Metamorphosis of a Foundation
Andrew and Geraldine Moulton began by trying to help a few kids. Three years later, their Butterfly Foundation is performing surgeries and training orthopedic surgeons around the world.
A chance encounter on a New York street corner 3 years ago was the catalyst for what today is an international foundation for spinal-deformity surgery. How Andrew Moulton, MD, and Geraldine Collado (now Mrs. Andrew Moulton), cofounders of Butterfly Foundation, got from point A to point B is a confluence of the extraordinary dedication of the couple and their colleagues, their own unique backgrounds, the generosity of a key corporate sponsor, and, finally, knowing how to make the most of relationships with the right people. All in all, it provides a blueprint for how a physician or a medical practice can establish a nonprofit foundation of their own.
Butterfly Foundation, with offices in Dominican Republic and New York City, gathers and facilitates the medical personnel, equipment, and supply resources required to put together comprehensive spinal surgery teams to treat patients with severe spinal deformities, who otherwise would not receive surgery. If helping disadvantaged children is one part of the foundation’s mission, the other is training physicians, largely in third-world countries, in the latest spinal surgery techniques.
It all began in 2002 when the Moultons literally ran into each other at an intersection in Manhattan. At the time, Andrew was a spine surgeon fellow at NYU. He had received his undergraduate degree from UCLA and completed his medical degree at SUNY-Downstate School of Medicine in Brooklyn, followed by a residency at SUNY. He also had received a Traveling Fellowship from the North American Spine Society, which took him around the world and allowed him to study with some of the world’s biggest surgeons. (Moulton is primary instructor of the Orthopedic Spine Division of New York, Medical College, Valhalla, MY, and in private practice at University Orthopedics, Westchester, NY).
Collado was in New York for job interviews when she met Andrew. A media personality in her native Dominican Republic where she hosted an Oprah-style talk show, she was making the rounds of Spanish-language media in the United States when she bumped into Andrew. An exchange of business cards led to a whirlwind courtship and then marriage.
Soon thereafter, when Andrew visited Collado’s native country, the couple were introduced to Dariel, a 9-year-old boy who was paralyzed by a deformed spine that developed after a tumor resection. The couple arranged for Dariel to be brought to the United States, where Andrew and his colleagues performed corrective surgery. In a matter of days, Dariel was taking his first steps.
“It was pretty amazing, and at that moment I decided we were going to make this [foundation] happen—no matter what” Geraldine says.
History of the Foundation
To a degree, the groundwork for what would become Butterfly Foundation had already been laid. Prior to meeting Andrew, Geraldine had used the power of her celebrity to raise funds to take gifts to the patients of Robert Reid Cabral Pediatric Hospital in Dominican Republic during the holiday season. The children there suffered from such diseases as tuberculosis, cancer, and pneumonia. Because of the lack of resources, patients were placed in overcrowded rooms in the worst of conditions. Some of the children had been abandoned by their families and were living in the hospital.
Butterfly Foundation was incorporated on February 3, 2003, and the first mission was led by Jeffrey Spivak, physicians from the Hospital for Joint Diseases in New York, and his visionary mentor Thomas Errico, MD, from NYU.
The American doctors and their surgical teams worked with the surgeons of Gautier Hospital in Santo Domingo and guest surgeons from other Latin American countries to perform challenging corrections of scoliosis. The treatments were a great success.
In the evenings after surgeries, conferences sponsored by the Society for Orthopedic and Trauma Surgery were held for the orthopedic and neurological communities of Dominican Republic. The presentations and professional exchanges covered etiology, diagnosis, prognosis, surgical techniques, and recent advances in spinal deformity and traumatic spinal injury treatment.
Medtronic Sofamor Danek, a leading medical technology corporation, was a vital supporter of the initiation of the foundation. In addition to donating surgical spinal implants, the company offered state-of-the-art instrumentation and expertise, particularly with the assistance of company executive Peter Wehrly and product representative Seth Wax of Spinal Associates.
William Jana, MD, director of Health and Hospitals Systems for Dominican Republic, paved the way through a complex political environment. Cruz Bournigal, MD, chairman of orthopedics at Gautier Hospital, directed the care of patients and integrated the US surgical team and his medical staff. The highly respected Francisco Valdez, MD, translated discussions. Valdez and his partner Eric Rosario, MD, have become guardian angels of the foundation.
Their first mission to Dominican Republic served as the model for future missions to Vietnam, Malawi, Kenya, Jamaica, and Chile. Missions are now carried out at 3-month intervals. Since 2003, the foundation has performed more than 200 surgeries.
Today, Butterfly Foundation supports a full-time staff of four with an annual operating budget of approximately $200,000, most of which is secured by private donations. Additional pro bono services are provided by law and accounting firms.
The long-term goal of the foundation is to establish a spine center at its own hospital in Dominican Republic, which would serve as a permanent teaching facility for spinal surgeons worldwide. To that end, the foundation works under the adage, “Give a man a fish and he eats for one day; teach a man to fish and he feeds his village for a lifetime.”
Andrew says that the need for spinal-surgery training is self-evident. Even in countries as economically prosperous as Chile, whose per capita income rivals that of Central European nations, “orthopedic surgery is rudimentary. The techniques we teach are very sophisticated and very specialized.”
The types of spinal deformities vary from country to country, requiring the foundation’s staff and contributing surgeons to maintain several specialties. In Malawi, for example, spinal deformities tend to be the result of tuberculosis, a disease still rampant there. However in Chile, like the United States, complex deformities tend to be idiopathic.
Beginning a Nonprofit
Despite the seeming meteoric rise and stunning success of his organization, Andrew cautions that it was never easy and still isn’t. “Beginning a project like Butterfly Foundation requires a huge investment of work,” he says. “My advice to physicians thinking about starting one is to first volunteer on someone else’s before embarking on their own. You have to be willing to breathe, eat, and sweat the project, so above all, there can be no equivocating in your personal dedication to the cause that you are helping.”
If the foundation is planning to assist patients outside the United States, it helps to speak the language, literally and figuratively. In addition to English, both Moultons are fluent in Spanish and Portuguese, which helped facilitate the opening of their foundation’s office in the Spanish-speaking Dominican Republic. Of course, the fact that Geraldine was famous in her native land helped immeasurably, and sometimes in unexpected ways.
“It helps if you have someone in the developing country where you plan to work who is equally committed to your project,” Andrew says.
In one of the first missions to Dominican Republic, its Customs agents prevented vitally needed spinal implants and other surgical equipment from entering the country. After a little digging, Geraldine learned that a prominent Dominican Republic orthopedic surgeon at a rival medical facility was behind it. Unbelievably, he feared being overshadowed by the visiting American physicians.
“Geraldine paid a visit to the Customs agents,” says Andrew, “and through a little good-natured flirting—they were completely flattered that a celebrity like herself would pay attention to them—and some cold cases of beer, they turned their backs and let us grab the equipment.”
Does the work for Butterfly Foundation help or hurt Andrew’s orthopedic medical practice at University Orthopedics in Westchester, NY?
“There’s no doubt that the time I’ve invested in the foundation is a huge draw against the time I can spend on my private practice,” he says. “Let’s just say that my office manage would prefer that I spend more time in the office.”
Still, despite all the challenges of beginning and growing the foundation, Andrew and Geraldine Moulton would not have it any other way. For Geraldine, her decision to give up her media career and fevote the rest of her life to the foundation represented a complete change in lifestyle and attitude.
“As a media personality, I was always surrounded by people who wanted to do things for me,” she says. “But I decided in the next chapter of my life, I wanted to serve others.”
For Andrew, the foundation’s reward can be reduced to one memorable surgery. Juan, a 15-year-old boy from Dominican Republic, had a severely deformed spine with a 130-degree thoracic curvature and an 80-degree lumbar curvature. Near the end of the 13-hour operation, signals suddenly emerged that the patient was becoming paralyzed.
“I increased his blood pressure slowly, and then took just a moment to sit down and pray,” Andrew recalls.
Increasing the patient’s blood pressure worked, the boy’s vital signs returned to normal, and the operation was a complete success.
“It’s at times like that when I know that with determination, experience and a little serendipity, anything can be done,” Andrew says.
Performing pro bono work in a developing country reminds Andrew of why he pursued a medical career in the first place.
“You know, most of us when we were younger had an idealized view of being a physician,” he says. “But soon we learned it’s not just about helping people, but billing, paperwork, and so on. Working for the foundation takes me back to the basics of being a doctor. When the people thank you, they really mean it. You’re the only chance they have.”