Thursday, March 29, 2012

Day 6: March 27, 2012

It’s hard to believe that Op Walk has come to an end. 6 days, 36 patients and 47 total joints later the atmosphere at Hospital General De La Plaza De La Salud is joyful. After completing one last physical therapy session, the patients were ready for the final ceremony where each patient is presented and cheered on by family, friends and Op Walk members. Thanks to the extraordinary efforts of our physical therapy team and the hard work of each and every patient, most of the patients walked to their seats. For the Op Walks staff and volunteers this was particularly emotional after working so closely with these wonderful people over the last 5 days. Following completion of the patient presentations and final picture, everyone was saying their goodbyes when one of the patients hushed the crowd and spoke of her gratitude and blessed us for the work we had done. She thanked the Op Walk team and said that now the way she would repay us would be to take care of herself to honor us, so that when we come back next year Dr. Alcantra can say "we have triumphed". She then broke into song, giving an emotional and heartfelt performance, which was met with cheers, beaming faces and tears of joy from the crowd. She is a living embodiment of the Op Walk Mission and her words served as a fitting conclusion to the week.

We cannot thank the Hospital General De La Plaza De Salud for hosting us, and their amazing staff for all of their hard work. A special thanks to Dr. Alcantra and his staff, especially coordinators Adianez Santiago and Eddie Sanchez, whose tireless efforts made this trip possible.

Of course, a special thanks to all of our donors, especially DePuy, whose generous donations have allowed this project to continue for the last 5 years. DePuy not only supplies the implants for each patient, but their staff provides an invaluable service during the trip. DePuy representatives Domenic Dinardo, who is also an Op Walk Board of Directors member, Josh Eaton, Danielle Kinding worked diligently over the past 5 days in constant communication with the team both in and out of the OR. They were critical in the day to day operations of the operating room and ensuring all the equipment necessary was available for each case. Without Depuy’s donations this trip would not be possible and the lives of the hundreds of patients who have been helped over the past five years would be very different. It only takes a visit to the postoperative clinic to appreciate the impact that this mission has made. Each year patients return and express their continued gratitude. Our internist Dr. Jeffrey Katz is currently compiling the outcome data for the patients treated thus far.

As this year’s mission comes to a close, we look forward to next year and our continued partnership with the Hospital General De Plaza De Salud and DePuy to aide the underserved populations of the Dominican Republic.

Tuesday, March 27, 2012

Day 5: March 26, 2012

In addition to performing surgery and physical therapy, a large facet of Operation Walk is education. It has been an amazing opportunity to learn about a different culture, healthcare system, in addition to getting to know an remarkable group of patients, medical students, and hospital staff. With that sense of professional open exchange, we have also used this opportunity impart our techniques and practices. In preparation for the mission, nursing coordinator Barbara Aggouras provided an educational inservice with the floor and ancillary nurses as an orientation. Likewise, OR Coordinator Paul Laemmle performed an orientation to the OR Staff. Our goal is to provide the same safe and professional care as we would at our home institutions. As such, we have incorporated use of the WHO surgical safety checklist since 2009 to ensure he correct site and patient prior to every surgery.

Each day of the trip has been an education. The severity of disease amongst our patients and the opportunity to work with such experienced and skillful surgeons is a tremendous opportunity for the orthopaedic residents. Each year three orthopaedic residents accompany the trip, including a PGY3, PGY4, PGY5. They serve to help manage the floor as well as work one on one with the attendings in the OR . The PGY 4 serves as the chief medical officer and was the primary coordinator with Dr. Alcantra and his team before and during the mission. Dr. Collin May performed the role this year. He did a superb job and the success of the mission thus far is truly a credit to his hard work. Unique to this experience, we are able to be involved in the care of the patient from start to finish, which is a luxury we are not always afforded in residency. From the first day during the preoperative evaluations and ground rounds, where we reviewed each patient and their imaging and discussed of the indications and special considerations for each case, to XRay rounds this morning where we reviewed each patient's post-operative radiographs and the intra-operative findings while the surgeon's discussed why and how they performed each procedure. Having the opportunity to work and learn from 4 leaders in the field has been an amazing opportunity.

The spectrum of disease seen here is vast, providing an education in of itself and a chance to learn how to manage problems we might not otherwise encounter. For example, we have a 43 year old patient with a history congenital genu varum (bow-legged) treated with surgery at age 10. She subsequently has developed significant pain and instability such that with each step her knee collapses. Radiographs showed significant degenerative changes in addition to deformities of her femur and tibia making this a complex case. Residents had the opportunity to discuss the patient with Dr. Thornhill and the other surgeons, as well as examine the patient and her gait in order to prepare for the case, in addition to assisting in the procedure. And of course, we had the chance to see the patients joy as she took her first few steps on her brand new knee.

Likewise, attending anesthesiologist Mercedes Concepcion has created a wonderful experience for the anesthesia residence. We had the pleasure of working with Dr. Daniella Lazea and Dr. Monica Hoagland. They did an amazing job performing spinal anesthesia and femoral nerve blocks to provide our patients with good pain control. They did a staggering number of procedures over the past 5 days, and it has been an great supplement to their anesthesia training.

Of course, we also want the local medical students to gain as much from this experience as possible. In addition to daily teaching on morning rounds with the surgical attendings, our internist Dr. Katz has been performing informal patient based educational sessions on the floor. Today we held a teaching session with all of the medical students discussing management of perioperative medical problems/emergencies, an introduction to osteoarthritis, rheumatoid arthritis, and joint arthroplasty, as well as some case based learning. The medical students were attentive and interested, and hopefully gained some knowledge that will help them with their future endeavors.