Day 5: March 26, 2012

In addition to performing surgery and physical therapy, a large facet of Operation Walk is education. It has been an amazing opportunity to learn about a different culture, healthcare system, in addition to getting to know an remarkable group of patients, medical students, and hospital staff. With that sense of professional open exchange, we have also used this opportunity impart our techniques and practices. In preparation for the mission, nursing coordinator Barbara Aggouras provided an educational inservice with the floor and ancillary nurses as an orientation. Likewise, OR Coordinator Paul Laemmle performed an orientation to the OR Staff. Our goal is to provide the same safe and professional care as we would at our home institutions. As such, we have incorporated use of the WHO surgical safety checklist since 2009 to ensure he correct site and patient prior to every surgery.

Each day of the trip has been an education. The severity of disease amongst our patients and the opportunity to work with such experienced and skillful surgeons is a tremendous opportunity for the orthopaedic residents. Each year three orthopaedic residents accompany the trip, including a PGY3, PGY4, PGY5. They serve to help manage the floor as well as work one on one with the attendings in the OR . The PGY 4 serves as the chief medical officer and was the primary coordinator with Dr. Alcantra and his team before and during the mission. Dr. Collin May performed the role this year. He did a superb job and the success of the mission thus far is truly a credit to his hard work. Unique to this experience, we are able to be involved in the care of the patient from start to finish, which is a luxury we are not always afforded in residency. From the first day during the preoperative evaluations and ground rounds, where we reviewed each patient and their imaging and discussed of the indications and special considerations for each case, to XRay rounds this morning where we reviewed each patient's post-operative radiographs and the intra-operative findings while the surgeon's discussed why and how they performed each procedure. Having the opportunity to work and learn from 4 leaders in the field has been an amazing opportunity.

The spectrum of disease seen here is vast, providing an education in of itself and a chance to learn how to manage problems we might not otherwise encounter. For example, we have a 43 year old patient with a history congenital genu varum (bow-legged) treated with surgery at age 10. She subsequently has developed significant pain and instability such that with each step her knee collapses. Radiographs showed significant degenerative changes in addition to deformities of her femur and tibia making this a complex case. Residents had the opportunity to discuss the patient with Dr. Thornhill and the other surgeons, as well as examine the patient and her gait in order to prepare for the case, in addition to assisting in the procedure. And of course, we had the chance to see the patients joy as she took her first few steps on her brand new knee.



Likewise, attending anesthesiologist Mercedes Concepcion has created a wonderful experience for the anesthesia residence. We had the pleasure of working with Dr. Daniella Lazea and Dr. Monica Hoagland. They did an amazing job performing spinal anesthesia and femoral nerve blocks to provide our patients with good pain control. They did a staggering number of procedures over the past 5 days, and it has been an great supplement to their anesthesia training.

Of course, we also want the local medical students to gain as much from this experience as possible. In addition to daily teaching on morning rounds with the surgical attendings, our internist Dr. Katz has been performing informal patient based educational sessions on the floor. Today we held a teaching session with all of the medical students discussing management of perioperative medical problems/emergencies, an introduction to osteoarthritis, rheumatoid arthritis, and joint arthroplasty, as well as some case based learning. The medical students were attentive and interested, and hopefully gained some knowledge that will help them with their future endeavors.