AAOS Bulletin - April, 2006

Teaching the humanitarian message

By Kathleen Misovic

Many people don’t have access to quality health care. That’s one of the most important lessons that R. Richard Coughlin, MD, an associate clinical professor of orthopaedic surgery at the University of California San Francisco (UCSF), believes he can give to orthopaedic residents.

To accomplish this goal, Dr. Coughlin, the 2006 AAOS Humanitarian Award winner, was instrumental in starting a program that allows orthopaedic residents to do a residency rotation in South Africa.

R. Richard Coughlin, MD, winner of the 2006 Humanitarian Award, serves the underserved both as part of Orthopaedics Overseas and as a medical specialist for the UCSF Dance Injury/Prevention Clinic.

“The experience exposes young, impressionable minds to what medical reality is to many people around the world,” Dr. Coughlin says. “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.”

As a third-grade student, Dr. Coughlin listened to his teacher talk about a great 20th century physician named Albert Schweitzer, a man who selflessly dedicated his life to helping others around the world. That lecture, given almost 45 years ago, sparked a desire for helping others and is the driving motivation behind Dr. Coughlin’s passion for overseas volunteerism.

After graduating magna cum laude at the Universidad Central del Caribe in Bayamón, Puerto Rico, and completing his training in orthopaedic surgery, Dr. Coughlin 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. This effort in promoting international volunteerism within the group and community has led to more than 50 trips.

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 says. “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 Dr. 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.

“It is largely Rick Coughlin’s example that has inspired a generation of orthopaedic surgeons to become international volunteers,” says Michael C. MacAvoy, MD, of San Francisco. “Without question, I consider my monthlong rotation in Africa the most invaluable month of my entire residency.”

Stuart L. Weinstein, MD, AAOS past president, presented R. Richard Coughlin, MD, with the 2006 Humanitarian Award during the Ceremonial Meeting of the AAOS Annual Meeting.

Recognizing Dr. Coughlin’s exemplary achievements in Africa, Orthopaedics Overseas awarded him its Volunteer of the Year Award in 2000. 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 enables residents to become more involved with patient care and to help train local medical professionals. “The program has a greater impact if we can leave more knowledge behind,” Dr. Coughlin says. “That greater impact comes from teaching and training, sustaining the education we bring.”

Dr. Coughlin says 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 can get angry,” Dr. Coughlin says. “This realization motivates you to do something to change these disparities.”

This 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 says. “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 people’s 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 says. “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 says, explaining that dance troops often can’t afford to offer health insurance coverage to 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 dancers 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 says.

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 says. “Receiving the award challenges me to do better and use it as a steppingstone 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 says.

Furthering his desire and commitment to the underserved, Dr. Coughlin completed a Master of Science in “Public Health for Developing Countries” at the London School of Hygiene and Tropical Medicine. Dr. Coughlin is associate clinical professor of orthopaedic surgery at the University of California San Francisco and is currently working on the steering committee for Global Health Sciences at UCSF.

For more information on Orthopaedics Overseas visit them online.


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