Sunday, February 07, 1999
The aim of Dr. Barnechea, site coordinator for Orthopaedics Overseas' volunteer program in Peru, and the Peruvian government is to retain their orthopaedic surgeons. To do that, he said, "we have to give them the tools to do what they want to do in their own country."
As a division of Health Volunteers Overseas, the orthopaedics program recruits physician volunteers for minimum two-week stints in Peru to give lectures and demonstrate surgical techniques.
The partnership has already paid dividends. Through promotional efforts of noted hand surgeon Alfred Swanson, MD, a large number of hand surgeons were encouraged to travel to Peru and demonstrate microsurgery techniques. "Before they came, hand surgery was not a specialty in my country," said Dr. Barnechea. Now, "this subspecialty is an organized presence."
For the most part, volunteers work in Peru's Instituto Peruano de Seguridad Social (IPSS) hospital system, which provides coverage through employer and government funding for about 6 million of Peru's 22 million people.
Resident training takes place mainly in Lima, but links between IPSS and universities in other provinces allows them to send residents for specific training sessions when volunteers do not have the extra time for travel to outlying areas.
Dr. Barnachea's involvement with guest volunteer trainers dates back 18 years. As a first-year resident he trained with Paul Spray, MD, Oak Ridge, Tenn., under the auspices of the CARE/Medico program. "Dr. Spray pushed me to be part of the program as a local coordinator," Dr. Barnechea recalls. First through CARE and now through HVO, Dr. Barnechea has become the preeminent champion of in-country training for orthopaedic surgeons.
In a country known for its volatile politics as well as its geographic grandeur, Dr. Barnechea has steered clear of politics and religion in his quest to bring physician training to Peru. To accomplish his goal, he realized he would have to build alliances. Manuel Vasquez, the head of IPSS, has become a backer and was instrumental in recently obtaining a formal inter-institutional agreement between IPSS and HVO.
In addition, Pablo Moreno, the HVO coordinator in Peru's Office of Foreign Affairs; Ada Pastor, MD, the National Manager for Health Services; Percy Cupen, MD, the National Manager of Development for Education; and Jorge Muffarech of the Ministry of Labor have all furthered the growth of the volunteer trainer program, according to Dr. Barnechea.
As is common in most developing countries, Peru has a variety of orthopaedic needs. "If you go to the large cities," explained Dr. Barnechea, you will find physicians with a full range of training obtained in North America or Europe. They are able to do certain procedures, but are limited by the "cost of the paraphernalia that the orthopaedic surgeon must have." In a small town, a general surgeon may be doing orthopaedics. That person may need training in total joints. Another area of need is teaching all physicians how to properly refer orthopaedic cases. In some instances, said Dr. Barnechea, people in remote regions who have injuries requiring specialty care may not reach a hospital in Lima for up to 10 months.
Residents who receive training from HVO volunteers are "very enthusiastic," said Dr. Barnechea. The orthopaedic volunteer program must be a two-way street, he said. "If those who have the need only receive [the training], they don't value the help as much as when they have to put something into it."
Accordingly, he said, "our idea is to make a screening, a diagnosis, of each one of the areas [of need] and provide that information to these organizations and to ask for a specific task."