Edgar T. Araiza, MD, (in white shirt) examines a patient in Tanzania and provides bedside instruction to local orthopaedic residents and medical students.
Courtesy of Edgar T. Araiza, MD


Published 8/1/2017
Katie McMullen

Building Bridges in Global Orthopaedic Care

HVO Traveling Fellowship helps participants and trainees broaden professional perspectives
I applied for the Health Volunteers Overseas [HVO] Fellowship with the intention of helping to make a difference, and to learn how orthopaedics is practiced in countries without all the resources … afforded to us in the United States," explained Eric M. Cohen, MD. "But it turned into so much more."

Dr. Cohen traveled to Bhutan in March 2016, as a recipient of an HVO Orthopaedics Traveling Fellowship.

"I learned quickly to think on my feet, and gained tremendous confidence in my ability to handle adverse situations, while at the same time sharing operative principles with my fellow residents," agreed Edgar T. Araiza, MD, who trained local orthopaedic residents and medical students at the Kilimanjaro Christian Medical Center (KCMC) in Moshi, Tanzania during August 2016.

HVO is a nonprofit organization dedicated to improving global health through education. Each year, several qualified senior orthopaedics residents are selected to receive traveling fellowships. Participants receive funding to complete a 2- to 4-week assignment at an HVO orthopaedic project site in a developing country. Over the course of their assignments, fellows share their knowledge with younger residents and medical students at the project site. In exchange, they gain exposure to surgical pathologies not commonly seen in the United States, and learn from their overseas colleagues about practicing medicine in a low-resource setting.

"The Fellowship offers an opportunity for residents to contribute to the global practice of orthopaedics, while expanding their skills and broadening their professional perspective," said HVO Executive Director Nancy Kelly, MHS. "As senior residents, HVO Orthopaedic Fellows have an important perspective to share with younger residents and medical students. In addition, they build unique, life-long friendships that connect them to the global orthopaedic community."

The impact of the training provided under the program is evidenced in comments from the post-trip survey each participant completes.

"There was a missed pediatric septic hip referred from an outside hospital that we diagnosed on the ward and took to the operating room," wrote Dr. Cohen. "As a result of this case, I gave a grand rounds lecture to the orthopaedic department on pediatric septic hip evaluation and diagnosis. Pictures of the slides from my presentation were distributed to the orthopaedic technicians throughout the country so they too could learn about pediatric septic hips. The students were engaged during the presentation and when we had another child referred with hip pain the interns and students enthusiastically applied the Kocher criteria and discussed the differential diagnosis for this patient. … I felt I made a big difference for the future."

"HVO's model is centered around building the local medical infrastructure through education," commented Eli Kamara, MD, who traveled to an HVO project site in Nicaragua. "It's a far less sensational model when compared to surgical mission trips, but it's much more sustainable."

In the wake of their fellowships, many participants report a significant impact on their own careers and professional relationships.

"As a resident, it exposes you to a different educational model and way to perform orthopaedics," said Dr. Kamara.

"International volunteer work is important for residents to learn how other healthcare systems and cultures work, and how to best integrate into these systems," explained Dr. Cohen. "It also provides exposure to pathology and treatments that residents may have only read about in textbooks. But most importantly, it teaches cultural competency, teamwork, and flexibility—all important tools for a physician to have and develop."

"I made life-long friends and colleagues with the residents at the institution. Their humble attitude and great knowledge of orthopaedics with the limited resources available to them inspires me to improve my craft daily," wrote Dr. Araiza in his post-trip survey. "[The trip] made me question the things I do in my practice and ask if I can be more efficient. … Lastly, it made me take a closer look at how empathetic I truly am in my day-to-day life as a surgeon."

According to HVO's annual program report, Dr. Araiza is not alone in his assessment. In 2016, 100 percent of HVO volunteers specializing in orthopaedics reported that their assignment had broadened their professional perspectives, and 97 percent said that their assignment had enriched their commitment to global health and service and increased their cross-cultural competencies.

In light of this impact, it is not surprising that many fellowship participants continue to develop an ongoing association with HVO.

"I look forward to volunteering with HVO in the future," Dr. Kamara said. "I think [the HVO] model of service through education is excellent."

"I look forward to visiting that site for years to come and hosting my colleagues from abroad in America as well," reflected Dr. Araiza.

For colleagues who consider participating in an HVO program, Dr. Kamara advises openness and flexibility: "I would advise them to come with an open mind and embrace the local way of doing things; try to share ideas and techniques … that can build on the local knowledge, rather than starting from scratch."

"Confident, yet caring surgeons will share the knowledge that these outstanding residents want," agreed Dr. Araiza. "Take the time to learn the culture and ways of doing things at your volunteer site before making any changes. We are there to help them and ourselves."

HVO accepts applications for the Orthopaedics Traveling Fellowship on a rolling basis. Fellowships are available to senior residents training in programs recognized by the American Board of Orthopaedic Surgery. Residents can volunteer at HVO orthopaedic projects in Bhutan, Bolivia, Ghana, Malawi, Nicaragua, Tanzania, or Uganda. Details about applying are available on the HVO website, at https://hvousa.org/get-involved/apply-for-a-fellowship/

Katie McMullen is communications manager, Health Volunteers Overseas.