NICARAGUA, JANUARY 2018 – Omar Khatib MD, Class of 2018

On Sunday January 14, 2018 Dr. Steven Grindel and I set out to Managua, Nicaragua to go for our yearly week long mission trip. However, for several months prior to our trip, we had to review the proposed surgical cases that the orthopaedic surgeons sent us and have all our implants and instruments organized and ready to go with us on the trip. The most difficult part of the travel is usually the Nicaraguan customs approving our surgical instruments and implants passing through, but luckily we had no problems this year. Medical College of Wisconsin (MCW) Department of Orthopaedic Surgery has three groups go yearly and one group already went down to Managua several months ago and the next group is set to go next month. The senior residents, Scott Kuzma and Scott Smith, on the previous trip told me how great it was so I was very excited for this opportunity to travel with Dr. Grindel, especially since I am going into a Shoulder and Elbow fellowship.

Rodgrigo Grijalva and Pablo Corea, senior orthopaedic surgery residents at Lenin Fonseca Hospital were both here at MCW over the past year for 2 months and they were there to meet us at the airport. We not only go to Nicaragua but we make sure that the residents in Nicaragua come here to experience orthopaedic surgery in the United States. We stayed at the La Pyramide which has pyramid shaped buildings with balconies and terraces with beautiful palm trees throughout the property.

The next day we saw our patients that we would be doing surgeries on throughout the week and it was amazing to see how far these patients drove to see us at Lenin Fonseca. We saw a humerus non union but most of our patients were shoulder instability patients who were dislocating on a frequent basis with no surgeon in the country able to provide any stabilization procedures. We also saw a type IV AC joint separation in a young rugby player that we proposed a modified Weaver Dunn procedure for which was never done in Nicaragua before.

Over the next three days we operated from morning til afternoon and then enjoyed the beauty of the country in the evenings. We were on national TV one day which really highlighted to me what a profound impact we have on delivering health care to these patients. The skill I appreciated the most was how to adjust to a low resource environment and still perform complex surgeries in an efficient manner. The power drills and drivers that they use were from a Black and Decker set that would be purchased from any home improvement store. The instruments needed for next day’s surgery had to be selected and sent to a different hospital for sterilization; there is no opportunity to ask for more instruments during the case because the sterile processing area had been undergoing repairs for the past several months. Traction is a temporizing procedure in the United States, but is often times the definitive treatment for femoral shaft fractures in Nicaragua.

The surgeries were fun, but it was equally enjoyable to be with friends such as Rodrgio and Pablo that we got to know in Milwaukee. On Wednesday we got together for amazing dinner at Pablo’s home and Dr. Grindel gave a few lectures. We also got to see the amazing volcanoes, beaches, and the old city of Grenada during our time.

When we left back to Milwaukee at the end of the week, I can truly say that this was one of the most impactful and lasting experiences I had during my residency. The global experience at MCW is truly unique because not only do our residents experience health care in an underserved and impoverished country, but their residents who are excellent surgeons get to come here and learn from our faculty. One of our alumni, Dr. Marcella Woiczik, always travels once a year to Nicaragua with Dr. Jeff Schwab’s group and I feel like this experience will have a lifelong lasting impact on me.