By V. Franklin Sechriest II, MD, Commander, Medical Corps, United States Navy
In the five years following deployment of the USNS Mercy in response to the Asian tsunami of 2004, the U.S. Navy continues to support and expand humanitarian aid missions through the use of two hospital ships staffed with military and civilian medical personnel1. During these missions (USNS Mercy to Southeast Asia in 2006 and 2008; USNS Comfort to South America in 2007), orthopaedists from the U.S. Navy as well as from civilian nongovernmental organizations have maximized each ship's operational capacity and resources to treat hundreds of patients with acute (Fig. 1), chronic (Fig. 2), and complex (Fig. 3) musculoskeletal conditions. Additionally, professional collaboration between orthopaedic crew and host-nation physicians aboard hospital ships has facilitated the transfer of knowledge and technology that otherwise would not have been possible in local shore-based facilities or military field-hospitals. Notably, because these hospital ships are easily mobilized, orthopaedists have been able to access patients for treatment and follow-up care in multiple nations and/or geographic locations during a single mission2.
Fig. 1 Fig. 2: Fig. 1 Anteroposterior radiographs showing the left humerus of a thirty-year-old Filipino man whose segmental fracture (left image) was treated with acute intramedullary nailing (right image) aboard the USNS Mercy in 2006. Fig. 2 Anteroposterior radiographs showing the right femur of a twenty-eight-year-old Indonesian man whose long-standing nonunion (left image) was treated with cephalomedullary nailing and iliac crest bone-grafting (right image) aboard the USNS Mercy in 2005.
Fig. 3: Anteroposterior radiographs showing the left humerus of a forty-year-old man who was brought aboard the USNS Mercy for treatment of a low-grade chondrosarcoma (left image). This patient underwent a biopsy and a Tikhoff-Linberg procedure (right image) during a week-long humanitarian aid mission to Tawi-Tawi, Republic of the Philippines, in 2006.
For as long as the U.S. Department of Defense continues to deploy hospital ships on joint military and civilian multinational humanitarian aid missions, orthopaedists will have access to an extraordinary operational platform to deliver advanced surgical treatment to needful patients abroad3. Because these sea-based military humanitarian aid missions are designed to include civilian personnel (i.e., Project HOPE, Operation Smile, and Save the Children USA) as medical colleagues and force-multipliers, there exists a great and untapped potential for new partnerships between the U.S. Navy Medical Corps and civilian orthopaedic humanitarian organizations.
Operation Walk: A Way to Give Back. My Experience
By Douglas A. Dennis, MD
Joint replacement is a well-proven surgical procedure that can relieve substantial pain and functional disability for those with advanced osteoarthritis. More than 1,000,000 joint replacements were performed in the United States alone in 20071. Unfortunately, many people from developing countries who suffer from disabling arthritis of the hip or knee joints have little access to the life-changing benefits of total joint arthroplasty. To address the severe needs of these people, Lawrence D. Dorr, MD, founded Operation Walk in 1994. Over the last decade, numerous additional chapters of Operation Walk have been founded, including Operation Walk Denver, which I have the privilege of leading.
Operation Walk is a not-for-profit, volunteer medical service organization that provides free surgical treatment for patients in developing countries (and occasionally the United States) who have disabling arthritis and little to no access to life-improving care. The patients who are selected typically live under terrible conditions and often have not walked normally without pain for periods of fifteen to twenty years. Because of their inability to walk and provide for themselves, many lose their jobs, their families, and the ability to experience the basic joys of life. If these patients were living in America, they would have had a total knee or hip replacement performed decades earlier, and therefore they are very grateful for the care that they receive.
In the host countries, local surgeons, doctors, and nurses play an integral role in the entire process. Prior to our missions, they screen and evaluate potential surgical candidates. The results of these evaluations, along with patient radiographs, are sent to Denver for review months before the mission trip begins. This enables our team to plan and assemble appropriate supplies, including the specific sizes and types of joint implants that will be needed. Thereafter, the logistical task of coordinating schedules, surgical supplies, and transportation begins. Approximately eight tons of supplies are shipped in advance to the target nation for each mission. A large team of approximately forty-five health-care providers, including surgeons, anesthesiologists, internists, physician assistants, physical therapists, and other volunteers, travel to the host country for each mission with the goal of completing approximately fifty to seventy joint arthroplasties. Local surgeons, doctors, and nurses participate in each mission, with the goal of receiving the education necessary for them to help care for patients in their own countries in the future.
My experience in participating in Operation Walk has been the most fulfilling part of my medical practice. The blessings we have in America are plentiful. Operation Walk is an outstanding way to give back to those throughout the world who have so little access to the quality health care that we routinely receive.
US markets for large-joint reconstructive implants 2009 RPUS21LJ09. Toronto, Ontario: Millennium Research Group; 2009.