Teaching the humanitarian message

2006 Humanitarian Award winner shares his philosophy with residents

By Kathleen Misovic

For his efforts to instill the humanitarian spirit in orthopaedic residents, and for his personal commitment to bringing orthopaedic care to the poor, underserved and uninsured both at home and abroad, the AAOS presented R. Richard Coughlin, MD, with the 2006 Humanitarian Award.

Dr. Coughlin, an associate clinical professor of orthopaedic surgery at the University of California San Francisco (UCSF), was instrumental in starting a program that allows orthopaedic residents to do a residency rotation in South Africa. “The experience exposes young, impressionable minds to what medical reality is too many people around the world,” Dr. Coughlin said. “I think they get it. I think the younger generation is more aware of what’s going on in the world than generations before them.”

AAOS President Stuart L. Weinstein, MD, presents the 2006 Humanitarian Award to R. Richard Coughlin, MD.

Dr. Coughlin’s interest in humanitarian work started when he was a young physician, soon after he finished his medical training and entered private practice specializing in foot and ankle orthopaedics in San Francisco. He took a trip to Guatemala with his senior partner, Taylor K. Smith, MD, to provide care to underprivileged people through Operation Rainbow, a nonprofit organization providing free care to children in medically underserved countries. Drs. Smith and Coughlin were so happy with their overseas volunteer experience, they helped to create an orthopaedic branch of the organization in the early 1990s.

Charity begins at home
Through the years, Dr. Coughlin continued his involvement with Operation Rainbow, providing free orthopaedic care in countries the program serves, such as Peru, Nicaragua, El Salvador and Honduras. But he realized that there were uninsured and underserved populations in the United States as well. So he left private practice and joined the UCSF faculty at San Francisco General, the county-run hospital that cares for the uninsured and indigent.

“The beauty of diversity and humanity is here everyday. I found out I don’t need to be in the jungles of Africa to serve disadvantaged patients,” he said. “I deal with a lot of patients who tend to be more vulnerable to trauma due to their socioeconomic status and their exposure to violence.”

Dr. Coughlin also kept up his work with Operation Rainbow, frequently accompanied by UCSF residents. He found that residents who participated in these trips were more likely to continue humanitarian work. “We found that 40 percent of the residents who went on Operation Rainbow trips repeated their involvement with overseas projects,” he explained.

So Coughlin and the other orthopaedic surgeons at San Francisco General decided to establish an orthopaedic rotation in overseas volunteerism. They partnered with Orthopaedics Overseas at its site in Mthatha, South Africa, allowing residents to spend a month in a remote part of Africa teaching medical students and caring for patients. The venture has been so successful that Dr. Coughlin is currently working on developing a partnership with another Orthopaedic Overseas site in Managua, Nicaragua.

Orthopaedics Overseas not only enables residents to get more involved with patient care, it also enables them to help train local medical professionals. “The program has a greater impact if we can leave more knowledge behind,” Dr. Coughlin said. “That greater impact comes from teaching and training, sustaining the education we bring.”

Dr. Coughlin said his work with the indigent both at home and overseas has enabled him to use his medical skills to his fullest abilities.

“Once you become aware of how unfair the world can be and see the significant disparities in the access and quality of health care, you get kind of angry,” Dr. Coughlin said. “This realization motivates you to do something to change these disparities.”

It has also helped him keep his perspective on why he became a physician, especially when it’s so easy to get bogged down in the day-to-day paperwork.

“Think of volunteering as an antidote to managed care, a way to fill your soul,” Dr. Coughlin said. “As doctors, we get so lost in the details and paperwork of our practice we don’t recognize the enormous potential we have for positively affecting peoples’ lives.”

Keeping dancers on their toes
Another population Dr. Coughlin positively affects is the dance community in San Francisco. “Dance is an art form I came to appreciate when training in New York City,” Dr. Coughlin said. “It’s a beautiful combination of high culture and athleticism.”

While serving as a board member for a local dance company, Dr. Coughlin learned that, unfortunately, many performers are either uninsured or underinsured. “It soon became very clear to me that the dancers were a disadvantaged patient population,” he said, explaining dance troops often can’t afford to offer health insurance coverage for their members.

To serve these dancers’ medical needs and thank them for their commitment to the arts, Dr. Coughlin is one of the medical specialists who provides them with free care through UCSF’s Dance Injury/Prevention Clinic, which is housed in a new performance building, ODC Commons. The clinic recently expanded to offer general health services, such as nutrition counseling. “It’s become a healthy dancers’ program focusing on more than musculoskeletal injuries,” Dr. Coughlin said.

A humbling experience
Although he is very proud to receive the 2006 Humanitarian Award, Dr. Coughlin looks at it as symbolizing the beginning point, not the end result, of his commitment. “It’s very humbling, to say the least,” he said. “Receiving the award challenges me to do better and use it as a stepping stone to create a better culture and environment for training residents.”

As part of the Humanitarian Award, the AAOS will donate $5,000 to Dr. Coughlin’s volunteer organization of choice, Orthopaedics Overseas.

“The award gives us a chance to build on the momentum of the program, and to spread the impact of the hospital and university here in San Francisco to other parts of the world,” Dr. Coughlin said.

For more information on Orthopaedics Overseas, visit online.

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