Day 2: Friday March 19th

Today was our first full day in the OR and the team is starting to hit its stride. Between the time the first case started at 8am and the time the last case ended at 8pm, there were 16 joint replacements performed in 12 patients.

Meanwhile, on the floor, the patients who underwent procedures on Thursday began the process of postop rehab. With the assistance of our enthusiastic physical therapists, many patients were able to get out of bed and walk with their new joints less than 24 hours from their procedure!

It recently occurred to this blogger that while some of you reading these entries may be experts in orthopaedics, some of you may not be! To give you a sense of what's involved, here's a brief explanation:

At the many joints of the human body, including the hip and knee, bones are covered by cartilage -- a smooth substance which allows bones to slide past each other without causing pain. When this cartilage wears down, movement of the joint causes bone to scrape against bone, a process that is generically termed "arthritis." Take a look, for example, at one of our patients' x-rays below:

The patient's right hip (which is on the left side of the above image) is relatively normal -- there's a well-appearing ball and socket which are separated by a nice space on the x-ray (the cartilage layer). In contrast, the patient's left hip (on the right side of the image) has advanced arthritis with obvious abnormalities in the ball and socket, as well as the cartilage that normally coats the two bones. This condition can be quite painful, and often leads to difficulty with walking, climbing stairs and other activities.

In cases of advanced arthritis, joint replacement can be an excellent way to decrease pain and, in turn, improve function. In the hip, this involves replacing the ball (which is attached to the femur, or thigh bone) as well as the socket (which is attached to the pelvis). Here's an x-ray of the same patient depicted above, this one taken shortly after undergoing total hip replacement earlier today:

Total joint replacement of the hip and knee are common procedures in the United States and other wealthy nations, but remain relatively inaccessible for most individuals living in the developing world. As a result, individuals with advanced arthritis continue to suffer with pain, limited mobility and, in certain cases, loss of livelihood.

Thanks to the generous support of Operation Walk donors, scores of disadvantaged patients who would otherwise not have been able to afford joint replacement have been given the opportunity to eliminate pain, and walk again. This is the goal that drives our mission, and we remain deeply grateful to those who enable us to do this work.

Day 1: Thursday March 18th

Today the Operation Walk Boston team began their 2010 mission in the Dominican Republic.

The day began with the preoperative clinic, in which all potential patients were interviewed and examined by the operating surgeon as well as anesthesia staff members. Within just a few minutes of the clinic opening its doors, all available seating was occupied by eager patients and their dedicated caregivers (see picture at right). While most of the patients arrived in pain – limping or being pushed in a wheelchair – everyone involved looked forward to discharge day, when many will be confidently walking out under their own power.

As a result of the excellent preparation that occurred ahead of time, there were remarkably few surprises and everything went quite smoothly with the preoperative clinic. While there was certainly a lot of work to get through this morning, the Operation Walk team benefited from the generous assistance of a virtual army of local Dominican medical students who generously volunteered their time to support the mission. In fact, when we reached the hospital at 6am this morning, there were over 60 medical students already waiting to help! (See picture at left for a small sampling of the Dominican medical student volunteers.) This incredible show of support is a testament to the great enthusiasm for Operation Walk that exists here in Santo Domingo.

Next came Grand Rounds, where the expertise of all five joint replacement specialists was brought to bear on each surgical case. The event remains an annual highlight due to its extraordinary educational value, and it was widely attended not only by Operation Walk team members but also by Dominican students, residents and ancillary staff. (In the picture at right, Dr Siliski posts an x-ray while Drs Mattingly, Thornhill, Scott and Katz look on.)

After a quick lunch it was time for the first round of operations! The first incision was made shortly after 2pm and, by the time the team left for the day at 8:30pm, eight joint replace ments had been performed for five grateful patients. (At right, Drs Scott and Thornhill perform a total knee replacement while Jeremy Smith assists.)

For me the most memorable patient of the day was a young 21-year-old who had lost her mobility due to left hip arthritis, the result of a traumatic injury sustained as a teenager. In the preop area she came across as relatively shy and quiet, with an expression that was primarily one of trepidation. As she wheeled out of the OR with her new hip, however, she gave us a thumbs up and flashed a huge smile. It’s an image I will not soon forget.

All in all it was a very successful first day in the OR, and the team is excited to have gotten started. Be sure to check back tomorrow for an update on Day 2!

Day 0: Wednesday March 17th

For most members of the group, Wednesday was a travel day spent flying from Boston to the Dominican Republic. Our take-off was delayed when the plane’s “check engine” light came on as we reached on the runway, necessitating a trip back to the gate, but the flight was otherwise uneventful. Once in Santo Domingo we found the group buses at the airport, rode over to our hotel, and settled in for an evening of team meetings over dinner.

On the night before the mission begins in earnest tomorrow, excitement is high. After months of anticipation, the group is ready to get started. It’s important to acknowledge, however, the tremendous amount of work that has already taken place to ensure the success of the mission. Those who haven’t previously organized an international surgical mission (myself included) may not appreciate how much planning and preparation are required before the first patient presents to the pre-operative clinic tomorrow morning.

The process of identifying operative candidates began last fall, with our Dominican colleague Dr Luis Alcantara screening potential patients not only for appropriate surgical indications (end-stage arthritis) but also overall health and financial need. Since then there have been several additional screenings by teams of orthopaedic surgeons, anesthesiologists and others to optimize patient selection.

Considerable effort has also been spent procuring orthopaedic implants and medications, many of which have been supplied at no cost by generous donors. A wide variety of team members have been recruited, including surgeons, nurses, therapists, OR personnel and pharmacists, to name but a few.

Tomorrow, the team looks forward to meeting all prospective patients in the pre-operative clinic, and beginning with the first round of surgeries.

This blog will be updated daily during our weeklong trip, so be sure to check back often to stay current!

From mission coordinator Roya Ghazinouri

It is hard to believe we are only two days away from the start of our second independent mission to the Dominican Republic. Paul Laemmle, our OR Coordinator, and I have spent the day unpacking 500 boxes of cargo and meeting with our colleagues in the DR to finalize our plans for the start of a very successful mission.

I am humbled by the trust and support we have been receiving from our friends at Hospital Plaza de La Salud.

Dr. Alcantara and Dr. Gomez, our orthopaedic surgeons at the hospital, have screened and met with all of our patients, and have trained a team of Dominican medical students to work with us during our mission.

Our floor nurses in charge, Margaret Higgins and Barbara Aggouras, are arriving tonight. They will be holding a 6-hour training session for our Dominican nurses on the postoperative care of arthroplasty patients.

Our team will be arriving on Wednesday to start a week of surgeries, patient care, clinical education and collaboration.

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

Final preparations underway

With their departure date just days away, the Operation Walk Boston team is making final preparations for their 2010 trip to the Dominican Republic.

Patient selection, which began nearly six months ago, is nearly complete. Most recently the charts of all potential patients were reviewed in their entirety by a multidisciplinary team, which included representatives from Anesthesia as well as Orthopaedics. This year, the mission aims to provide approximately 60 joint replacements for 45-50 patients.

All supplies have been carefully packed and shipped to our host site, the Hospital General Plaza de la Salud in Santo Domingo.

Preoperative x-rays, which were formerly stored in hard-copy form, have been digitized to allow for electronic record-keeping.

The team is excited for their upcoming trip!

Tracking outcomes following joint replacement

In the provision of surgical services abroad, it is often difficult to obtain adequate follow-up. This year, Operation Walk Boston is attempting to break the mold by following up on the patients who underwent total joint replacement during prior trips.

The study, led by Dr Jeffrey Katz and medical student Nina Niu, will attempt to assess functional outcomes at one year following total hip and total knee arthroplasty. In addition, the study will explore the implications of living with osteoarthritis in a developing country, which has largely not been studied previously.

Orthopaedic supplies on the way to Haiti

This past Tuesday January 12, the country of Haiti was devastated by a 7.0-magnitude earthquake estimated to affect nearly three million people.

In light of initial reports documenting a dire need for orthopaedic supplies, the Operation Walk Board of Directors has decided to ship the orthopaedic cargo being stored in the Dominican Republic to Haitian hospitals located near the Dominican border.

In addition, physicians and surgeons from the Hospital Plaza de La Salud in Santo Domingo have been working with Partners In Health to provide care and supplies for those in need.

Our thoughts and prayers are with the people of Haiti, especially those who have lost loved ones.