11/9/15
Travel and Medicine
A Fifty Year Odyssey
Haiti to Bangladesh
Terry R Light, MD
November 7, 2015
Many Orthopaedic Surgeons
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Travel extensively
Perform remarkable
service
Work under very
difficult
circumstances
I am not unique
I Believe
There is much to
gain from
overseas
orthopaedic
travel for
education and
service
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Surgical Experiences
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Haiti
Nigeria
Lithuania
China
Singapore
Egypt
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Viet Nam
Thailand
Cambodia
India
Bangladesh
Objections to Travel
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It will be expensive and disruptive to be
away from my office
It may be dangerous
I could get sick
I like the US better than anywhere else
I have nothing to teach
I will do it when I am more experienced
FOCUS – 1961-1975
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Foreign
Ophthalmologic
Care from the
United
States
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FOCUS – 1961-1976
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Three Founders
Year round month
long volunteers
After 15 years
Clinic turned over
to well trained
Haitian
Ophthalmologist
Haiti - August 1962
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Parent planned adventure at 15 years
Planned partner – Jimmy Funk
Solo
Haiti - Summer 1962
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Haiti - Summer 1962
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Maison de l’Espoir – Port de Paix –
Caroline Bradshaw
L’Ile de la Tortue – Pere Roger Riou
1975
Resident Trip to Haiti
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Peachtree
Orthopaedic Group
Three partners
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Jim Funk
Scoot Diamond
Bob Wells
Annual Trips for
more than 30 years
Hôpital Albert Schweitzer
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1975 – PGY-3 Trip to Haiti
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Polio
Severe Clubfoot
Rickets
TB Hip
Potts Disease
15 y/o male
TRL biopsy of distal femur
Local
Two days later
Plan Amputation
without
histology
• YIKES!
• Really?
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Above Knee Amputation with
Esmark wrap and 4 sutures
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Was this the “right”
treatment?
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If we don’t do it… no one will
Is it wrong to treat patients differently
in different situations
I think so
New Haven Histology
Dx - Osteosarcoma
Paul Farmer, MD
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Harvard Public
Health physician
Haiti caregiver
Argues that we
should never be
content with less
than the best
treatment for
every patient
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1980 - Trip to Haiti
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Lectures at Port au Prince Medical
School
Surgery scheduled at Episcopal
Health Center
Pre-op visits the day before surgery
Life is hard in Haiti
Pre-op Patients
Temptation to work outside
your comfort zone
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30 Minute Hiatus
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Several Palmar
Burn Hand
Patients recruited
Palmar Burns
from young
children falling
into cooking fires
1982 – Abak, Nigeria
1982 - TRL Mission
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Invited by Nigerian Cardinal to evaluate
Cross River State
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Orthopaedic Needs
Opportunities to establish new
Orthopaedic Clinical Program
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welcumwhimon
Reality
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Donated X-Ray Machine had never
been installed at Hospital
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All Politics is Local
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Hospital Chief of Surgery owned XRay machine in his office one mile
from Hospital
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It would be OK to do orthopaedics
without X-ray but really not interested
in having an X-ray machine at the
hospital
1986
ABC Traveling Fellowship
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Tremendous Opportunity to visit
English speaking Centers
Applied
Letters of Support
Plan for 6 week absence
1986
ABC Traveling Fellowship
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Tremendous Opportunity to visit
English speaking Centers
Applied
Letters of Support
Plan for 6 week absence
UNSUCCESSFUL
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Bunch Rebound Plan
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Take the time off
Do my own
fellowship
Where would I
like to go?
My 1986 “Fellowship”
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Hamburg, Germany
Edinburgh, Scotland
Dieter Buck-Gramcko
Douglas Lamb
Windsor, England
Tokyo, Japan
Kyoto, Japan
David Evans
IFSSH Meeting
Post Congress Mtg
Befriended Hand Surgeons interested in
Congenital Hand Anomalies world-wide
1986 – met Toshi Ogino, MD
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September 1993
Kansas City, Missouri
CHASG Founding
Ogino, Benatar, Light, Foucher, Wood, Ezaki, Cooney, Littler, Evans, Manske
1994 Windsor, England
The Queen’s Leonardo da Vinci
Anatomic Drawings
1994 - Vilnius, Lithuania
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Lessons Doing
Demonstration Surgery
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Select simple cases to demonstrate
basic principles
Have intermediary narrator, if
possible
Select simple cases
1995 Tampere, Finland
Vilkki Toe Transfer for RD
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Saint Petersburg, Russia
1996 - Chicago
1998 Leeds, England
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2000 Kyoto, Japan
2002 Loma Linda, California
2003 Hamburg, Germany
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2004 Buenos Aires, Argentina
2005 Pretoria, South Africa
2008 – Rotterdam, NL
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2011 Saigon, Vietnam
2013
Stockholm, Sweden
2014 Minneapolis
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2015 Rotterdam
CHASG
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Facilitated “Priceless” International
Friendships
Provided robust interchange of ideas
Kindred spirits willing to travel
anywhere for 2 day meeting
1992 – Chicago Shriners Hospital
Caring for Kids from Lithuania
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Lithuania Children's Hospital
12 Visits between 1994 - 2010
Our Team Brings All Supplies
Lithuanian Mini Chernobyl
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All physicians
flee OR for
routine X-ray
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Mentoring Young Hand Surgeon
Darius Radzevicius, MD
Type VI Thumb Duplication
Ulnar thumb atop Radial
thumb
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Less is More
7 Year Follow-up
Residents
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Hospital Ceremony
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A big bore
Takes away from
time that could be
spent caring for
patients or
teaching
physicians
Ceremony
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Brings attention
to the work being
done and the
underlying need
Allows
celebration of
success
Publicity
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Lithuanian Film crew in OR
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Power Failure
Lights out
Patient wheeled to
window
Surgery completed
President watches
TV news
Evolution of Lithuanian
Project
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Demonstrate procedures
Lithuanian Surgeons assist
Assist Lithuanian Surgeons
Review their cases
Internet case consultation
Assist with International Hand
Surgery Meeting (2014)
Friendships grow with time
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1989 China
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Travel requires a Visa
“Visa may be obtained in airport with
official letter of invitation”
My Mom thought this was a bad idea
Lesson
Listen to your mother
The Golden Rule
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It is their country
You are a guest
They make the
rules
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Microsurgery in China
Shanghai Conference Case
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Metacarpal Synostosis
TRL suggests complex
remedy
Toshi Ogino proposes
simpler strategy
TRL agrees to Ogino
procedure
Many, many observers of
osteotomy on small hand
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Binoculars for All
Viet Nam 1999-2015
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Michael Lehoang, MD
How Much “Stuff”
Should You Bring
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Bring Everything
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Don’t use their precious stuff
Demonstrate what is possible when
get they get the stuff we have
How Much “Stuff”
Should You Bring
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Bring Nothing but Personal Loupes
and Scrubs that fit
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Use their stuff
Demonstrates what can be done in
their facility with their stuff
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4/2009 Saigon, Vietnam
History – Prior Infection
Treatment Alternatives?
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Centralization
On top plasty
Distraction
Lengthening /
Free Fibula
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Greenstick Ulna Osteotomy fixed
with Hand Drill Inserted K-wire
No Intra-op Imaging
6 months post-op
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6 Years Post-­‐op
ASSH Ambassador
2014 - India / Bangladesh
Outpatient Visits
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Demonstration Surgery
Saturday Coimbatore
Hand Course Attendees
Raja Sabapathy
Inspiring Leader
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Coimbatore treated case
Diagnosis?
Cross Hand Transplant
Dr. Hari Venkatramani
Bangabandhu Sheikh Mujib
Medical University
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Bangladesh
Three Day Course
Three Day Course
60 Attendees
Concluding Ceremony
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Respectful (possibly blind)
Audience
Coimbatore, Nashik, Dhaka,
Delhi
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14 Days
8 Airplane Flights
29 Talks
10 Surgeries
65 Patient Consultations
Is it Ethical to Cut and Run?
F. Continuity of Care of the Surgic al Patient
• The surgeon will ensure appropriate continuity of care
of the surgical patient.
• An ethical surgeon should not perform elective
surgery at a distance from the usual location where
he or she operates without personal determination of
the diagnosis and of the adequacy of preoperative
preparation.
• Postoperative care should be rendered by the
operating surgeon unless it is delegated to another
physician who is as well qualified to continue this
essential aspect of total surgical care.
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Prepare to be healthy
Bring your meds
Take prophylaxis
Immunizations
Consider
evacuation or
treatment
strategy in
advance
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Expect the Unexpected
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Stuff will go wrong
Count on it
Miscommunication is routine
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Patient “recruitment”
OR Requirements
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Bad news is hidden
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What can you change?
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TIME OUT
Particularly
important when
there are language
and cultural barriers
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Opportunities
Summary
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Overseas Orthopaedic Experiences
are extremely rewarding
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Opportunity
to treat
“underserved”
• to educate
physicians thirsty
for exposure to
current practice
• to learn from
skilled overseas
colleagues
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International friendships are
priceless in a fragile world
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