“I feel it truly changed my perspective on what it means to be a doctor.”
As part of MCW’s orthopaedic surgical training program, fifth year residents have the opportunity to participate in an international externship with Milwaukee Orthopaedics Overseas (MOO).
The goals for this experience are to foster a spirit of volunteerism, enhance surgical skills and decision-making, provide exposure to third world disorders, further cultural sensitivity, and strengthen teaching skills. This experience gives residents the opportunity to develop an understanding of the affects of health-care resource use; impacts the residents’ outlook and attitude toward the delivery of health care and allows for professional development.
MOO consists of attending physicians from MCW and the University of Utah as well as nurses, physical therapists and translators. The MOO “brigada” works closely with Los Pipitos, a non-governmental organization dedicated to improving the lives of Nicaraguan children with disabilities. Each year the team travels to several cities in Nicaragua in November to hold clinic and identify surgical candidates from within the Los Pipitos organization. The team returns in April for 1-week to perform over 40 surgeries ranging from malunions to pelvic osteotomies.
Recently, the program has expanded to include a resident exchange program as well an expansion in the surgical program. Residents from the Louis Fonseca Hospital in Managua travel to Milwaukee for 2-months to learn a variety of techniques and MCW residents have he opportunity to travel to Managua for 1-2 months to experience Orthopaedics in a developing country. In addition, Dr. Schwab has recently expanded the surgical program to include surgical cases at both Fonseca Hospital and the Pediatric Hospital in Managua.
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Nicaragua, January 2018
In January 2018, senior resident Dr. Omar Khatib accompanied Dr. Steven Grindel on a medical mission trip to Nicaragua. They spent the week doing surgeries at Lenin Fonseca Hospital in Managua. Most of the patients they saw were shoulder instability patients who were dislocating on a frequent basis with no surgeon in the country able to provide any stabilization procedures. While there, Dr. Grindel and Dr. Khatib were featured on tv performing a modified Weaver Dunn procedure on a young rugby player with a type IV AC separation.
Dr. Khatib says “The skill I appreciated the most was how to adjust to a low resource environment and still perform complex surgeries in an efficient manner..” Read about Dr. Khatib’s experience.
Nicaragua, November 2017
The Fall “MOO Brigade” to Nicaragua included Dr. Jeffrey Schwab, Dr. Scott Van Valin, Dr. Jonathan Kraus, Senior Residents Dr. Scott Smith and Dr. Scott Kuzma, Jacelyn Ahrens (surgical first assist), Cynthia Torres ATC, Mary Bestor, RN at Children’s Hospital, Elizabeth Moberg-Wolff and Linda Kliebhan. The team spent their time at three different hospitals working alongside local surgeons doing complex adult and pediatric surgeries.
Dr. Smith says “The experience that Dr. Schwab has developed has set a great example for what mission work can be and how as physicians we can have a lasting impact on our fellow man. I will be forever indebted for this experience.” Read about Dr. Smith’s experience.
Dr. Kuzma says “Having the privilege to go to Nicaragua as part of my residency was an invaluable experience that taught me many lessons and will enhance my future practice.” Read about Dr. Kuzma’s experience.
Peru, January 2017
In January 2017, senior resident Dr. Jesse Bauwens accompanied St. John Vianny Parish on a medical mission trip to Piura, Peru. The trip was an elective rotation for Dr. Bauwens where he and Dr. Van Winkle saw over 150 orthopaedic patients in clinic in the church and at surrounding villages. They spent a day doing carpal tunnel releases in an operating room that was built in the basement of Santisimo Sacramento Parish. Dr. Bauwens dedicated his trip to the memory of Dr. Jim Wallace.
Nicaragua, November 2016
In November 2016, senior resident Dr. Lisa Sienkiewicz accompanied Dr. Jeffrey Schwab and Dr. Scott Van Valin on the first of their annual trips to Nicaragua.
Dr. Sienkiewicz writes “Going to Nicaragua was a meaningful trip that has impacted how I think about healthcare and will surely influence how I practice orthopedics in the future. It has truly inspired me to be better physician. For future residents, I would highly recommend going to Nicaragua and only hope they enjoy it as much as I did.”
Nicaragua, April 2016
The spring 2016 MOO “brigade” included Dr. Jeff Schwab, Dr. David King, senior residents Dr. Anthony LoGiudice and Dr. Matthew Smith, Mary Bestor, RN at Children’s Hospital, Dr. Marcella Woiczik and her Pediatric Orthopaedic Fellow, Dr. McCall McDaniel, and Mindee Hooley, a surgical tech from Shriner’s Hospital for Children in Salt Lake City, Utah. Roughly 50-60 patients showed up and waited in line in an auditorium for their chance to be seen by our team of orthopaedic surgeons. They had two makeshift exam rooms in the back of an auditorium with privacy supplied by bedsheets strewn across wires. Translation was provided by two surgeons and one medical student from Nicaragua. Clinic itself was a mixture of adult and pediatric orthopaedic pathology with a heavy leaning toward pediatric.
Nicaragua, November 2015
The fall MOO brigada included eight members this year including Dr. Jeff Schwab; Dr. Scott Van Valin; Dr. Leah Cobb, a former MCW resident and a pediatric orthopedic surgeon in San Juan, Puerto Rico; Dr. Jill Martin, a current 5th year resident; Mary Bestor, a nurse from Children’s Hospital who works closely with the orthopedic department; two physical therapists who specifically work with children with physical disabilities, Linda Kliebhan and Leslie Paparsenos; and Miguel Castro, Dr. Cobb’s husband who is a native spanish speaker and served as an interpreter for us. We also worked closely with several Nicaraguan orthopedic surgeons both in the clinic and in the OR. During the week, we held several busy clinics at various sites where we saw both children and adults with problems such as hip dysplasia, nonunions and malunions, scoliosis, and many aliments related to cerebral palsy. Part of the group was able to run a Ponsetti casting clinic to teach physical therapists and other providers this method of treating clubfoot.
Four of the days were spent operating at two different hospitals. We performed cases including pelvic osteotomies, tendon lengthenings for contractures related to cerebral palsy, multiple foot procedures, a distal humerus osteotomy for a malunited supracondylar humerus fracture, and a revision ORIF with bone grafting of a humeral shaft nonunion among many others. One day, our clinic finished early and some of the group traveled to Laguna de Apoyo Nature Reserve to swim in the beautiful Crater Lake.
“Going to Nicaragua was an incredible learning opportunity – I learned from everyone I worked with including my own attendings, the Nicaraguan physicians, the extremely knowledgeable physical therapists and the patients themselves. I also learned how to be innovative in the OR because the resources, such as fluoroscopy, that we are accustomed to are not always available or easily accessible in Nicaragua.”
Nicaragua, November 2014
The annual fall MOO “brigada” included six members: Dr. Jeff Schwab, Dr. Scott Van Valin, RN Mary Bestor, PT Linda Kliebhan, former residents and current pediatric orthopaedic surgery fellow at Cincinnati Children’s Dr. Leah Cobb, and former resident Dr. David Meister. The group flew into the capitol city Managua and saw clinic patients Monday, Tuesday and Wednesday in various neighboring cities. Most of the patients were children with a variety of conditions including clubfeet, developmental dysplasia of the hip, post-traumatic deformity and cerebral palsy. New to the fall trip were a couple of OR days. On Thursday and Friday they performed surgeries including varus derotational osteotomies, hamstring and Achilles lengthenings, various foot surgeries (osteotomies and releases), a tibial tubercle transfer and ORIF tibia non-union. In total they saw about 150-160 patients in clinic and performed 10 surgeries. Dr. Meister: “The most valuable part of the mission is the collaborative nature we share with the physicians, nurses, and staff at the clinics and hospitals. We scrubbed with our Nicaraguan colleagues on all the cases, and discussed treatment options and approaches in clinic. Everyone including patients and providers seemed to benefit and learn from this team approach.”
Nicaragua, March 2014
In March 2014, the MOO “brigada” once again returned to Nicaragua. Senior residents Charlie Eggert, MD and Eric Linford, MD joined Drs. Schwab, Tassone and Woiczik for the annual trip. For the first time, Dr. David King joined the faculty. During the week, they performed 43 operations and saw over 70 patients in clinic. The majority of the cases involved children with cerebral palsy, however they also cared for a number of adults with complex deformities and non-unions. Although much of the time was spent at the hospital, there was ample time to experience Nicaragua. Highlights include many great meals at local restaurants and a couple afternoons at the ocean.
Nicaragua, November 2013
In November 2013, senior resident Leah Cobb, MD accompanied Dr. Schwab and Dr. VanValin to Nicaragua in the first of their two annual trips. The MOO team saw over 100 patients in clinic in preparation for their return trip in March.
Nicaragua, February 2013
In February 2013, senior residents Joel Hein, MD and Jared Tyson, MD accompanied Dr. Schwab, Dr. Tassone and the team from MOO on their annual medical mission to Nicaragua. Once again MCW orthopaedic surgery resident alumni, Dr. Marcia Woiczik, made the trip from the Shriners Hospital in Salt Lake City. Together they performed 46 surgeries and saw over 100 patients in a variety of clinics. The patients ranged from children with clubfeet and DDH to adults with long standing non-unions. In addition to the medical side of the trip they got to experience the Nicaraguan culture and see beautiful parts of the country including a volcanic crater lake.