The Department of Orthopaedics is committed to producing and fostering clinicians and trainees who serve, learn, and give. This is exemplified in the work they do globally to establish relationships, provide training for physicians and staff in underserved countries, develop research and practice models in the field, and help those who need it most.
Global programs are constantly evolving and expanding as faculty and staff are seeking new ways to serve and locations in need. Today, the Department of Orthopaedics is involved in varying capacities in Honduras, India, San Salvador, Norway, Nepal, Jamaica, Kuwait, Sri Lanka, and Tanzania.
The legacy of critical illness leaves millions of survivors worldwide with long-lasting deficits in physical and brain function as well as anxiety, depression, and post-traumatic stress disorder. Early rehabilitation in the intensive care unit (ICU) may prevent or minimize these effects. Amy M. Pastva, PT, MA, PhD, is collaborating with a global team from the University of Melbourne/Austin Health, Australia (Sue Berney, PT Ph.D., and Linda Denehy, PT, Ph.D.), Royal Brisbane and Women’s Hospital, Australia (Jennifer Paratz, PT, Ph.D.), and Johns Hopkins University, USA (Dale Needham, MD, Ph.D.), to study the effectiveness of functional electrical stimulation of leg muscles during in-bed cycling (eStimCycle) on muscle bulk, strength, physical function and brain function at hospital discharge and at 6 and 12 months afterward in patients who were critically ill in the ICU (ClinicalTrials.gov ID: NCT02214823). This is one of the first of global studies in critical care rehabilitation and the combined effort will help guide treatment strategies worldwide for patients at high-risk for ICU-acquired deficits.
Current and former Duke residents and fellows, including Dr. Daniel Mangiapani (PGY-4 resident); Dr. Jordan Schaeffer (Resident Class ’13); and Dr. Tim Randell (Fellowship Class of ’15), traveled to San Salvador to participate in Operation Walk Utah. Operation Walk Utah was started in 2007 by Dr. Aaron Hofmann (Hofmann Arthritis Institute), who had a dream of doing free surgeries in third-world countries with a team of volunteers. It is a private, not-for-profit, volunteer medical service organization that provides free joint replacement surgeries for patients with disabling arthritis in developing countries and in the United States. Operation Walk also educates in-country orthopedic surgeons, physical therapists, and other health care professionals about advanced treatments and surgical techniques for diseases of the hip and knee joints.
During the trip to San Salvador, the Operation Walk Utah team performed 72 joint replacements in 5 operative days, spanning 3 ORs. Cases ranged from a 35-degree valgus knee with MCL incompetency to bilateral total hip arthroplasty on severely dysplastic hips. On the team’s final day, they rounded on all the inpatients, whose joy and happiness radiated on both their faces and the faces of their families.
“It was, no doubt, a life-changing experience that has changed my outlook on what ‘service’ truly is,” says Dr. Mangiapani.
In May of 2018, as part of the Touching Hands Project through the American Society for Surgery of the Hand, eleven physicians met in the San Pedro Sula airport, just outside this industrial capital of Honduras (population approximately 1.2 million). They had come from Michigan, Texas, New York, Rhode Island, and North Carolina eager to make a difference. As a group, they quickly appreciated that they were serving a greater cause than that defined by their individual roles. They became a true team – a team illuminated by shared experiences, education to a collective mission, and passion for what they would do. The group evaluated 152 patients to begin the week and create our surgical schedule. The team performed 52 cases over the week; almost all the procedures were complex cases that included both adult and pediatric/congenital reconstructions. The doctors reported that they struggled mentally with not being able to “cure” everyone in a week, but they could sense the hope provided to those they treated, and the awe of such a responsibility that can still be realized by simple gestures and nervous smiles from the many children and adults of Honduras with whom they connected.
From January 1-8, 2018, Dr. Selene Parekh and a team of two international foot and ankle surgeons; a resident from Harvard University; Zankhna Parekh, physical therapist; a nurse; and a team of 12 Indian national foot and ankle surgeons traveled to Hyderabad, India to take part in the annual Parekh Family Foundation Foot and Ankle training program.
During this year’s trip, the team:
- Distributed over 500 pairs of shoes to children in need
- Trained over 130 surgeons and 70 physical therapists
- Started nurse training and education in diabetic foot care
- Performed charitable surgeries for those suffering from neglected orthopaedic issues ranging from hallux varus, end-stage ankle arthritis, cavovarus deformities, and pes planus conditions, to name a few
- Evaluated patients in charitable foot and clinics
Each year, a group of Duke DPT 2nd-year students and Duke DPT alumni travel to St. Elizabeth’s Parish in Jamaica to participate in a weeklong health care mission trip. The group serves as the staff for a stroke camp that provides high-intensity physical therapy for members of a rural farming community who have suffered a stroke. Resources and access to rehabilitation and long-term care are virtually non-existent.
In February 2020, Duke Orthopaedic hand surgeon Dr. Marc Richard joined a group from Stanford University for a visit to Hospital 175 in Ho Chi Minh City, Vietnam, for a week-long exchange including education, surgery, and the establishment of research protocols to understand the effect of the mission trip.
The Stanford team members included Dr. Robin Kamal (Duke Hand Fellowship alumnus) and Dr. Lauren Shapiro (Duke Hand Fellowship future alumna). Preparing to treat patients who traveled from all over Vietnam, the team spent their first day in indications clinic where they examined varied and complex cases. Subsequently, the next few days were spent in the operating rooms in the mornings and teaching, lecturing, and reviewing case presentations in the afternoons. The team primarily performed hand and upper extremity cases including distal radius fractures, both bone forearm fractures, distal humerus, and humeral shaft fractures and malunions, distal radius mass biopsy, elbow instability, and multiple tendon transfers for a patient with a radial nerve injury following a motorbike accident.
Through a grant, the group established follow-up protocols through a smartphone text message system for operative patients including the use of patient-reported outcome measures. The goal is to understand the ability to affect change through episodic mission trips and to identify barriers to success such that necessary changes can be made. The group plans to return in 2021 and continue this work.
The camp is organized four times per year through the non-profit organization Friends of the Redeemer United (FORU) whose mission is to encourage a healing process through awareness and involvement in spiritual, social, educational, and health-related services in rural Jamaica.