One of the greatest satisfactions that an orthopaedic surgeon performing hip and knee arthroplasties experiences is seeing how their patients do post-operatively. The dramatic improvements in pain relief and function typically seen are among the strongest reasons to specialize in hip and knee surgery.
In October of 2008, a team of nearly 50 orthopaedic surgeons, nurses, OR technicians, physical therapist and other support staff traveled to Lima, Peru, and performed 48 total hips and knees as part of Operation Walk, a not-for-profit volunteer organization that provides tertiary joint replacement care for patients in countries where such care is typically not available. While the team was able to see the short-term outcomes, one often wonders "How will these folks do once we leave?"
When Operation Walk Maryland's team leader, Harpal Khanuja, MD, offered the chance to return to Lima in February with a small team, I jumped at the chance. One of the greatest satisfactions of participating in an Operation Walk is the interactions with patients and their families as well as the local health care providers. To see them again, and to see how they had done, seemed irresistible. While I have participated in several Operation Walks, I had never gone back to perform such a follow-up visit. There was another motivation to return however; while we had accomplished much in our October trip, there was still some work that we both felt was left undone.
The entire team had become particularly attached to one patient: a young woman with severe rheumatoid arthritis who presented to us with both knees spontaneously fused. While we were able to replace one of her knees on our first trip, she clearly needed the other side replaced. Dr. Khanuja and I hoped that as a part of this trip, we could "finish what we started." This particular patient was so striking given not only the severity of her disease, but the warmth of her personality and her stated desire to help others with her new found mobility. She had pledged to use her excellent English skills to help us on return trips to Lima.
As we entered the hospital with Dr. Gaston Barnechea, who facilitated our first and this follow-up visit, Dr. Khanuja and I were both somewhat concerned about the availability of implants to perform this relatively complex procedure. Further, we wanted to ensure that her outcomes from the first side were good enough to justify the risks of attempting her second knee. After we examined her and saw how well the one knee was functioning, we were committed to performing the other side. Although our implant choices were more limited than we would have liked, the procedure went smoothly, and I think we both felt a sense of closure and that we had really helped someone. Although one does to a certain extent get this type of satisfaction routinely as part of our practices, it nonetheless felt special.
On our second day in Lima, we arrived early at the hospital to see the rest of our patients. As we walked into the clinic, we quickly saw patients and families that we recognized and to my astonishment, they started to clap for us as we walked down the hall. Assisted by Carmen Pichard, MD, a fourth-year resident from Hopkins who is a native Spanish speaker, as well as Dotsie Czajkowski, Dr. Khanuja's nurse practitioner, we saw almost every one of the patients we had operated on in October. All were doing well, and any fears that we had about patients not doing well once we had departed were erased.
What was most striking were the functional improvements that these patients described. Many had been wheelchair bound prior to their replacements and were now able to ambulate independently; needless to say they were eager to show off their new found ambulatory capacity. The images of patients and their families sharing their gratitude captured by Fred Loor, Dr. Khanuja's brother-in-law and our trip scribe, will I am sure provide much for those members of the team who could not come on the follow-up visit.
When I returned home, several people asked me if it was worth it to travel to Lima for two days. Unequivocally, the answer to that question is yes.
If you would like to make a donation to Operation Walk please visit www.operationwalkmd.com/donationform.pdf or contact Operation Walk Maryland directly at 410-229-9800. 100% of all donations will directly assist with providing patient care including the purchase of dressings, crutches, and the surgical implants.
