Wednesday, April 17, 2013

Day Six

Our Mission is complete but it has just begun for Dr. Alcantra and his team of doctors, nurses and therapists in the Dominican Republic. In all we performed operations on 43 patients, performing 61 total joint arthroplasties in patients from 18 year to 82 years of age. We cannot give enough thanks to our Dominican medical colleagues. 55 post graduates and medical students helped us with everything from bringing Physical Therapy supplies to and from the cargo room to translating for us on rounds every day. They were a warm light to our mission. We will miss them dearly and wish them all well on their journeys forward. Dr. Edward Sanchez and Adianez Santiago deserve special mention here. Without their help over the past 2 years the mission would not have been possible. They have helped with everything from pre-screening of patients to discharge. They are some of the most amazing people any of us have had the pleasure of working with.
Dr. Alcantra with patient

Dr. Alison Weisheipl and Krisha Parekh with patient 

Dr. Adinez Santiago and Edward Sanchez (Opwalk Coordinators)

Brooke Fontana PT working with patient

Entire Opwalk Team with all of our patients

Dr. Burke with Medical Student Volunteers

Brooke with her patient

Chief Resident Colin May rounding in the morning

Dr. Katz and the Team teaching about Rheumatoid Arthritis

Dr. Archana O'Neill with a patient

Dr. Ellen Fitzpatrick and Dr. David DaLury

Last Day

Franklin in the Cargo Room as it gets packed away

Brooke and Yil with patient
Dr. DaLury and Dr. Thornhill discussing a patient
Carl Harper MD operating on a hip

Franklin, Steve and Anne as they pack up CPD

Monday, April 15, 2013

Day Five

Today we completed our final four operations, all went succesfully. As demonstrated by the X Ray seen here the level of disease and deformity we are able to treat is extremely severe. We are fortunate to have such skilled surgeons to correct these deformities. However, once the operation is completed the real work begins, starting with the nurses in the PACU and continuing to the ward. While on the ward patients are receiving vigorous Physical Therapy from a great team of therapists from as close as New England Baptist and Brigham and Womens and as far away as Kansas City and New Hampshire. Patients start receiving treatments at 7 am and it continues until 8 or 9 each night. Ensuring that the patients are able to adequately mobilize and return to their normal activities as soon as possible is perhaps the most vital part of the mission. To their credit our patients meet this challenge head on with enthusiasm and grit. Our therapy team routinely remarks on what a pleasure it is to work with such motivated patients.
Severe Valgus Deformity

Post op

Scott PT, Dr. Thornhill and patient (see X Rays)
Carolyn PT walking with her patient

The hallway this afternoon looked like a crosswalk on a main street downtown as all of the patients walked up and down the corridor, many climbing stairs with minimal assistance. Carolyn Beagan (Head Physical Therapist) has been extremely pleased with the progress seen today. We were even able to ambulate several of our post op day 0 patients after their femoral nerve blocks wore off.
Emily Pt getting ready to work with a bilateral total knee patient
Yil working with a bilateral total knee patient
Busy ward

Dominican and US Central Processing Team

After all of our cases were completed Paul Laemmle and Debbie Pitts led the OR team in breaking down our cargo room. In addition, the CPD finished cleaning and washing the final sets of instruments and packing them away. In all over one hundres sets of hips and instruments were cleaned, sterilized and repackaged this week. To give some perspective that volume of equipment is usually processed over a span of 5 to 10 days at major academic centers who have large teams and enormous autoclaves. This was all done with two tiny autoclaves and no more people than those seen in the picture above. Truly a remarkable effort.

Sunday, April 14, 2013

Day Four

Today we completed our final full day of operations. Tomorrow we have four operations to take place in each one of our four Operating Rooms. 

However, at this point in time we would be remiss if we did not recognize one of the most important groups in Operation Walk Boston. The nursing staff. In many ways they are the unsung heroes of our mission and do not get the recognition that they deserve. However, this is not the type of group to seek the Lime Light. Adjectives such as diligent, hard working, and irrespresible are more accurate in describing this group of peope. Consider the following. When operating at maximum capacity we will often have 50 to 60 surgeon hours completed per day. In order to adequately care for these patients our nursing staff will easily log 200 to 250 hours of nursing care. All in all this amounts to an incredible amount of work. Yet, at no point will you ever hear anything but enthusiasm and cheer. After a 12 hour day, each day we readily find volunteers to stay late to take care of a late arriving post operative patient, leaving the hospital at midnight only to arrive back at 6 am the next day.
US and Dominican Nursing Staff at the Charge Desk

Barbara Aggouras NP taking a 10 second break to smile for a picture
Everyone has worked incredibly hard but several people in particular deserve particular recognition. Barbara Aggouras NP and head of the nursing staff on Operation Walk Boston has, for the past several years, performed the work of 3 people. And she has done it every day without showing anything but a smile and attitude that inspires everyone around her. She is invaluable to us, both as a leader and as one of the most wonderful people anyone has had the pleasure of interacting with. What Barbara is to the floor, Debbie Pitts is the Operating Rooms. If you took a tour of the cargo room you would see a fully stocked Central CORE not much different from what you would find at Massachusetts General Hospital or Brigham and Womens. The difference between the two is that one was assembled over weeks and months with input from logistical experts and consultants, and one was assembled from several tons of boxes over two day span with the knowledge that in 48 hours the space would need to be able to accomodate the needs of five surgeons operating upon twelve to sixteen patients per day with no room for error. Debbie Pitts and Paul Laemmle had the job of performing the latter task. In many respects Debbie and Pauls work is nothing short of a miracle.

Suzanne Fernandes and Jessica Glennon (Nurse in Charge)

Christina Foley and a Post Op Patient

Patient arriving to the PACU late last night

Julia reviewing patient vital signs before heading to the floor

Patient going home being driven by Heather, Dr. Thornhill and Dr. Alcantra

Saturday, April 13, 2013

Day Three

Today we had yet another great day. Patients were mobilized with Physical Therapy and discharged home doing wonderfully. However, at this point in time we would be remiss if we did not recognize our incredibly talented group of surgeons who are the key to this great mission.

Drs. Thornhill, Burke, Fitz, Mattingly and Dalury are some of the most talented surgeons in their field. To be able to operate with them is an honor and a privilege. The thoughtfulness and precision with which these men approach each case is incredible and inspiring to their residents. As much as we privileged and lucky to interact with the wonderful patients of Opwalk Boston, we are equally lucky to be able to interact with their surgeons. Today each of our four operating theatres operated upon three patients performing no less than five Total Joint Replacements. The Anesthesia and Surgical Teams worked together in complete harmony and cases went quickly and smoothly with patients transferring to the floor in as little as 45 minutes on some occasions. It should be noted that the severity of the deformity and disease experienced in the Dominican Republich is significantly greater than that experienced in the United States. The ease with which these surgeons are able to control and overcome the technical challenges are literally world class.

We would be remiss if we did not mention the generosity of Depuy at this point in time. All of the implants, totalling hundreds of thousands of dollars are donated free of cost or obligation. Throughout the day they carefully track our inventory and ensure that we are prepared not only for the challenges of the current case but the cases to come later in the week. Their gift literally changes the lives of our patients and we are eternally grateful for that.

Tomorrow we have our final full day of operations, after which we will transition to Rehabilitation Mode where we will highlight the amazing work done by the Physical Therapy and Nursing staff.

                  Collin May (Chief Resident) completing a bone cut during a Total Knee Replacement with Dr. Thornhill
Opwalk Boston Depuy Team
Chief Medical Officer Ellen Fitzpatrick performing a post operative check

Dr. Thornhill and Dr. Burke performing bilateral total knee replacements

Patient post operative day 2 walking without pain

Sarah and Yvette (OR nurses from BWH)

Day Two

We managed to finish all the interviews and surveys today and it went really well. Some themes have emerged as we hear the stories of how the patients' physical activity and lives are changed by their surgeries. Many are able to spend more time with family and to visit neighbors. They are taking their grandchildren to the park, and several have described how wonderful it is to be able to lift, care for, and play with their grandchildren again. Some of the younger patients have resumed work or returned to work with renewed vigor. Another major theme has been the desire to" pay it forward". Many of the women who received knee replacements described their ability to visit home-bound neighbors and take care of sick community members, just as their neighbors cared for them when they were bed- or wheelchair-ridden with osteoarthritis.


Some have returned to dancing, and many more walk for exercise and feel much healthier since their surgery. It has been fantastic to hear the patients' stories as they share the joy brought by changes in their physical activity and the new or renewed opportunities their artificial joints afford. Our goal is to identify and define the ways in which patients' physical activity has changed since surgery, and we have also been asking about barriers that prevent even further renewed activity. We want to know what allows OpWalk patients to broaden their activity horizons after surgery and what might be holding them back so that we can address and help them surmount these barriers.

Friday, April 12, 2013

Day Two

     We completed the first day of our mission on Thursday. By the end of the day, our patients were in good spirits and were being cared for by our Dominican and Boston Nursing Staff.
As we arrived on the ward on Friday, our patients were mobilized by our Physical Therapy Staff, walking down the hallway and doing their exercises as our staff and our Dominican colleagues cheered them on ....Our ORs went into full gear with our surgeons and anesthesiologists and OR staff planning to perform 20 joint replacements throughout the day.
     We also conduced our second post-operative follow up clinic seeing our patients from 2009, 2010 and 2011. The stories they share with us is the reason we do this mission. It is stories about walking 11 km from one town to the other and doing house work and caring for others in need; or the story of farmers getting back to their work on the land and using tractors and providing for their families again... We may be operating on one patient, but our work impacts the lives of many others..........
      There are many people to thank for making our days here a success. As our team continues their work here, a large group of individuals in administration, housekeeping, biomed, pharmacy and food services are quietly but attentively caring for us to ensure that all our operations go smoothly
We are grateful for their support..... More to come........

                                                       Nurses with patient Post op Day 1 
                                                Patient walking with Physical Therapy Post op Day 1
                                                  Patients waiting to be seen in Post Op clinic
Roya, Carolyn and Jill

Video of the Post Op Clinic

Thursday, April 11, 2013

Day One

Today was yet another incredible testament to how much can be accomplished when a group of people all work together for a common good. The day started early with the pre-operative clinic running smoothly and patients moving from station to station in a wonderfully efficient manner. This was thanks in no small part to the innumerable medical student volunteers who serve as translators, patient transporters and cultural liaisons through the relatively complex pre-operative evaluation. Patients were screened by our excellent team of nurses prior to entering the exam room. Upon entering the exam room patients were met and evaluated by members of the surgical team as well as Anesthesia and Physical Therapy. Our fantastic Anesthesia Team, led by Dr. Mercedes Concepcion (a native of the Dominican Republic) had already reviewed patients medical histories but were further able to provide counsel on medical optimization of patients prior to surgery.  Dr. Concepcion's team performed a thorough cardiopulmonary exam as well as reviewing the pre-operative 12 lead EKG. Fortunately no patient required cancellation today for medical comorbidities which is a testament to the efficacy of pre-operative interventions spear-headed by the Dominican Opwalk Team in the months leading up the mission. We then discussed each patient at our Grand Rounds which lasted approximately two hours. This meeting allows everyone to become familiar with the patients but also allows time for academic discussions of the optimal treatment algorithm for complex patients. We cannot say enough good things about the medical student volunteers and the fantastic Anesthesia team with which we are working. They are such a marvelously talented group of people and it gives us great pride in knowing that our patients in the Dominican are getting the exact same level of care that they would receive back home in the United States.

 Dr. O'Neill interviewing patients.


 Patient with with severe knee osteoarthritis.
Dr. Thornhill leading Grand Rounds

 The entire surgical team can discussing patients' imaging
Dr Weisheipel examining a patient pre-operatvely. . 

Wednesday, April 10, 2013

The Whole Team is Here

     Today the entire Operation Walk Boston team arrived in Santo Domingo. With many smiling faces, both new and old we made our way through the Capitol to our base of operations.
     We just finished a lovely dinner where we heard updates from Dr. Thornhill, Dr. Ellen Fitzpatrick, Dr. Mercedes Concepcion, Paul Laemmle, Barb Aggrouras, and of course Roya Ghazinouri. We had many new members to introduce from all facets of the mission.  Highlighting some of the changes was the promotion of Jessica Glennon to our Nurse in Charge. She will be responsible for the flow of the patients to and from the Operating Room as well as coordinating patient care. Debbie Pitts was again recognized by Dr. Thornhill for her untiring efforts to ensure that all of the cargo and appropriate implants are in place and ready to go tomorrow. It was truly wonderful to see so many people happily coming together for a greater good. The energy and enthusiasm in the room was palpable.
     We have an incredibly ambitious schedule this week but we are all looking forward to the challenge. Over the course of this weeks mission we hope to highlight specific departments, sharing the details of just how much time, effort, and enthusiasm went into their work in order to make this year even better than the last. Looking forward to tomorrow!

Tuesday, April 9, 2013

Cargo Room Ready

Paul and Debbie spent all day yesterday organizing our 380 boxes of cargo. The job is almost complete. Today they will spent all preparing our pharmacy, OR equipment and refining their organizational process. Their work is one of the most important aspects of our mission. Without their hard work, planning and organization surgery simply would not be possible.