Operation Walk 2011 - Day 6, March 29

The final day of Operation Walk 2011 was a day of celebration. The team made its way to the hospital one last time for morning rounds on our patients, and settled in for some final physical therapy, discharge teaching, and clinical duties.

The team would be leaving with 14 patients still in-house, and pass-off to the Dominican staff who would take over their care was an essential part of the process. We are fortunate to have Dr. Luis Alcantara (pictured at right), a talented and experienced Orthopaedic surgeon who practices in Santo Domingo as a member of the Op Walk team. All of the Op Walk patients in the hospital transition to a team under his supervision, and everyone who was operated on over the course of the week is seen by him in follow-up clinic. Close follow-up is essential to a good surgical outcome, and without Dr. Alcantara's help, the mission could not meet its goal of providing the highest level of care.

The highlight of the day was certainly the group photo. Patients still in the hospital made it out of their rooms and walked down the hallway to where the photo was to be taken...all the while cheered on by the members of the Op Walk team.



Those patients who had been discharged earlier in the week came back to the hospital to join in the photo, and there were many smiles and lots of hugs as patients reunited with each other and with their providers. All of the physicians, medical students, nurses, therapists, and staff (both American and Dominican) joined the patients in the photo as well--as you can see below, it was quite a scene.



As the mission comes to a close, I feel deeply honored to have had the opportunity to work with such an incredible group of patients, whose resilience, strength, and high-spirits bouyed all of us through an arduous week. Their unquestioning trust in our abilities and intentions to help them was truly moving. I am thankful for the generosity of Hospital General Plaza de Salud, its staff, and the wonderful physicians, nurses, and students who gave so much of their time and energy, as well as the facilities to make this mission possible. And I am proud to have worked with a team of people so hardworking, talented, and dedicated to their cause. As a newcomer to the group this year, the collaboration between nursing, therapists, pharmacists, physicians, and staff was incredible to be a part of -- rarely does this happen so seemlessley in the hospital setting in the States. I can say with confidence that we all took a personal and emotional investment in every patient that was operated on this week; never was there a mention of my patient or your patient -- they were all our patients.

I look forward to beginning the planning and preparation for Operation Walk 2012. We will be monitoring the progress of our patients throughout the year with updates from Dr. Alcantara. Our goal of continuing to collect data regarding out outcomes will proceed through the help of Dr. Katz and others.

To finish off the blog entries from this year's trip, here are a few more pictures of our team...

And here we have the cargo room...stocked and waiting for our arrival next year!

Operation Walk 2011 - Day 5, March 28

Day 5 of the Op Walk mission marked the final day in the OR for our team. Over the course of the week we had replaced 59 joints in 43 patients (21 unilateral joint replacements and 12 bilateral)! 45 knee 14 hip replacements. The magnitude of this undertaking is difficult to convey, but potentially more illustrative is the manpower it took to make these surgeries happen -- 50 Op Walk volunteers, all working 14+ hour days, multiple Domincan surgical, medical, and anesthesia physicians and an army of 70+ Dominican medical students working nearly equal numbers of hours, and a whole host of staff from Hospital General Plaza de la Salud who took care of housekeeping, OR turnover, food preparation, and much much more. The teamwork of all involved was impressive to watch. We owe thanks to our leadership team for putting together such a well-oiled machine--CEO Dr. Thomas S. Thornhill, Mission Coordinator and COO Roya Ghazinouri, OR coordinator Paul Laemmle, Chief Medical Officer Dr. Kanu Okike, and Nursing Coordinator Barbara Aggouras who put in countless hours long before the trip began to ensure the systems were in place for the mission to be a success.

Joint replacement of the hip and knee are common procedures in the United States and other wealthy nations, but remain relatively inaccessible for most people in the developing world. This is certainly true for many in the Dominican Republic, where implant costs and the lack of comprehensive health coverage force those with arthritis to continue to suffer with their pain, limited mobility, and oftentimes loss of livelihood. Because many of the patients treated by operation walk have had lonstanding disease, the level of deformity we see here is often much more significant than what is typically seen at home in the U.S. Pictured below is one such patient who was wheelchair-bound due to her deformity.

These are her preoprative xrays, showing the extent of her arthritis and deformity of her knee joints.

This is what her knees look like following bilateral total knee replacement.

Here she is walking with Dr. Thornhill, Dr. Maher, Dr. Okike and one of our Dominican Medical Student volunteers.

On the floor, more and more postoperative patients got up and walking and on their way home today. To see the smiles on their faces as they regain their mobility is one of the more heartwarming things that I have ever experienced. Here's a picture of a few of our patients, walking less than 2 days after their joint replacements.


The quote of the day came from Nela Garcia de Gonzalez (pictured with Dr. Scott, at left). Nela is a 62-year-old woman from Higuey, a small town in the Eastern part of the country, about 3 or so hours from Santo Domingo. "I couldn't shower. If I ever dropped anything, I couldn't pick it up. I love to clean my house and that was really difficult for me. I also really love the beach, but I live on the second floor of my house and coming down the stairs was so difficult that i didn't leave very much. With my new knees, I'm gonna go to the beach!" We wish her many long years of beachgoing ...

The day finished off with an afternoon of lectures given by our surgeons, anesthesia attendings, and nursing staff to a packed house of both American and Dominican attendees. The lectures were given in English, but with real-time spanish translation such that all in attendance were able to get the full benefit of the knowledge imparted.

We will end today's blog with some photos of team members hard at work (but enjoying themselves!)

Operation Walk 2011 - Day 4, March 27

"Voy a ser una persona normal otra vez. No voy a necesitar ayuda nunca mas. Voy a ser capas de sentarme, subir escaleras, y ponerme la ropa sola."

I'm going to be a normal person again. I won't need help anymore--I'll be able to sit, climb stairs, and put on my clothes all by myself.

-Familia Ramirez, Op Walk patient

Ms. Ramirez (pictured above, and at right) is a 27 year-old woman with longstanding hip pain as a result of previously undiagnosed rheumatoid arthritis. As indicated by the quote above, she was severely debilitated by her disease and had difficulty with even the most basic of daily activities. She agreed to share her story with us and our blog readers (as well as with the local press, see below) because she says, "(she) hopes many more people can be helped in the same way (she) has been." Because her hip arthritis is due to a chronic rheumatologic condition, rheumatoid arthris, Ms. Ramirez was evaluated by our Rheumatology specialist and Operation Walk volunteer Dr. Jeffrey Katz. After establishing her diagnosis with a series of blood tests and further x-rays, Dr. Katz is currently working with her physicians here to begin her on anti-rheumatic medications with the hopes of slowing the progression of her disease and its effects on her other joints.

While Day 4 progressed uneventfully in the operating room, near mass-hysteria broke out on the floor when singer, songwriter, and producer Juan Luis Guerra (in middle in picture, above), a 15-time latin Grammy and 2-time Grammy award winner visited with the Operation Walk patients. As one of the most internationally acclaimed Dominican artists alive, his was a truly special visit for our patients. At right is pictured Ms. Ramirez, and an article in the local newspaper detailing her time with Mr. Guerra.

As the week has gone one, I have been struck by how smoothly the operating rooms and the incredibly busy operative schedule has been run. Four total joint replacements in each of four operating rooms per day is an huge undertaking in any operative setting, let alone in a foreign country on unfamiliar territory. This is wholly a testament to the efforts of our operating room nurses, scrub techs, and staff. The logistics in creating four safe, sterile, and fully functioning operating rooms is immense, and these people deserve special mention. Many of them are pictured below...

Finally, we at Operation Walk want to give a huge thanks once again to our sponsors, without whom this trip would not be possible. The cost of the orthopaedic implants alone would be prohibative and Depuy Orthopaedics has graciously absorbed that cost.

We look forward to our final day of operating tomorrow, and to more and more of our patients heading for home.

Operation Walk 2011 - Day 3, March 26

A sleep-deprived, but excited and energetic Op Walk crew made their way to the busses at 6:00 AM this morning. Interdisciplinary rounds at the hospital start by 7:00 AM, with teams made of surgeons, residents, nurses, therapists, and medical students seeing all 4o inpatients prior to the start of the ORs. We were pleased to find this morning that all our patients were doing well -- many having taken their first steps yesterday, and a few even ready for discharge! It is incredibly gratifying for everyone on the team to see our patients doing so well so soon after such major surgery.

This would certainly not be possible were it not for the incredibly hard work of the inpatient nursing and therapy staff. By the time the first incision was made in the OR today, the floor nursing staff was already in full swing, attending to the needs of the weeks' patients. Theirs is a complex task of managing not only our own Op Walk staff, but also coordinating care with the Dominican hospital nursing and medical personnel who we work alongside. They are intimately involved in the day's activities -- some of their innumerable responsibilities include: ensuring adequate pain management, monitoring hemodynamic and fluid status, dosing medications and fluids, positioning and mobilizing postoperative patients, changing dressings, doing discharge teaching, and much much more. Our nursing staff has shown incredible devotion to their task, arriving early and always the last to leave the hospital at night. The payoff for that devotion is clear in the faces of their patients...

In addition to their patient care responsibilities, another major theme of the mission for our nurses is education. They each spend much of their day alongside students and Dominican nurses, and take great care in teaching as they perform their clinical duties.

With one more full day of OR left for the trip, we look forward to many more of our patients taking their first steps and very soon heading for home. As one of our nursing colleagues said recently, "This is what its all about. This is why I became a nurse." This is a common feeling among the people who are a part of the Op Walk mission, and despite the long hours we are bouyed by the knowledge that we are changing lives for the better, and that really is what its all about.