David Spiegel, MD, FAAOS, has been a leader in international orthopaedic care for more than 20 years. A winner of the 2017 AAOS Humanitarian Award, Dr. Spiegel has brought his expertise in neuromuscular disorders, spine conditions, trauma care, and the Ponseti method for clubfoot treatment to health systems around the world, including Nepal, Iraq, Pakistan, China, and others.
According to Dr. Spiegel, he began his work in international volunteerism after completing his residency. He had the opportunity to visit Ashok Banskota, MD, an orthopaedic surgeon and the founder of the Hospital and Rehabilitation Centre for Disabled Children (HRDC) in Kathmandu, Nepal. During his work in Nepal, Dr. Spiegel gained an appreciation for the local surgeon’s ability to find contextually relevant solutions to problems and to treat complex orthopaedic cases, despite having limited resources.
Inspired by Dr. Banskota and his colleagues, Dr. Spiegel continued his work in Nepal, visiting the country on multiple occasions. His work included setting up and volunteering with a project through Health Volunteers Overseas (HVO), a nonprofit organization dedicated to improving global health by bringing education, training, and professional development opportunities to health workers in resource-scarce countries.
Working with local doctors
One of Dr. Spiegel’s most influential contributions in Nepal was introducing the Ponseti method for children suffering from clubfoot. The project started when he was living at the HRDC hospital for six months in 2004. HRDC cares for more than 300 clubfeet per year. The Ponseti method is minimally invasive and contextually relevant. The method has been successful, and the HRDC team has now treated more than 5,000 feet, delivering services through the main hospital and four satellite clinics. As of 2017, almost 800 feet were being treated per year, and a study presenting 10-year follow-up data was published in The Journal of Bone & Joint Surgery in December 2018.
Dr. Spiegel noted that there was some uncertainty about the use of the treatment for walking-age patients, but Dr. Banskota and his team were willing to push the envelope and determine whether the method would be valuable in that patient cohort. “Essentially, you have local physicians who are super talented [and] highly motivated in one of the poorest countries on Earth,” noted Dr. Spiegel, “who embraced the technique, adapted it to suit their context, and kept standard records [that] allowed them to publish a unique study—the only follow-up of patients treated after walking age with more than 10 years of follow-up.”
While volunteering, Dr. Spiegel makes sure to tailor his approach to the needs of the environment in which he is working. “I don’t think solving the problem is necessarily training a bunch of subspecialty orthopaedic surgeons; it’s probably a better idea to strengthen the delivery of basic or essential orthopaedic services at the population level in a low- and middle-income country,” noted Dr. Spiegel.
As a volunteer with HVO, Dr. Spiegel focused on educating and training staff in methods best tailored to their settings; he also provided mentorship and professional support for their research. While volunteering in Iraq, he also worked with colleagues and their trainees to evaluate patients and perform surgery, in addition to didactic lectures. During more recent volunteer trips to Pakistan, he ran trauma courses with local colleagues and friends for general orthopaedic surgeons, and their two-day workshop has been delivered in Lahore, Peshawar, and most recently Karachi.
When thinking about how to be an effective volunteer, Dr. Spiegel emphasizes that volunteers must seek to meet the needs of those they are there to serve. “We’re a guest in someone’s home,” he observed, “and we need to be invited. If we’re invited, I think we should listen before we speak. We should understand the challenges faced by our colleagues, we should know about the health system, we should know about the types of problems, and we should know about the patients and their families and what resources for postoperative care and rehabilitation are available in their local communities.”
To expand on effective volunteerism, Dr. Spiegel recently coedited a second edition of the textbook “Global Orthopaedics: Caring for Musculoskeletal Conditions and Injuries in Austere Settings,” a practical manual for those interested in volunteering in low-
resource environments. The book aims to give individuals exposure to pathologies with which they are not familiar, in addition to those with which they might be familiar but may witness in a different fashion. Dr. Spiegel and his coauthors, Richard A. Gosselin, MD, MPH, MSc, FRCS(c), and Michelle Foltz, MD, have worked to create a comprehensive manual for those volunteering in low-resource settings.
Through his textbook, in addition to encouraging other experienced surgeons to volunteer, Dr. Spiegel urges young residents and fellows to get started volunteering early in their careers. “It’s an amazing educational experience for the trainees, as well as those in practice in high-resource settings,” he noted.
According to Dr. Spiegel, the experience expands skills and knowledge by exposing young surgeons to a wide range of surgical pathologies, as well as different presentations of common pathologies. “[Young surgeons] learn about different solutions to problems. They see how you can take care of problems without all the high-tech solutions; they see how other people live, and they see family relationships [and] societal things. … It’s a very intense, good experience,” he said.
Beyond his volunteer work on the ground, Dr. Spiegel served on the steering committee for the World Health Organization’s Global Initiative for Emergency and Essential Surgical Care, which works to address broader issues in the health systems of low- and middle-income countries. That work has led to an area of research that focuses on identifying the capacity of district hospitals to perform surgical services, as well as the availability of surgical services at the same hospitals, in addition to monitoring their performance.
In the end, Dr. Spiegel believes that the most valuable benefit of volunteering is the ability to expand one’s horizons as a surgeon and caregiver: “I think the biggest thing you have to do as a volunteer is to be able to close your eyes and completely put yourself in the place of whatever colleague or individual that you’re supposed to be interacting with right now.”
Dr. Spiegel chaired the Carl T. Brighton Symposium on Musculoskeletal Trauma Care in the Developing World, which established a network of interested orthopaedic surgeons to help ease the burden of musculoskeletal trauma. He is an AAOS member and a lifetime member of HVO.
In addition to receiving the 2017 AAOS Humanitarian Award, Dr. Spiegel was previously recognized with the President’s Call to Service Award by the President’s Council on Service and Civic Participation in 2006, the Golden Apple Award from HVO in 2009, the Pediatric Orthopaedic Society of North America’s Humanitarian Award in 2013, and the Walter P. Blount Humanitarian Award from the Scoliosis Research Society in 2016.
He works as a pediatric orthopaedic surgeon at the Children’s Hospital of Philadelphia and is on the faculty at the University of Pennsylvania School of Medicine.
Andrea Moody, MA, is the project support manager at HVO.
Interested in learning about global volunteerism?
Learn more during an event at the AAOS 2020 Annual Meeting:
Global Volunteerism for Orthopaedic Surgeons
244 – Instructional Course Lecture Wednesday, March 25
1:30 p.m. to 3:00 p.m.
Health Volunteers Overseas offer opportunities for orthopaedic residents
The Orthopaedics Traveling Fellowship will fund senior orthopaedic residents to volunteer at an orthopaedic project site for two to four weeks. Applications are accepted on a rolling basis. Visit www.hvousa.org/fellows to learn more.