Orthopaedic surgeons have many opportunities to offer their services for domestic and international humanitarian outreach. At the AAOS Fall Meeting in San Antonio, Texas, three speakers shared personal stories about bringing orthopaedic care to underserved communities during a session, titled “Domestic and International Humanitarian Outreach.”
Amy Ladd, MD, chair of the AAOS Board of Specialty Societies, discussed her work with Native Americans on a Navajo Reservation, which she called a “devastatingly poor” population living in a remote area—which made it difficult for them to receive high-quality health care. Half the population is unemployed, does not have electricity or running water, and does not speak English.
“More than 15 percent are in poor or extremely poor health,” she said, noting that a reduction in smoking is the only recent improvement in health in this population. In addition, a quarter of the population is underinsured. The most common diseases and conditions are diabetes, obesity, substance abuse, and depression, whereas the most common causes of death are heart disease, cancer, and accidents.
Dr. Ladd described her volunteer work at the Chinle Comprehensive Health Care Facility in Arizona, which is run by the Public Health Service. The 60-bed facility has an orthopaedic clinic once a month, which is staffed primarily by a physician’s assistant and itinerant orthopaedic surgeons. There is also a hand clinic run by occupational therapists one to two times a month. “It’s a regular thing, even though we’re not there regularly. There is sustainability and continuity,” she said.
Why should others get involved? “I look at it as our own backyard,” said Dr. Ladd. “There’s definitely a blemished history. There’s abject poverty worse than in many developing nations.”
Next, Rick Wilkerson, DO, of Northwest Iowa Bone, Joint, & Sports Surgeons, P.C., recalled his humanitarian trip to Peshawar, Pakistan, in 1990. He became involved with the Health Volunteers Overseas program and described the challenges he faced and lessons learned. “I found this to be
extremely rewarding. It was amazing how you can make very deep connections very quickly,” he said.
“It was [during my time] there that I learned that despite the best intentions of many of us who send [medical supplies] overseas to the developing world to try to make things easier and better for surgery, it doesn’t always work out,” Dr. Wilkerson said. For example, he said, Italy donated a batch of C-arms to Libya, but one of the machines broke, and no one knew how to fix it, rendering it useless. Similarly, Germany donated an operating room light—but no extra light bulbs. As each bulb burned out, the light was less useful.
“The reality is that many of us don’t have long periods of time away from our practice to work [overseas], but you can still be very effective,” he said. He encouraged attendees to find a humanitarian trip that works for them, as there are many organizations putting together such partnerships, with varying lengths of participation.
Dr. Wilkerson shared his personal 10 keys to a successful volunteering mission:
- Enter with an open mind and a willingness to learn and share ideas.
- Learn about the culture before departing.
- Be familiar with the available local equipment and support.
- Do not expect to transition orthopaedics in the developing world to U.S. standards.
- Know that work days in the developing world are often 8 a.m. to 2 p.m.
- Plan on meeting some very bright and capable surgeons.
- You will probably see things you have less experience treating.
- It is very easy to try to do too much; take care of yourself.
- Concentrate on indications and complications.
- The goal for all organizations should be self-sustainability.
“You’ll learn as much or more than you teach,” said Dr. Wilkerson. In his case, Dr. Wilkerson encountered a patient with leprosy, which he had not seen before.
Lastly, Kaye Wilkins, DVM, MD, of the University of Texas Health Science Center in San Antonio, noted that although many programs are available overseas, areas within the United States also require extra assistance.
Dr. Wilkins shared his personal experience of providing pediatric orthopaedic care to southern Texas, which did not have specialized care when he arrived in 1973. Two orthopaedic surgeons had approached him to help provide pediatric orthopaedic care in cities along the Texas/Mexico border. He agreed and began working at McAllen Medical Center.
“They were gathering patients with pediatric orthopaedic conditions for me to see and recommend treatment,” he said. The most common conditions were clubfeet, malunited or inadequately managed fractures, developmental dysplasia of the hip, and limb deformities. He also started developing other clinics where there was a need for such care.
In time, fellowship-trained pediatric orthopaedic surgeons established practices in the area, and today, there are about 50 practices.
“There are lots of opportunities to provide outreach in the United States,” he said. “I focused on providing specialized pediatric orthopaedic care, but I think the same principles apply for doing the same in [other subspecialties].”
In conclusion, he shared the following tips for surgeons considering domestic humanitarian work:
- Make sure you are invited by one of the local physicians. Ask them what they want; do not tell them what they need.
- Try to include a local physician in treatment planning.
- Be sure there is another physician, preferably one with some surgical experience, involved in the treatment process to provide follow-up care.
- Become acquainted with the travel options for the patients, including the availability of transportation, should the patient require treatment at a facility with a higher level of care.
- Be sensitive to the level of medical treatment exhibited by the local physicians.
- Provide a report on the plan of care, follow-up treatment, and results to the local referring physician.
- Always express an appreciation for being able to participate in the local medical community.
Kaitlyn D’Onofrio is the digital medical writer for AAOS Now. She can be reached at firstname.lastname@example.org.