Butterfly Foundation in the News

Surgeon’s nonprofit group gets kids needed scoliosis surgery

Orthopedics Today (April 2006)
By Susan M. Rapp


At a time when most young orthopedic surgeons are still getting established in their practices, Andrew W. Moulton, MD, 37, spends much of his time in the Dominican Republic. But don’t get the wrong idea – he is working just as hard down there are his colleagues in the United States.

The difference is, that in addition to practicing spine surgery at Westchester Medical Center, Valhalla, N.Y., Moulton devotes a lot of time and energy to teaching surgeons in developing countries how to operate on children with severe, life-threatening cases of scoliosis. He does that mostly in the Dominican Republic where he operates a rotating scoliosis surgery service, depending on where the greatest numbers of patients are that need treatment, and he travels there every few months.

Moulton has also worked with surgeons in Malawi, Chile and Jamaica and is developing similar programs in Vietnam and Laos.

He decided early in his career, after he took part in a clubfoot clinic in Honduras, that such humanitarian work was his calling. “I had interest in doing volunteer work and teaching, in particular,” Moulton told ORTHOPEDICS TODAY.

But what sets him apart from the many other orthopedic surgeons with similar interests is that he acted on the idea and continues to do so.

Although the volunteer work Moulton does is challenging and time consuming, he’s not in it alone. To help with the effort, he established the nonprofit Butterfly Foundation or Fundacion Mariposa in 2003 with his wife, Geraldine Collado, who is Dominican, and the support of his mentor, Thomas J. Errico, MD, New York University Medical Center, New York.

Moulton takes care of the surgical end of things, like coordinating surgical teams for the trips and planning the operations. “We’ll bring teams of 20 plus people, everyone from neural monitoring to blood recycling,” he said noting that much of the equipment is stored locally.

Collado, “who has good ties there, having worked in television for many years as the Dominican Oprah, is responsible for managing daily functions in the Dominican Republic, like customs, hotels, drivers, watching out for all sorts of snags in publicity and local politics,” Moulton explained. Foundation administrator Carmen Bartholomew handles financial and accounting activities and legal matters through pro-bono work by Hagop J. Markarian EA and Gibson, Dunn and Crutcher LLP.

In addition, orthopedic device manufacturers like Medtronic Sofamor Danek and Stryker support the mission with needed implants, instrument sets and medical supplies. Technical support from Seth Wax and Spinal Associates who have rallied behind the program has been vital. Materials coordination from drills to Cobbs has been handled by Crown Prince. Francisco Valdez, MD, a prominent orthopedic surgeon in the Dominican Republic, has guided them through many of the complexities of the countries medical and political challenges. “Their experience has been indispensable every step of the way.”

What he thinks makes his program different from other charitable missions is the conception which the foundation was based: By teaching local surgeons to do the scoliosis procedures – and there are three in the Dominican Republic working full-time on this project who keep the service running – “you’re kind of teaching them how to fish instead of giving them fish,” Moulton explained. Eric Rosario, MD, keeps the service running full time and has become one of the more skilled deformity surgeons in the Caribean.

“I never thought I would be able to teach spine surgery in a developing country, because it’s complicated. The work itself can be dangerous, and it requires a certain environment as far as equipment, implants, cell savers…and fortunately, we’ve been able to develop this. We have in one way or another had donated or arranged everything we need, and we run a pretty sophisticated project right now.”

Genetic component

In the process, Moulton and colleagues Sameer Mathur, MD and Andrew Merola, MD, have pursued a genetic marker for the severe cases of scoliosis he sees in Dominican children, where many more children than the typical 3 in 1000 need surgery. The hereditary type of scoliosis that occurs there, Jarcho-Levin syndrome on spondylocostal dysplasia, causes the ribs to fuse and the surgical treatments to be that much more complicated. The whole rib cage can be twisted around. It’s very severe and it can cause pulmonary complications and paralysis. It’s relatively common in the Dominican Republic more so than anywhere else probably,” Moulton said.

To study this further, on his trip there this January he took blood samples for the genetic testing that is now being done at the University of North Carolina. Results could lead to counseling children and their parents with that rare type of deformity about the nature of their disease or helping Dominican children figure out whether they are at risk for Jarcho-Levin syndrome.

Why did the foundation adopt the butterfly concept? It started when Moulton was dating his wife. He called her his little butterfly or “mariposita” in Spanish. Later, the name seemed fitting for the new foundation they started together. Because of their society’s attitudes toward their deformity, “we saw how these kids would come in, sort of bundled up, socially withdrawn, embarrassed, almost outcast. …Once they have their surgeries and they come back, they’re standing up straight and they’re very bright-eyed and smiling,” Moulton said.

He notices the greatest change in the girls. They gain confidence and become “almost flirtatious, with colorful clothes on and very outgoing. It kind of reminded us of butterflies.”

Moulton’s next longest running program is based in Malawi, one of the porrest countries in the world, he said. “Obviously, health care goes neglected. There are a lot of people trying and doing their best, but when it comes to spine surgery, that’s sort of lower on the schedule.”

Moulton’s next trip Malawi is scheduled for April 29 to May 7; he goes there twice a year. He is working closely with Nyango Nkandawarie, MD. Nkandawarie’s strong ties throughout southeast Africa bring many of his colleagues and residents to Malawi for the experience.

As chair of the North American Spine Society’s SCRUBBS (spine care relief united beyond borders) program, Moulton advises many other groups working on similar projects. He is also a member of the Scoliosis Research Society advisory board.

Butterfly Foundation


With the Butterfly Foundation, Dr. Moulton and his colleagues teach spine surgery in communities that need it around the world. See a short, introductory video, then learn more about the foundation below.

Video Documentary

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