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WOGO surgeons Dr. Robyn Hakanson (far left) and Dr. Audrey Tsao (third from right) pose with patients and volunteers while working in Kathmandu, Nepal.

AAOS Now

Published 4/1/2011
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Robyn J. Hakanson, MD

Women helping women on a global scale

By Robyn J. Hakanson, MD

In 2006, while part of a professional panel on the impact of arthritis in women, I was fortunate to connect with four other fellowship-trained female orthopaedic surgeons. Only 4 percent of orthopaedic surgeons are women, and, as members of that minority, our group formed an immediate bond.

Although we were all from different backgrounds, we shared a common value: the desire to give back. As we exchanged stories about the challenges of being a woman in this field, we also talked about how our small group could make a big impact, and Women’s Orthopaedic Global Outreach, or WOGO, was born.

Inspired by Lawrence D. Dorr, MD, we chose to incorporate WOGO as an Operation Walk team. Dr. Dorr, the founding father of Operation Walk, along with many of his colleagues, has worked tirelessly for more than 16 years to provide free joint replacement surgery to thousands of patients in the developing world.

In December 2009, WOGO set its sights on Kathmandu, Nepal, for its inaugural trip. Operation Walk had recently sent teams to Nicaragua, Peru, and Vietnam, but Nepal.

A predominantly rural country located between India and China, Nepal is one of the poorest countries in the world. With no health insurance or government assistance programs, most Nepali citizens have almost no access to health care. The average annual income is only $1,200. Knee replacements are simply not an option; if one is needed, the patient must travel abroad and pay cash, a luxury that very few can afford.

The women of Nepal
Women overall are disproportionately affected by arthritis and related disabilities. Culturally, Nepalese women are even more affected. Older women are expected to help their daughters with housekeeping and raising the children. Women not only care for the home, they also help run businesses with their husbands and extended family. Women who are unable to work can become a significant burden on an economically challenged family.

I eagerly anticipated meeting the women of Nepal, learning about their lives, and giving them a chance at a new life with new joints. My greatest supporters during the planning stage were my private practice knee replacement patients, who offered money, prayers, and encouragement.

In April 2010, I traveled to Kathmandu along with fellow WOGO surgeon Jennifer L. Cook, MD, WOGO’s two team leaders, and team leaders from Operation Walk who graciously shared their knowledge and experience. On this trip, we met with local and governmental officials to arrange the secure transport of our supplies and the safety of our team during the upcoming trip. In addition, we conducted initial screenings, reviewed patient radiographs provided by the host surgeon, and determined which supplies and how much help would be required. Visiting the hospital and meeting some of our potential patients made clear the overwhelming need.

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WOGO surgeons Dr. Robyn Hakanson (far left) and Dr. Audrey Tsao (third from right) pose with patients and volunteers while working in Kathmandu, Nepal.
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Robyn J. Hakanson, MD, gets a hug from a patient after knee replacement surgery.
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Dr. Hakanson (front) and Audrey K. Tsao, MD, (rear) examine patients in Kathmandu, Nepal.

We met mothers, grandmothers, and wives who lived with extended families and needed to be in good health to care for the household. They had no prior knowledge of knee replacements and were surprised to learn that we could help them walk without pain. Our Operation Walk mission would improve the quality of their lives tremendously.

A team takes off
Back in the United States, we were able to raise more than $200,000 and procure enough donated supplies to realize our trip. On Sept. 24, 2010, 58 women and men—five primary operating surgeons, two other orthopaedic surgeons who served as surgical assistants, team leaders, anesthesiologists, internists, physician assistants, nurses, surgical techs, warehouse personnel, biomedical engineers, a medical student, a photographer, and assorted other volunteers—from 10 different states met in Kathmandu.

Some of our volunteers had never been abroad before, and many were initially overwhelmed. But everyone worked together, and what could have been a logistical nightmare was instead a well-choreographed ballet. I enjoyed scrubbing in with team members from all over the country and operating with my female peers.

Working conditions at the Nepal Medical College Teaching Hospital were just as foreign to us as knee replacement surgery was for our patients. It was back-to-basics surgical care. The only means of sterilization was an old autoclave, functional but very slow. We had shipped more than 9,000 pounds of instruments and supplies, but our inventory of trays and backup instruments was small. In 3 days over the course of the week, we were able to replace a total of 44 knees in 26 very happy patients.

We also hosted a formal education symposium for orthopaedic surgeons and other health professionals from Nepal. We shared our knowledge and discussed interesting cases with our Nepali colleagues as we forged some enduring relationships.

One of the most rewarding experiences of the entire trip for me was spending time with a group of schoolgirls. We brought them soccer jerseys and balls, and we listened as they talked about their future plans. Although many wanted to be nurses, teachers, or doctors, most had never seen a female physician.

Our final days in Nepal were emotional, to say the least. The patients and their families expressed their appreciation with small gifts, poems, religious icons, and other tokens. They all wanted photos of “the lady doctors.” We hugged and laughed and cried. I know I helped change their lives, but they also helped change mine.

Our WOGO team is already looking to the future and planning a trip to Guatemala this year. We hope to continue empowering women through joint replacement surgery, educating healthcare professionals in the countries we visit, and engaging girls and young women by serving as mentors and role models.

Robyn J. Hakanson, MD, is in private practice in Mount Airy, N.C.; she can be reached at rhakanson@nhsc.org

More information about WOGO, as well as pictures and a blog about the trip, is available at www.wogo.org