Hospital Antonio Lenin Fonseca in Managua, Nicaragua
Courtesy of Robert F. Murphy, MD


Published 10/1/2013
Robert F. Murphy, MD

HVO—A Valuable Opportunity for Residents

“¿Qué piensas? (What do you think?)” asked my colleague Dino Aguilar, MD, MBA, as we reviewed the postoperative radiographs of a patient’s tibial shaft fracture. Even though we had struggled to reduce the fracture while using a half-broken C-arm on a nonradiolucent table, I thought the X-rays looked pretty good. My 2-week adventure as a Health Volunteers Overseas (HVO) volunteer in Managua, Nicaragua, was off to a good start!

A global calling
As a resident, I wanted to participate in an international elective to broaden my horizons, give back to the orthopaedic community, and see a different part of the world. I sought out Health Volunteers Overseas, formerly known as Orthopaedics Overseas, for assistance.

According to their mission statement, “HVO is a network of health care professionals, organizations, corporations and donors united in a common commitment to improving global health through education.” The organization offers international service opportunities in more than 15 subspecialties, with 17 orthopaedic sites around the world.

I opted to spend my international elective in Managua, Nicaragua, for the following three reasons:

  1. The site accepts resident volunteers (in fact, 11 of the 17 orthopaedic sites do).
  2. Due to time constraints, I was limited to a 2-week trip.
  3. I felt my knowledge of the Spanish language would be useful when communicating with patients and local orthopaedic surgeons.

I spent my 2-week rotation at Hospital Antonio Lenin Fonseca, the largest public and tertiary-referral hospital for the greater Managua area. Most of the orthopaedic cases are trauma related and include motorcycle accidents, pedestrians struck by motor vehicles, and machete wounds to the hand. The orthopaedic service at the hospital is very busy and, as a resident volunteer, my services were much needed and greatly appreciated.

Hospital Antonio Lenin Fonseca in Managua, Nicaragua
Courtesy of Robert F. Murphy, MD
(left to right) Dr. Mario Cuadra, Dr. Robert Murphy, Dr. Russell Carrero, Dr. Dino Aguilar (HVO Site Liaison)
Courtesy of Robert F. Murphy, MD
Dr. Murphy with a patient from Managua, Nicaragua
Courtesy of Robert F. Murphy, MD

Most of my time was spent in the operating room. Even as a resident volunteer, I was always at least the first assistant for surgical cases. We performed a variety of trauma procedures, from tibial nailing to percutaneous fixation of a distal radius fracture to a compression hip screw for an intertrochanteric femur fracture. The Nicaraguan surgeons were open to my input and suggestions and to modifying the surgical plans based on my experience. As a resident surgeon this was exciting but also humbling—I was not just an observer, but a real part of the surgical team!

Resident as teacher
HVO’s mission also involves improving the knowledge and skills of the host country surgeons; therefore, I gave lectures and workshops to the Nicaraguan orthopaedic surgeons. Although they have excellent knowledge of basic trauma principles, they are not as familiar with other aspects of orthopaedic care.

For example, one presentation focused on recent updates in shoulder arthroscopy, which was very well attended, as Nicaraguan orthopaedic surgeons receive very little training in sports medicine. I also lectured on the radiographic evaluation and classification of acetabular fractures, which they rarely see (fewer than 10 per year). In addition, I conducted a resident workshop on the systematic physical examination of the knee during which residents performed the ligamentous maneuvers on each other. It was truly gratifying to be able to take the excellent training I have received here in the United States and share it with those who don’t have the same opportunities.

My HVO experience was meaningful and worthwhile, and I encourage all U.S. orthopaedic residents to seriously consider taking an international elective. Not only is it a chance for personal and professional growth and development, but it is also an opportunity to share the outstanding training and education we receive with other physicians.

For more information about HVO, visit

Robert F. Murphy, MD, is an HVO volunteer and the resident member of the Council on Education