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While in Nicaragua, Anna Cooper, MD (right), assisted in performing an ACL reconstruction.
Courtesy of Dino Aguilar, MD

AAOS Now

Published 11/1/2015
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Katie McMullen

HVO Orthopaedics Traveling Fellowships

An opportunity for residents to expand professional perspective

I cannot emphasize enough how exceptional this experience was for my professional development. I gained a lot of confidence in my diagnostic, surgical, and teaching skills. This fellowship allowed me the freedom to explore my autonomy as a practitioner and educator," wrote Rachel M. Thompson, MD.

In August 2014, Dr. Thompson traveled to Thimphu, Bhutan, to work with staff and students in the Orthopaedics Department of the Jigme Dorji Wangchuck National Referral Hospital. She was the recipient of the Health Volunteers Overseas (HVO) Orthopaedics Traveling Fellowship, which funded her one-month volunteer assignment to provide essential teaching, training, and professional collaboration to local students of orthopaedics.

"I applied for the HVO fellowship because I have always had an interest in health disparity, healthcare systems, and healthcare delivery. It was important to me to experience how other healthcare systems deliver their care and to work toward more equitable care regardless of nationality or location. In that light, HVO empowered me to lessen the knowledge gap and work toward more modern orthopaedic management in a country that has been very isolated until recently," reported Dr. Thompson.

HVO is a nonprofit organization dedicated to improving the availability and quality of health care through the education, training, and professional development of the health workforce in resource-scarce countries. HVO volunteers provide clinical and didactic education to students and colleagues through continuing education and degree granting programs, faculty and staff training, mentoring, education material development, and professional collaboration. The Orthopaedics Traveling Fellowship provides funding for senior orthopaedic residents to volunteer at HVO orthopaedic project sites in Bhutan, Bolivia, Ghana, Malawi, Nicaragua, Tanzania, or Uganda.

"As Director of the Orthopaedics Traveling Fellowship program, I join other donors who are investing in the future of orthopedics abroad," said Dean K. Matsuda, MD. Dr. Matsuda is a long-time overseas volunteer, former member of the board of directors of Orthopaedics Overseas—a division of HVO—and the current director of HVO's orthopaedics fellowship program.

"My hope is that residents (typically PGY-4 or PGY-5) with adventurous spirits and even a small desire to serve (as this often grows with exposure and experience) from supportive residency programs apply for a fellowship," said Dr. Matsuda. "I believe the great majority will return with a broadened perspective of themselves, their careers, and their world. A few will find a way to integrate medical missions into their future orthopaedic practice … contributing to the improvement of global orthopaedic care while enriching their professional and personal life back home."

"This opportunity facilitated a transition from my previous international volunteer work to orthopaedics. It fueled my desire to continue such works in the future," reported Anna Cooper, MD. Dr. Cooper is a 2015 Orthopaedic Traveling Fellow who volunteered in Nicaragua this past July.

"Learning how to operate with minimal preoperative workup and intraoperative tools was especially valuable in my approach to case preparation and in my understanding of how much we take for granted in the United States. Discovering alternative methods of approaching cases is particularly useful at the senior resident level," wrote Dr. Cooper.

Among orthopaedic volunteers who have filed post-assignment reports with HVO since 2014, 95 percent report that the experience has broadened their professional perspectives and nearly five in every seven report that their work overseas increased their clinical confidence.

In addition, orthopaedic volunteers report on their ability to affect the quality of orthopaedic care abroad. Dr. Thompson said, "It is the small changes that make a large impact. Your insistence on a time-out before surgery, your effort in educating the staff on common pediatric orthopaedic anatomic variants (such as in-toeing, out-toeing, or physiologic genu varum), your introduction of improvised wound VAC techniques, and your placement of a hohmann retractor during a hemiarthroplasty for a hip fracture seem like meager attempts at education, but once you have left the volunteer site, if one time-out saves a patient from a wrong-site surgery or one hohmann improves femoral version for one patient, you have achieved your goal. You have chipped away ever so subtly at the layers of healthcare disparity around the world."

"As a group, orthopaedic surgeons are a resourceful breed, but we sometimes think the latest/greatest tool or technique is absolutely critical to a good outcome, which is often not the case," said Dr. Matsuda. "Returning with a 'can do' attitude has made me a more creative and less demanding surgeon."

Health Volunteers Overseas accepts applications for the Orthopaedics Traveling Fellowship on a rolling basis. The fellowship is available to senior residents training in programs recognized by the American Board of Orthopaedic Surgery. Details about applying are available on the HVO website.

Katie McMullen is communications and development coordinator for Health Volunteers Overseas. She can be reached at k.mcmullen@hvousa.org