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"This is medicine and caring in its purest form"

Gifts enable orthopaedic surgery residents to perform operations in high-need areas around the world
Posted January 22, 2018
  • Louis Okafor, left, a chief resident of orthopaedic surgery at Hopkins, scrubs in for an operation at a Guatemalan hospital. Coincidentally, he is working beside Thomas Mixa, a surgeon who completed his Hopkins orthopaedic surgery residency in 1991.

  • "Doing medical outreach is like hitting the research button. I come back with a whole new energy," says Okafor, pictured second from left with colleagues in Trinidad.

  • A senior orthopaedic surgery resident at Hopkins, Jay Reidler, center, completed an outreach program with Global Spine Outreach in Monterrey, Mexico, performing surgeries on children suffering from severe scoliosis. (credit: Sarah Larson)

  • "We had to think about which surgical techniques would allow us to help as many children as possible with our limited resources," says Reidler, the second face visible from the right. (credit: Sarah Larson)

There's a sound Louis Okafor, A&S '09, won't forget anytime soon, if ever: the crunch of bone scraping bone, or in clinical terms, "audible crepitus." A chief resident in Hopkins' Department of Orthopaedic Surgery, Okafor heard the sound as he helped a patient with end-stage arthritis in both legs onto an examining table in Trinidad's Eric Williams Adult Hospital. Okafor was part of a team of 50 volunteer surgeons and other health professionals in Trinidad with Operation Walk, an international medical humanitarian organization.

Generous gifts from the Lundy Family Foundation and several grateful patients annually provides partial support for Hopkins' third-year orthopaedic surgery residents to participate in these outreach programs. The department is seeking additional funds for an endowment that would fully fund the residents on their outreach trips.

"Residents are at a very formative phase of their careers, and having an opportunity for global service now gives them much more benefit than it could at any other point in their careers," says Paul Sponseller, chief of pediatric orthopaedics and a veteran of several medical outreach trips in South America. "It gives them a sense for how care can be provided in other situations and provides the essential experience of caring for patients, without all of the extra factors sometimes seen in modern medicine."

The Trinidad visit was Okafor's second global outreach program and first with Operation Walk Maryland. Over four days, Okafor's team saw 48 patients and performed 52 hip and knee replacements, free of charge. By comparison, Trinidadian physicians had performed only eight joint replacements in 2017. The patient with severe arthritis, Okafor explains, was wheelchair-bound and required a bilateral hip replacement.

"We rarely do bilateral surgery in the states [both hips during the same operation], but we didn't know when we were going to be back. If it weren't for us, [he] never would have received care," Okafor says. "I have a video of him singing and dancing after his surgery, and he is so happy.

"This is at the core of the Hopkins experience: giving back and sharing what you've learned with the world."

Jay Reidler, a senior orthopaedic surgery resident, completed an outreach program with Global Spine Outreach (GSO) in Monterrey, Mexico, in March 2017. In the United States, he explains, physicians usually intervene in cases of rapidly progressing early-onset scoliosis, an abnormal curvature of the spine. But in some underserved areas in Mexico — such as the one Reidler visited — patients lack access to physicians with experience in such conditions. Many children do not get the appropriate intervention at an early enough stage to prevent significant deformities.

It's rare to see the severe forms of advanced scoliosis the GSO team saw in Mexico in the United States, Reidler says. He and his cohort of 15 volunteers performed 10 complex procedures alongside doctors at Christus Muguerza Hospital Alta Especialidad​ during their stay.

"Part of the goal is to partner with local surgeons to teach them and train them in more advanced techniques," he says.

Global outreach hones another critical skill for residents: doing more with less. Practicing in environments with less technology and fewer resources makes residents better physicians. "The spinal implants we used in Mexico, such as screws and rods, were all donated by medical supply companies, and we did not have an endless supply," Reidler says. "We had to think about which surgical techniques would allow us to help as many children as possible with our limited resources."

Harpal Paul Khanuja, chief of adult reconstruction and an associate professor of orthopaedic surgery at Hopkins, knows how valuable such international experiences are — but regrets that he didn't have the opportunity to pursue them earlier in his career. He co-founded Operation Walk Maryland along with his wife, Maria, a nurse practitioner with Johns Hopkins Community Physicians, and they've taken a trip every year, performing surgeries in Ecuador, India, Peru, and Trinidad.

"This is medicine and caring in its purest form," he says.

"Doing medical outreach is like hitting the reset button," says Okafor, who plans to follow in the Khanujas' footsteps in making outreach trips an annual tradition. "I come back with a whole new energy. [The trips] have helped my growth as a surgeon and as a human being."

To learn more about the Department of Orthopaedic Surgery residency program, or to support the endowment fund to expand outreach opportunities for residents, please contact Kristin Noetzel, associate director of development.