The US Virgin Islands (USVI) have always been a special place for rheumatologist Rebecca Manno, MD, MHS, because she and her husband, Nick Hoyt, have vacationed in the territory for the past 20 years. But after the two devastating Category 5 hurricanes in 2017 (Irma and Maria), Dr. Manno began learning more about the health care needs in the region. It was important for her to help and be of service to the community—which was without stable rheumatologic care prior to the storms. And the aftermath left an even larger gap in care for patients with rheumatic disease.
“There were zero full-time rheumatologists residing in the USVI. Most patients had to travel to the continental US or Puerto Rico for rheumatologic care,” Dr. Manno explained. “Traveling off-island for health care became financially prohibitive for many patients due to extremely high costs and limited resources. I wanted to be part of the solution.”
The USVI is a limited resource territory, Dr. Manno added. “Although there has been a great deal of recovery from these natural disasters, there’s still a lot of work that needs to be done. Unfortunately, many health care providers left the territory following these events.”
Dr. Manno relocated with her husband to the USVI in August 2019. Prior to that, she had been Assistant Professor of Medicine, and Assistant Director of the Vasculitis Center at Johns Hopkins University, where she completed her fellowship training in rheumatology and joined the faculty in 2011. She has maintained her faculty status as Adjunct Assistant Professor of Medicine in the Division of Rheumatology at Johns Hopkins.
For Dr. Manno, vasculitis encompasses everything that is great about being a rheumatologist. “It’s a group of heterogenous [diverse] diseases, which on the surface, appear very different. But as you look more closely, they share many features—the hallmark feature—inflammation of blood vessels,” she noted. “It requires attention to every aspect of the patient, not just a single organ system. The systemic vasculitides are challenging but rewarding diseases to research and care for.”
Dr. Manno joined a group practice in the USVI—Comprehensive Orthopaedic Global (COG)—which is an orthopedic (and now rheumatologic) private practice with offices located on St. Thomas and St. Croix. COG employs three full-time general orthopedists, a part-time pediatric orthopedic specialist, a part-time orthopedic pediatric spine specialist, and Dr. Manno. “As the only full-time rheumatologist in the territory, I see patients predominately in St. Thomas and travel to St. Croix for patient care at least once per week,” she said.
While practicing general rheumatology and caring for patients with all of the rheumatic diseases, Dr. Manno sees plenty of inflammatory arthritis, ie, rheumatoid arthritis, spondyloarthritis, psoriatic arthritis, and lupus. “I have seen and diagnosed several cases of vasculitis since relocating here as well,” Dr. Manno said.
“The biggest challenge with rural medicine is limited resources and the limited access to advanced technology, although there are improvements being made every day. For example, obtaining an MRI to look for large vessel vasculitis or a CT scan with 3D reconstruction to look for polyarteritis nodosa is not so easy here,” Dr. Manno said.
But she sees this as a positive. “There’s an opportunity to build things in partnership with the community and endless opportunity for growth,” she said. Working in a small community also allows for personalization, both for patient and physician interactions. “There are some incredible doctors in the USVI and I very much enjoy sharing patients with them, and working to grow programs and resources for health care,” she said.
“I enjoy being engaged with the community. It allows me to really understand the culture and the community of my patients,” Dr. Manno said. “And it’s a beautiful, caring, family-oriented, and joyful community that is a privilege to be a part of.”
Rebecca Manno, MD, MHS
Medical Degree: University of Maryland School of Medicine
Residency: Internal Medicine, University of Maryland Medical Center and Baltimore VA Medical Center
Fellowship: Rheumatology, Johns Hopkins University
Author: Nina Silberstein
This article originally appeared in the May/June 2020 isssue of the VF newsletter.
