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Halifax loses a medical pioneer

Dr. Ivar Mendez is leaving Halifax for his next career step in Saskatchewan, but he’s also leaving behind a significant legacy.

Dr. Ivar Mendez, renowned neurosurgeon-scientist and founder of Halifax’s Brain Repair Centre, is leaving the city in June to join the University of Saskatchewan and Saskatoon Health Region. There, Mendez will serve as the unified academic head for all surgery in Saskatchewan. He’ll oversee the work of 170 surgeons around a province that has already taken significant steps in making its healthcare system more efficient. Saskatchewan has invested in more resources, including nurses, doctors and other healthcare professionals, and created more beds for both long and short-term patients. Mendez calls his new role “pioneering.”

“It’s a very unique position in Canada,” he says. “Saskatchewan has been working to reduce wait times for surgery. By next year, anyone who needs surgery will get it within three months. That is truly unheard of in Canada.”

Mendez arrived in Canada as a teenager with his family from his native Bolivia. He studied in Toronto, then Sweden and was recruited to Halifax from there. He recalls being interested in study of the brain from a young age.

“When I was a teenager, it fascinated me that organic matter—brains, cells, chemicals, electrical impulses—have the ability to imagine something that does not exist,” he tells Halifax Magazine. “The human brain can imagine things that do not exist. It can create the concept of God, of love, of self-sacrifice. That was so fascinating to me that I wanted to learn more about the brain. I wanted to study the brain and help people with brain problems. It’s an amazing thing, our mind. It has the capacity to do anything. And it still fascinates me.”

Dr. Mendez founded Halifax's Brain Repair Centre. Photo: Tammy Fancy

Mendez is no stranger to pioneering work. A decade ago he and his team took the foresight to create technologies they thought would shape the future delivery of neurosurgery and more. Mendez focused on three aspects: putting new cells in the brain to reconstruct its pathways; addressing brain-machine interfaces, that is how computers will work with organic systems such as the brain; and the use of robots and remote presence technology.

All three have had tremendous impact on brain repair and care here in Halifax and beyond. For the use of new cells in the brain, Mendez and his team created the “Halifax Injector,” an instrument that allows those new cells to be placed into the brain. One example of the success of this instrument is a Parkinson’s patient who took part in a study involving the Halifax Injector. New cells were injected into his brain and, five years after that surgery, he’s no longer on medication. The new cells in his brain are producing dopamine, the production of which is lacking in Parkinson’s patients.

The naming of the injector was no accident. “I felt Halifax, Nova Scotia, Canada have a strong track record of innovation,” says Mendez. “Our reputation around the country is that we are the backwaters of the country, where there is no innovation…but we are leaders and pioneers in the issues we are working on here.”

The creation of a brain-machine interface has met with equal success. A 13-year-old female patient with dystonia, a condition in which the brain makes the body’s muscles contract, almost into a constant state of charley horse, had two electrodes planted into her brain. Patients with this disease often suffer from malnourishment because of the extra energy expended from the constant contraction of muscles. This particular patient needed 24-hour care and rarely left her bed. Six months post surgery, she’s gained weight and can stand up. Now in her early 20s, she’s married with children and living a normal life. “We’ve been able to modulate those cells that we not working well. We were able to change the life of this kid,” says Mendez.

And finally, there are the robots and remote presence technology. Standing at about five feet tall and topped with a screen, the robots move around a hospital and operating room, guided by a physician who is behind a computer elsewhere—in the province, country or even overseas. The robots allow doctors to provide everything from basic care to surgery, particularly in remote or rural areas where doctors and health professionals are in short supply. All of the work is done in real time.

Today, the robots are in use in emergency rooms in Cape Breton, three are in Prince Edward Island and one is set to head to Yarmouth. There is one in the QEII in Halifax and Mendez calls it a “team member.” In all cases, he says its role fits seamlessly into the life and work of a healthcare setting.

“It’s amazing how naturally the patients react to this,” Mendez says. “Because they get the care when otherwise they wouldn’t get the care.”

Nain, Labrador was one of the first communities where Mendez sent a robot. But when he arrived to pick it up after a pilot project, the hospital staff became so enthralled and reliant on it, they raised their own funds to keep it. That robot is now like one of the staff. She even has a name: Rosie.

Mendez already sees where the technology is headed. A smaller, more portable remote presence robot called “Doctor in a Box” will help bring healthcare to where its needed most and immediately. All that is required is a cell phone signal to connect it with medical expertise anywhere. Doctor in a Box can be used by first responders who can work with a physician to perform procedures at the site of an accident. Remote communities that may not have easy access to transportation, but have a cell phone signal, can use it for everything from basic care to emergencies. It’s an easy technology to access even for the most remote communities; about 95 per cent of communities of the world have access to a cell phone signal.

Another technology Mendez is working on now is “virtual hands,” which allow a surgeon to perform operation via the robot in real time over great distances. The “hands” show up on the screen as a glowing outline, directing the surgeon onsite how to perform the procedure. Again, the work is pioneering. “Nobody else in the world is doing this,” Mendez says.

Many healthcare professionals and patients in Saskatchewan are already familiar with Dr. Mendez’s work. That includes Lois Berry, associate dean North and North-Western Saskatchewan Campus Rural and Remote Engagement at the University of Saskatchewan. Berry is a nursing educator who specializes in the training of nurses in remote and rural communities in northern Saskatchewan. The problems in these communities are not unlike those in other rural and remote areas across the country: inaccessibility, shortage of staff and problems with delivery of care. But when her colleague, Lorna Butler, professor and dean of the College of Nursing, saw one of Dr. Mendez’s remote presence robots in action during a conference, a light bulb turned on.

Butler realized the robots could be used in the training of nurses in remote and rural communities in Saskatchewan. Now in two communities in the northern and sparsely population part of the province, student nurses train onsite with professors who are teaching via the robots. There are registered nurses on site, too, assisting with the training. Together, Berry says, having the on-the-ground practitioners with the academics via the robots offers a unique synergy for nurse training.

“It allows our professors to share their expertise in those communities, teach the students directly and we’re using it for the teaching of the basic nursing skills, so our instructor in the remotely moves around the lab, mentors and coaches the students that way,” Berry says.

She’s even seen how comfortable the students have become with the robot. At break time during a recent class, one student stopped to ask the professor who was teaching via the robot if she wanted coffee.

Berry speaks highly of Mendez’s work, having seen it in action. She says what he does is not the way of the future—it’s solving healthcare problems now.

“He’s a very rare physician, in that he has highly specialized technical skills, but he has clear understanding of what it means to deliver basic nursing care to vulnerable people,” she says. “That is a unique combination. It’s exactly what this country needs, physicians to have that kind of vision. He just gets it. And not just that he gets it, he does it. He doesn’t sit back and wait for someone else to do it.”

Mendez also does extensive humanitarian work, especially in his home country of Bolivia. He’s the founder of the Ivar Mendez International Foundation, whose work focuses on building human potential in the Bolivian Andes. Particular programs focus on nutrition, health and education. One project undertaken by that organization is the creation of nutrition bars made from quinoa, a super food that grows in Bolivia. About 5,000 children are helped through the Foundation.

He’s also a skillful artist, particularly in sculpture and photography. He shares the love of the art via his Foundation. Its arts program, which is sponsored by Nova Scotia artist Joy Laking, has children in the remote communities in the Bolivan Andes learning basic techniques of water colours, oil and acrylic painting, as well as sculpture and ceramics.

“I hope that out of the 5,000 children, one, two or three will be the leaders of the future because they had the opportunity to have a brain they can develop,” Mendez says.

While all of these works appear to have nothing in common, for Dr. Mendez they all serve the same purpose: to help the brain. Food to nourish it; creativity to help it grow; and new cells, interfaces and robotics to repair it.

“If you are malnourished in the first five years of your life, you’re never going to be able to develop the potential of your brain,” he says. “You’re already handicapped.”

He says he knows firsthand how art can inspire science.

“The creative of being an artist helps me be creative as a scientist,” says Mendez, adding that working in a field where he deals with life and death also helps with his art.

When he arrived in the city 18 years ago, Mendez says his decision was questioned by colleagues and mentors. But looking back, he says he’s very pleased with his work here. “I was able to build a vision from scratch,” he says. “I am very proud of what we’ve accomplished here in Halifax. I have a spiritual connection to Nova Scotia. I truly consider myself a Nova Scotian.”

Mendez says his legacy to Halifax is threefold. First, the city now has a clinical and academic structure he says, “matters to the average individual on the street.” Prior to his arriving here, patients needing brain surgeries or treatment had to go to Toronto, Boston or Montreal. Now, they can stay closer to home. Halifax, he says, has become a “centre of excellence” for such care.

Secondly, he says he hopes he was a role model to his students and taught them not just to be researchers and physicians, but to understand the importance of the arts and humanitarian projects. “Being a creative individual, a humanitarian, makes you a better physician,” he says.

His final legacy is more tangible in the form of the Brain Repair Centre on Summer Street, a $66-million project whose benefits go well beyond the science taking place in its labs. Mendez, who founded the Centre, wanted the building to be full of light and have a design that was open and welcoming. Its purpose is to allow people to communicate. He says the five-story bright foyer is just as important as any of the technology used in the building, and that treatments and cures are often more about people, too. “The real innovation comes from the generation of ideas when people communicate,” Mendez says.

Mendez says what he will miss most about Halifax are the patients he’s worked with over almost two decades in the city. They came to him from around Atlantic Canada, and in many cases, their lives have been changed forever and for the better. Since news of his next career step in Saskatchewan was announced, he says he’s received hundreds of emails, cards and letters from former and current patients.

“I am very fond of the nature and gentleness of Maritimers,” he says. “I have so many good memories of my interactions with patients here.”

He plans on keeping in touch with them using, appropriately enough, the robots he created here.

“Technology has allowed us to work in real time and have meaningful interactions with patients,” he says. “Distance is not that relevant anymore.”

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