conferences, according to Molnar. "The conference allowed us to develop a more personal relationship," she said. "Developing personal relationships is very important, in terms of bringing patients to WVU and saving lives. It is the difference between sending a patient to a stranger and sending a patient to someone you consider a friend."

Balatsa will be able to get the care she needs, because in Greece, everyone has the same level of insurance. For a patient to come to the United States for surgery, strict criteria must be met, but the costs will be reimbursed to the family by the state-run insurance system.

West Virginia University Hospitals does not accept international insurance, but it will submit paperwork so the patients' insurance will reimburse them. Patients from overseas must pay prior to their arrival, and Molnar says some families mortgage their homes, sell belongings, and take out loans to pay the bills.

"Health care is an export, just like steel or cars," says Gary Murdock, vice president of planning and marketing for WVUH. "This money coming into the state and the hospital allows us to provide a higher level of services than this community might otherwise be able to support."

Compassion for Children
Just as the hospital provides care for those in West Virginia who are unable to afford it, help is also given to the international community. Robert Gustafson, MD, has performed cardiac surgery procedures on four children from Nigeria, ranging in age from one to 13 years old. These cases are performed as charity care, brought to WVUH by the International Health Care Fund.

These children have congenital heart diseases that cannot be treated in Nigeria. "These children would not survive if they did not come to the United States for care."

Gustafson has also operated on two children from Belarus and one from Honduras, also as charity care provided by the hospital.

"The majority of their health care is paid for by the hospital," said Tina Slusher, MD, who works closely with the program. "Their nonmedical costs, which include travel, family accommodations, travel documents, and medicine and equipment for use once they return home, are underwritten by churches and service organizations, such as Rotary International."

Translating Hope
While coming to WVUH for care provides hope, it also means that many of the patients and their families are unable to communicate. The hospital's Language Line Interpreter Service (LLIS) translates their questions, concerns, and even daily meal choices.

"It is incredibly hard to travel thousands of miles for medical care, but to not speak the language makes it much, much worse," Molnar said. "Having a loved one in the hospital, facing a life-altering procedure is hard enough when you speak the language and are surrounded by friends and family for support. The LLIS allows us to communicate with both the patients and the families."

The service is staffed by certified medical interpreters, and provides interpreters for 140 languages. The interpreters are obligated to respect patient confidentiality.

"Even in a diverse community like Morgantown, it can be hard to find someone who speaks some languages," Molnar stated. "And when doctors, patients, and families need to talk about medical procedures, it is better to have a certified medical translator. These translators are available at the other end of a phone 24 hours a day, seven days a week."

Patients—and their families—say the care they receive at West Virginia University Hospitals is excellent. John Souferis traveled from Chicago to assist his cousin Haralambia while her husband Giorgios Giannakopoulos had surgery to remove a brain tumor. Souferis was very impressed by the care his cousin-in-law received. "I have been here for eight days," he said. "I think it is the people that make the facility; what they do complements the process. I am amazed at the staff here. They are a gift from God."

Patients and families like these are the best referral there is, Molnar says. "Word of mouth [is powerful], as patients and their families return home and tell others that there is hope. I have gotten faxes from patients themselves who have learned about us from a friend of a friend of a friend."

Providing some of the best health care in the world is the goal of West Virginia University Hospitals—as patients coming from Athens, West Virginia, or Athens, Greece, are discovering every day.

Summer 2004 Contents

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