From mission coordinator Roya Ghazinouri

“What has been accomplished is only an earnest of what shall be done in the future. Upon our heels a fresh perfection must tread, born of us, fated to excel us. We have but served and but seen the beginning.” Sir William Osler

Seven days ago, I wrote a brief statement on this blog while awaiting the arrival of our team in Santo Domingo. Today my heart is filled with gratitude for our patients, for our colleagues at Hospital Plaza de La Salud for creating a warm welcoming environment for our team, and for our great group of volunteers who worked tirelessly to make this mission a success.

The focus of our presence was to provide the best possible care for our patients. We were able to achieve this goal through collaboration and holding one another accountable for our clinical performance. We worked side by side with our colleagues from the Dominican Republic and I am proud to say that we achieved our goal. Our patients are now able to walk, dance and lead productive lives.

Thank you for your commitment and your dedication to Operation Walk Boston.

Roya Ghazinouri, PT, DPT, MS
Mission Coordinator - Operation Walk Boston

Day 6: Tuesday March 23rd

Today was a happy celebratory day on the Op Walk ward of the Hospital General Plaza de la Salud ("La Plaza" as it's called here in Santo Domingo). With all the surgeries completed, we spent the morning rounding on patients, continuing the physical therapy sessions, and in general wrapping things up before our departure.

Routine postoperative follow-up is crucial following joint replacement surgery, and we are fortunate to have our talented Dominican colleague Dr Luis Alcantara (pictured at right) as a partner in this project. He was the surgeon who carefully selected the patients for surgery, and he will be the one to see the patients back in clinic to ensure that their recovery goes as planned. We're certainly grateful to have Dr Alcantara as a partner in this mission.

The high point of the morning was the photograph, in which everyone involved with Operation Walk got together for a large group picture. Between the American volunteers (including surgeons, nurses, physical therapists, OR staff, pharmacists and others), our Dominican colleagues (including surgeons, medical students, nurses, and representatives from hospital admin) and of course the patients, it was a very large group that took quite a while to assemble! The end result was well worth it, however, as you can see below:

It doesn't come through here but, shortly after this picture was taken, the entire group of patients broke out into joyful song! It's a memory that will stick with me for a long time.

Tomorrow we'll be getting on a plane back to Boston, and Operation Walk 2010 will officially come to a close. Looking back on the week, it's clear that it was a great experience for everyone.

From my perspective -- as an orthopaedic resident -- I can say that it was truly an incredible opportunity. Most obviously, we were able to assist on procedures featuring complex pathology resulting from years of non-treatment that we rarely see in the U.S., which certainly contributes immensely to our education as surgeons. There are a number of other benefits, however, which are somewhat less obvious. In Boston interdisciplinary cooperation is prized but, in practice, teams are defined primarily along the lines of role and specialty, with most of the time spent on strategizing and planning occurring with orthopaedic residents and attendings. Here, in contrast, our rounding teams include not only surgeons but also medical docs, anesthesiologists, nurses, therapists, pharmacists and others (see picture at right). Everyone takes turns changing dressings, pulling drains, writing notes and, in general, doing whatever needs to be done. I can honestly say that I've learnt more about the practical day-to-day activities of nurses and physical therapists over the past week than I did over the last 8 years as a student and resident in Boston hospitals!

As a result of an agreement between Operation Walk and the Harvard Orthopaedic Surgery Residency Program, we are happy to report that there will be three residents going on the mission each year (a PGY3, a PGY4 and a PGY5). This year's group consisted of Jeremy Smith -- who served as Chief Medical Officer -- as well as Courtney Dawson and Kanu Okike (see picture below).

All in all it was a great trip. We reached our goal of performing 60 joint replacements in 45 patients, all of whom were extremely grateful. The logistics of the trip were exceptional, due in large part to the very careful planning that began last fall. Our team was hard-working, talented and enthusiastic: when unanticipated tasks popped up, there were always more than enough offers of help to get things done. We grew quite close as a group, and I know I'll always crack a smile when I run into an Op Walk team member once we're back at our regular jobs in Boston. We did a lot of good work, and had a great time doing it. Most importantly we were able to provide a service to a number of disadvantaged patients, a service which has the potential to dramatically improve their quality of life for a long time to come.

Soon it will be time to start planning for our 2011 trip, but for now we're looking forward to spending some time celebrating the successful trip (and also sleeping -- we're exhausted!). We'll finish up the blog entries for this year's trip with a few more pictures of our team members, happy to be celebrating a job well done!

Day 5: Monday March 22nd

With our last half day in the OR this morning, we were able to complete all of the remaining procedures and reach our goal of 60 joint replacements in 45 patients.

The last operation of the trip was a complicated revision case which was performed jointly by Dr Thornhill and his Dominican colleague Dr Alcantara (see picture at right). The specifics of the case would have made it challenging in any setting, but that was especially true here in the Dominican Republic given the resources at our disposal. In spite of these limitations, the procedure went smoothly and the patient is expected to do well.






Today the group was also surpised to see that we made the front page of the major newspaper here in the Dominican republic (see images below).



When translated, the captions read “No more wheelchairs” and “Surgeries for getting up and walking.” The continuation of the story runs under the headline “Surgeries raise patients from their wheelchairs” and “For free: In private sector would cost 400,000 pesos" (around US$13,000).

While this value is quite high (and way beyond the means of most people living in the Dominican Republic), it is actually a dramatic underestimate of the true cost of the procedures being performed. To begin with, the implants that we brought on the trip cost approximately US$800,000 alone! It is only through the generosity of Depuy Orthopaedics, who donated all the implants at no charge, that we have been able to conduct this work. (To get a sense of the hardware required to do these procedures, take a look at Josh with all the implants he had to bring just for the complicated revision case depicted above.)

When you see the end results, however, it’s hard to argue that it isn’t worth it. We'll end today's post with a few pictures of happy patients taken today:

Day 4: Sunday March 21st

It's hard to believe, but today was actually our last full day in the OR! We were able to perform another 16 joint replacements in 12 patients, and all procedures went well.

Today also saw the first few discharges of the trip, with the initial set of postoperative patients ready to leave the hospital. At right, the first patient discharged from the hospital poses with his nurses prior to going home.

On the floor, the postop patients continue to work on getting out of bed and walking. The process can sometimes be challenging at the outset, and the hard work performed by our dedicated physical therapists (see below for an example) cannot be overstated!


Over the course of just a few days, however, the patients begin to get the hang of it, and the process becomes a much more positive experience (see below).



As mentioned briefly in a prior post, the Operation Walk Boston team is seeking to do something on this mission which has not been done previously by any Op Walk team. In particular, the team is seeking to evaluate the outcomes of their procedures by conducting follow up exams on patients who received joint replacements last year. The project is being led by Dr Katz, a professor in the Brigham and Women's Hospital Department of Orthopaedic Surgery.

In the research, Dr Katz has been assisted by medical student Nina Niu (pictured at right), who reports the following:

"Last Thursday, during our first-follow-up clinic, we had the pleasure of seeing patients who received total joint replacements last year through Operation Walk. Twenty-eight smiling men and women attended this clinic. They were thrilled with their knee and hip prostheses, some even dancing their way into the clinic room to demonstrate their newly gained mobility.

"One woman reported that prior to the operation, she was in so much pain that she could not even sleep; now, she is dancing the bachata five nights each week. Another can easily walk up the stairs to his sixth floor apartment, which he couldn't do previously. It’s exciting to hear these success stories of how patients have been able to return to their lives, now free of pain.

"All patients were examined by our team of physical therapists, who reported significant improvement in measures such as muscle strength, range of motion and walking speed. We also collected follow-up data on self-reported pain and functional status, which we look forward to analyzing in the coming weeks.

"It’s exciting to measure the impact of Operation Walk, which ranges from increased angles of knee flexion to re-mastering the intricate moves of the bachata!"

All in all things have been going quite well with the mission. Sleep is scarce but enthusiasm and positivity are not hard to find. We'll end today's blog entry with a few pictures of team members working hard, and enjoying themselves while doing so!