Meet Dr. Cross
Russell Cross is an attending in the divisions of Cardiology, Telemedicine, Cardiac Imaging, the Fetal Medicine Institute, and Children’s National Heart Institute. He currently serves as the Director of Cardiac MRI, and has been at Children’s National for over twenty years. He began his education with a Bachelors of Science in Electrical Engineering at the University of Texas at Austin, and completed a Masters in Biomedical Engineering at the University of Texas Southwestern Medical School. Deciding that his interests lay more in providing clinical care, Dr. Cross returned to the University of Texas Southwestern Medical School for his medical degree. He went on to do his residency training in pediatrics at the University of Texas Medical School at Houston and his fellowship in pediatric cardiology here at Children’s National. Dr. Cross has also long been interested in utilizing his medical expertise to give back to the global community, and has focused his global outreach efforts in Bolivia and Haiti.
Dr. Cross attributes his interest in global health to watching his colleague in pediatric cardiology, Dr. Craig Sable, travel repeatedly to communities in Latin America and sub-Saharan Africa providing cardiac care and making sustainable improvements to care access and sophistication. Dr. Cross decided to accompany Dr. Sable on one such trip to Bolivia, thus beginning his global health work. On this first trip to Bolivia, the objective was “to determine the feasibility and the openness of the government and (local) providers to US providers coming in and providing care as well as working to advance the current care standards available,” recalls Dr. Cross. While Bolivia has a reasonable infrastructure capacity for treating patients with heart disease, there were only six cardiologists in the whole country, and “while they have a lot to offer, it was really only offered to people who could pay for it,” adds Dr. Cross. Travelling twice to Bolivia with Dr. Sable, Dr. Cross remembers the experience as very educational, but regrettably “the group wasn’t really able to do anything further” as a result of pushback from the Bolivian government.
Following his experiences in Bolivia, Dr. Cross was recruited by Dr. Robert Freishtat, currently Chief of Emergency Medicine at Children’s National. Dr. Freishtat travelled to Haiti almost immediately following the magnitude seven earthquake in 2010 to provide medical relief. Travelling back six months later, Dr. Freishtat recruited Dr. Cross and another cardiologist, Dr. Anne Greene, to come with the group and aid in the development of a new cardiac program at the Hôpital Sacré Coeur in Milot, sponsored by the CRUDEM foundation. “That experience was totally different from the Bolivia situation,” remembers Dr. Cross, “there was no infrastructure, we saw a lot of kids, did a lot of (echocardiograms), and made a lot of diagnoses, but there was nothing further we could do.” It was a frustrating experience to be able to identify what was harming a child and not being able to correct it. Given the lack of necessary infrastructure to provide the foundation for improving care, Drs. Cross and Greene wrote a letter to the foundation that funded the trip. “Basically (we) said we don’t think this is the right stage for congenital heart disease work to be done,” says Dr. Cross, “there was nothing we could do aside from make diagnoses, we couldn’t do any surgery.”
Returning to Haiti with the United Nations to provide medical care, Dr. Cross remembers, “there were so many things we could do that were a greater priority than heart disease.” In addition to the destruction of what little infrastructure Haiti had, “the story I am told,” recalls Dr. Cross, “is there was a medical meeting going on in Port-au-Prince, and the building was destroyed in the earthquake…many providers who had attended the meeting died, as well as the country’s main medical organizers.” Given this tragic combination of factors, things were not looking good for healthcare in general in Haiti, let alone the expansion of pediatric cardiac care.
However, in 2013, the Partners in Health organization, co-founded by the legendary global health physician Paul Farmer, established the Haiti Cardiac Alliance (HAC). “The goal of the (HCA) is to try and ensure kids who need access to cardiology care have access to it, so rather than just allowing the kids around port-a-prince to have this access they were hoping to build a referral system for kids around the country,” describes Dr. Cross. The advent of the HAC meant there would be an organization developing the infrastructure necessary to support cardiac surgery and treatment, so pediatric cardiac care would no longer end at a diagnosis. While Dr. Cross had been providing consultation to a cardiology group at the hospital, this critical systems development “was the point where we were like, ‘let’s get this running,’” he remembers.
Currently, Dr. Cross travels once or twice a year to Haiti with Dr. Freishtat as well as a physician from Northern Virginia and a physician from Pittsburgh. “We go down there and split clinical rotations,” says Dr. Cross. “Our model now, our goal, is evaluating kids mostly by telemedicine and talking with the doctors there (who do physical evaluations).” This consultation has helped get children with cardiac conditions properly diagnosed and submitted to the HAC system so they can receive surgery. So far, they have“identified over 20 kids who have been able to have surgery as part of this program over the last 4-5 years,” recalls Dr. Cross. “Probably every patient who gets surgery is a success story that wouldn’t have happened if we weren’t reading echos,” says Dr. Cross, however, “one of the things that I have to remind myself of is, it’s so easy for me to sit here at my computer and read an echo but that’s just the beginning of a huge amount of work for the people who are (organizing and performing the operations).” While there are times that, sitting in a temperature controlled office in Washington, Dr. Cross feels like his contribution is “just a drop in the bucket,” it’s the success stories, those over 20 kids who have gotten surgery, that reminds him of the importance of his role, and motivates him both to continue this work and to more appreciate his job at Children’s National.
Moving forward, “the hard part now is sustainability,” he says, “looking at (Dr. Sable) as the role model…he was so successful because he was able to partner with the local providers and help them to develop (their treatment capacity).” “We don’t have that in Haiti,” he adds, “there is only one person in Haiti who is finishing her pediatric cardiology fellowship, so right now that’s our next hurdle, how do we help the local people be able to build their care capacity?” Unfortunately, the infrastructure hasn’t sufficiently advanced to make this a realistic goal, however, “there are more and more people (getting) involved over time,” and “though right now it seems like there is very little we can do on the ground to help, knowing in the future we will be able to do more, that keeps me going.”