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an online version of the magazine Fall 2009

Cast Out in Tanzania

Class Notes
Wilkinson works to heal the wounds of childbirth.
Photo courtesy of Jeffrey Wilkinson

Wilkinson brings hope to suffering mothers in Africa.


The countryside of Tanzania is beautiful, often spectacular, the population enchantingly friendly. The health conditions are horrific.

Maternal mortality ranges from 578 deaths per 100,000 live births (according to Tanzanian officials) to 950 deaths per 100,000 births (World Health Organization). Some 53 percent of women deliver at home, cared for by a traditional birth attendant or a relative. Many deaths go unreported.

A key factor in these mind-numbing figures are the prolonged, obstructed labors endured by impoverished young women—some barely teenagers—who suffer internal wounds during the ordeal, resulting in vaginal or rectal holes known as fistulas through which urine or stool constantly oozes. These women often become outcasts because of the condition’s accompanying odor.

Addressing this problem—which afflicts an estimated 2 million women and girls in sub-Saharan Africa and Asia—has been the mission of Jeffrey Wilkinson ’93, a urogynecologist and obstetrician on the faculty of Duke. He has been living in Tanzania since July 2008, collaborating with physicians at the Kilimanjaro Christian Medical Center (KCMC). Working there and traveling the countryside, he has performed dozens of fistula-repair operations. "Fistula is the thing to follow," Wilkinson told The New York Times last winter. "If you find patients with fistula, you’ll also find that mothers and babies are dying right and left."

The Duke/KCMC women’s health project aims to train hundreds of providers in emergency obstetric care, and dozens of residents and students, in OB/GYN surgery, clinical care, and research, explains Wilkinson. He became interested in women’s health as a protégé of Hopkins’ Jean Anderson, who is director of the Johns Hopkins HIV Women’s Health Program, which she founded in 1987.

Wilkinson is determined to make an impact despite the daunting difficulties in Tanzania: The KCMC is the referring hospital for 11 million people and does not even have such traditional painkillers as morphine. "Our fistula patients are so full of hope and laughter despite Jobian levels of suffering. Each day they inspire me to keep working." star


Neil A. Grauer



Instrumental Healing

Class Notes
The Charness Family Quintet has produced five CDs.
Photo courtesy of Michael E. Charness, M.D.

Charness focuses on ailments afflicting musicians.


Like professional athletes, musicians sometimes play through pain. Unlike most athletes, however, many musicians don’t know how to avoid injury or obtain treatment for playing-related maladies—the pinched nerves, strained muscles, tendinitis, and other afflictions that are caused or exacerbated by the repetitive movement and awkward positioning required to make an instrument sing.

Michael Charness ’76, founder and director of the Performing Arts Clinic at Brigham and Women’s Hospital in Boston, is one of the country’s leading specialists in a relatively young field that focuses on fixing—and avoiding—such ailments. Charness—a professor of neurology and faculty associate dean for Veterans Hospital Programs at the Harvard Medical School, assistant dean at Boston University School of Medicine, and chief of staff of the VA Boston Healthcare System—has spent the past 20 years specializing in the care of instrumental musicians with hand problems.

A pianist since childhood, Charness continued playing classical music during his medical student days at Hopkins, often practicing at nearby Peabody Conservatory. As a neurology resident at University of California, San Francisco, he practiced up to three hours daily—and began to notice his hands becoming less responsive. Neurology colleagues couldn’t find anything wrong. Fortunately, a neurosurgeon in Charness’s chamber music trio diagnosed bilateral ulnar nerve entrapments—a condition that non-musician neurologists wouldn’t necessarily suspect. He operated successfully on Charness to fix it in 1984.

"I became interested in the fact that musicians can be disabled by very mild neuromuscular impairment," recalls Charness. "Within a few years, I was seeing musicians from all parts of the country, still at the back of my lab at UCSF," he recalls. "It wasn’t until I moved to Boston in 1989 that I was able to establish a clinic in a separate location."

Over the past two decades, Charness has treated several thousand musicians who have played everything from double basses to bagpipes. And music has remained an important part of his own life. He and wife Deborah Nathan, a professional flutist, have raised three highly accomplished musician children. Beginning in 1993, they performed as the Charness Family Quintet—with Sarah, now 24, and Jenny, 19, on violin; Daniel, 22, on cello; Deborah on flute, and Charness at the piano. They’ve produced five CDs of their work (www.charnessfamily.net).

"We used to perform about 20 concerts per year until the kids grew up and moved away," Charness says. "We continue to perform in various combinations about a half dozen times per year, but the logistics are very challenging." star


Neil A. Grauer

 Take Two Carrots and Call Me in the Morning
 Judgment Day
 Circling the Dome
 Medical Rounds
 Annals of Hopkins
Class Notes
 News from and about graduates.
 Learning Curve
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© The Johns Hopkins University 2009