Nicaragua Orthopaedic Mission 2016

Dr. Klippenstein and several of his OR coworkers have been participants in Operation Walk Winnipeg, a humanitarian surgical team that has travelled to the Central American country of Nicaragua to perform total knee replacements on an annual basis. As one of the two Canadian teams on this initiative, this interdisciplinary group of volunteers raises their own support, receives donated knee implants from two orthopaedic supply companies, and collects the funds and supplies necessary to perform 60 to 70 knee replacements on underprivileged citizens over the course of a week. As a further initiative to help this cause, Dr. Klippenstein collects used knee braces from his patients to distribute to needy recipients there.

Read Dr. Klippenstein’s talk, “Reflections on Operation Walk 2016” presented the following year at a fund-raising event.

Reflections on Operation Walk 2016

When my Brandon coworkers and I learned that we were accepted to join Operation Walk Winnipeg on their 5th medical mission to Nicaragua last November, we were thrilled. Thrilled, a bit nervous, and pleased about the prospect of a humanitarian adventure. We would join an excellent group of like-minded professionals, charitably volunteering our time and skills. We would do knee replacement surgery that we routinely perform in our jobs at home. We would provide improved mobility and pain relief to those who otherwise wouldn’t have access to this treatment. And it would all be for the common good. This was going to be great!

How our expectations were jolted when we arrived in Nicaragua. Despite what we had heard, we had not fully comprehended the bracing reality of the situation there, nor the enormity of the OpWalk mission. The medical need is tremendous, with the prospect of a knee replacement completely out of reach for the majority of the population. Furthermore, we had not anticipated just how quickly a collection of 65 medical professionals and volunteers from various centres could become a close-knit, singleminded and multi-tasking team, doing so much more than simply “charity work”.

Arriving by bus the first morning at the Roberto Calderon Hospital in the capital city of Managua, we could not have imagined the pervasive poverty that gripped the surrounding neighbourhood. Nicaragua is one of the poorest countries in the Americas, where over 80% of the population live on less than 2 dollars a day. Apart from the physical realities, we certainly weren’t prepared for the emotional impact created by scores of needy people, anxiously awaiting our arrival in a setting with such minimal medical resource. Contrary to our initial assumptions, these were certainly not routine cases. There was so much more than mobility and pain relief at stake. And there was nothing common about the good that was being done on this mission.

With perspiration brought on by the 30 degree heat and some initial trepidation, we walked from the patient-lined hospital hallways into the packed waiting room. It was overflowing with prospective patients and their wheelchairs, walkers, and waiting families, all hoping to be chosen for surgery. It was a scene I’ll never forget. The lowly hospital, the obvious hardship, and the rows of expectant, staring faces quickly set the stage for the mission ahead. Any self-satisfied notion of charitable medical care was quickly replaced with the immensity of the need and the magnitude of our task.

We soon learned that our higher mission was not simply to create straighter, more functional limbs, but to provide a life-changing intervention to move from a wheelchair existence to the possibility of independence, from chronic crutch walking to family supporting employability, and from endurance of disability to a life of hope. At no charge. And for those who otherwise would not have access to this possibility. As a previous OpWalk participant said, “If you don’t walk you don’t work, and if you don’t work you don’t eat”. And maybe not your family either.

As the first overseas medical mission for the three of us, we couldn’t have imagined the impoverished state of the hospital. The run down building was strapped with outdated and marginally functioning equipment, makeshift substitutes, taps with no water and patient rooms with no oxygen supply. Operating theatres featured rusted and seized up beds, brown water dripping from the OR lights, and flies landing on the sterile field. Wheelchairs had been fashioned from plastic chairs, and IV bottles hung from nails in the wall.

Overcrowded wards with torn mattresses on cracked plywood frames were occupied by patients whose bedside families attended to their needs and brought food from roadside vendors on streets around the hospital. It was a challenge to find even basic supplies like a roll of tape or a double-A battery. It became abundantly clear that quality care and relief of suffering here would not be predicated on modern technology and fully stocked supply shelves. Indeed, the stark contrast to our Canadian working conditions was shocking.

Working with new colleagues, learning unfamiliar surgical systems, and foregoing our usual luxuries of breaks, shift changes, and ample staffing, we kept up a pressing pace to meet the targeted operating list. Patients were prepped and introduced to the surgical team through interpreters in the pre-op areas. Four operating theatres worked nonstop through the day and sometimes into the evenings, each day changing up the team combinations. The donated implants from two orthopaedic companies with additional equipment and supplies that had arrived earlier by shipping container were carefully rationed to cover all the cases. Hardly a slate went by where an innovation wasn’t required to cope with limited or defective local resources. We managed to implant about 70 new joints in 3 1/2 days, in a hospital that typically performs about 200 replacements in an entire year, and only for those patients who can pay.

Having the opportunity to work with other orthopaedic surgeons and nurses, including educators and leaders in their field, was a tremendous privilege and wonderful learning experience. Daily gleaning surgical tips and ideas from our new colleagues, with their wealth of experience from other programs, was an added benefit of the trip. Trust and friendship grew over the OR tables, in the various patient care areas, and in the instrument preparation rooms. There was a palpable “I’ve got your back” sense that quickly embraced and supported us throughout the week.

Meanwhile on the wards, therapists busily mobilized post-op patients, who displayed amazing fortitude and determination to walk short hours after their operations, often for both their knees. They typically were able to leave hospital within a day or two of surgery, and with minimal pain medication. Team volunteers were tasked to assist our nurses to clean, sort, and sterilize equipment. Most of us performed tasks quite outside our usual duties at home. Days were long, exhausting, and tremendously gratifying.

What the Roberto Calderon Hospital did not lack was an eager staff of their own nurses, physicians, and trainees, intent on helping us attain our ambitious goals in whatever way they could. Some staff were know to several of our group from previous trips, but most of the contacts were new. These local health workers were friendly, sometimes a bit shy, and most respectful. From that first hectic day of assessing prospective surgical candidates, through the daily organizing of patients and OR theatres, to the last day of ward rounds and final physiotherapy sessions- their hospital staff translated, supported, and smiled.

In the OR theatres their nurses helped prepare and clean the rooms, routinely collecting our used and discarded supplies for later recycling. Their orthopaedic residents were keen to observe cases. Later I enjoyed going over a number of surgical scenarios with a senior resident preparing for his exams, with X-ray pictures from his phone, and in very broken English. Our two translators were in constant demand to facilitate necessary communication. Unfortunately my plan to learn some Spanish before our next trip is going slowly.

It was gratifying to host many of the local staff at our hotel later in the week for a joint celebratory dinner. There were exchanges of speeches, gifts, and language-challenged conversations, giving us a chance to get better acquainted and learn more about life in their country. We were told that our team’s practice of engaging and including their people in our work there was much appreciated and in contrast to non-Canadian teams that had come on similar missions. This likely helped us secure our plans to return to Managua for this year and into the future, despite the wishes of other groups hoping to take over the Nicaragua assignment. What has been built up over 5 years is certainly worth maintaining.

And so the hundreds of Nicaraguan recipients of new joints and new mobility over these 5 years would simply not have been so fortunate had it not been for Operation Walk Winnipeg and people like those in this banquet hall tonight. Not been as fortunate as this man who needed to support his extended family despite his crippled legs, and who now is able to get off his crutch and pursue more gainful employment.

Or as fortunate as this long time wheelchair bound single mother who had both her knees replaced, and who was able to walk out of the hospital on her own. This enabled her teenage daughter to return to school, having dropped out to look after her siblings.

Or indeed as fortunate as many others, each with their own particular restrictions and needs, now able to overcome barriers to mobility and employment and independence. It would have been good to hear more of their individual stories. What we do so routinely here in Canada, seemed to take on added significance and potential in Nicaragua.

But not so fortunate was this 22 year old man, who was hit by a truck on his motorcycle one month previously, breaking his femur and tibia. Because his family could not afford to buy the hardware needed to fix these fractures, he travels back and forth to the hospital, pushed in a wheelchair by his mother. He has regularly scheduled periods of traction through a pin in his knee, a long outdated fracture treatment, and receives intravenous antibiotics for persistently draining infection. It’s doubtful his femur fracture will ever heal properly with this treatment. Though much good work is being done here, there is still so much need.

It’s the faces and stories of people such as these who left the biggest impact after that amazing week. Their gratitude was truly humbling. Grasping your hand before surgery they would repeat that they believe in God and they believe in you. They would stand up beside their post-op beds on our rounds to deliver tributes and prayers. They would show up at the OpWalk hotel unannounced to bring thank you gifts. Its ultimately these Nicaraguan people who made the effort and cost so worthwhile and unforgettable. An experience such as this touches one’s life, values, and faith in ways that are inexpressible. In volunteering our time and skill, it felt like we ourselves had been the recipients of a wonderful gift.

An added bonus was three trips to rural schools that had been arranged by one of our team members for the end of the week.This gave gave some of us an opportunity to visit Nicaraguan children in their school settings, an eye-opening and emotional experience in itself. The dilapidated school buildings next to cattle sheds, seemingly devoid of any classroom resources, were filled with scores of cheering children and their parents in anticipation of our visit. Donated and collected school supplies were distributed, fluoride dental treatments were administered, and desks were painted. Rousing play time with donated balls and sports equipment reminded us that children are similar around the world, regardless of culture, means, or opportunity.

And so the three of us returned to Brandon having been rewarded with a truly life-changing experience, new friends, and many indelible memories. In a final sobering footnote to the trip, we learned that Hurricane Otto hit the shores of Nicaragua just 5 days after our return. None of us expected just how close the Operation Walk team could become, how deeply the people of this country would affect us, nor how our Canadian medical skills and efforts could be put to such meaningful use. There were many shared messages by our team members after the trip expressing just how wonderful, impactful, and unforgettable this experience was, but I’ll leave you with the words of one of the Nicaraguans who reached out to us after we left:

“My sincere appreciation and gratitude for the amazing and heart-stirring work done by each one of the Operation Walk members, in my country of Nicaragua. You are among the world’s finest people that I have met and that are always doing what is best for this wounded world. It was a privilege to have worked with each one of you. I and my compatriots would want you to know, how much forever thankful we were for your gentle caring ways, for all your compassion and going above your call of duty (bringing hope and love to my hopeless countrymen and countrywomen). We feel blessed and honoured to have known all of you. Until next time. God bless you”.

And we’re fortunate enough to be heading back to Nicaragua this November, ready to further the work of this amazing organization, and help translate the financial resources being raised tonight into new joints and new hope for needy people in Nicaragua. Thank you each one for your contribution to this most worthy and needy cause.