August 1998 Bulletin

Retired, but still caring

"Ever since I entered medical school, I had the idea that some day I would like to make a contribution in a developing country."

Orthopaedic surgeon Richard J. Kemme, MD, finds challenges and rewards as a volunteer for Orthopaedics Overseas

By Laura Pelehach


The last time Richard J. Kemme, MD, had treated patients for bone tuberculosis, he was a young resident training in St. Louis. Dr. Kemme rarely saw a patient with the condition in the ensuing 40 years of practice.

In recent years, however, Dr. Kemme has treated several patients with bone tuberculosis, as well as other conditions he hasn't seen for years, such as polio, and fractures that had gone untreated for so long that they were nearly impossible to fix.

For the past nine years, Dr. Kemme, a retired surgeon from Greeley, Colo., has volunteered for Orthopaedics Overseas, a branch of Health Volunteers Overseas, an organization that sends health care volunteers to developing countries to educate local health care workers and to treat patients.

For Dr. Kemme, volunteerism through Orthopaedics Overseas has fulfilled a goal that he was unable to attain in his younger years, when his busy practice left little time for anything else. "Ever since I entered medical school, I had the idea that some day I would like to make a contribution in a developing country," says Dr. Kemme. "When I heard about Orthopaedics Overseas some 20 years ago, I decided that that was the organization that could make this possible. I became a member of Orthopaedics Overseas so that my annual membership dues along with those of others would provide the funds needed to make sure the programs could be available when I retired."

It has turned out to be a mutually beneficial experience. Orthopaedics Overseas actively seeks retired surgeons like Dr. Kemme, who have had experience dealing with conditions that have long been eradicated in the United States, according to Kate Fincham, director of programs support for Orthopaedics Overseas. In many of these countries, some of those conditions are still rampant, and retired surgeons have a base of experience from which to work. "They are comfortable with the pathology and also with the rudimentary equipment for treating patients in the countries to which they are assigned," Fincham explains.

For many retired surgeons, volunteerism provides the perfect finale to a busy career. Although the number of patients they see in everyday practice has declined, their skills, curiosity, and desire to share knowledge have not ebbed. Another advantage is that on an overseas assignment, they can concentrate on the fundamentals of patient care, far removed from pressures and disillusionment of the U.S. health care environment that increasingly focuses on the bottom line. Of course, the exotic locations are part of the appeal as well. Orthopaedics Overseas sends volunteers to locations in Africa, South America, the Caribbean and Asia. In most locations, families are welcome, and Dr. Kemme's wife, Mary, has accompanied him on many of his trips.

A large proportion of volunteers for Orthopaedics Overseas are repeat volunteers. Although many take advantage of the opportunity to travel to a different country for each assignment, for the past nine years Dr. Kemme has concentrated on Malawi, a small nation in southeast Africa. After his first one-month assignment in Malawi, he was asked to replace the resigning program director for the Malawi Orthopaedic Project, and he decided that an annual visit to the south African country would allow him to stay in better touch with the problems, personnel, and needs in the country.

The major emphasis of the Malawi project is on training local health care workers in orthopaedic procedures. In Malawi, a country of 10 million whose annual per capita income is $249, orthopaedic care is scare. Only three full-time surgeons are available in the country, all three of whom are expatriates. The rest of the orthopaedic care falls on orthopaedic clinical officers (OCOs) who have been trained by Orthopaedics Overseas volunteers. (Clinical officers are comparable in training to U.S. physician assistants. They receive four years of medical training after high school, and undergo an 18-month training program to be qualified to practice orthopaedics.)

Today, at least one OCO is posted at all 24 district hospitals in Malawi, providing 90 percent of the available orthopaedic care. They are trained in nonsurgical procedures, such as closed reduction and traction for treatment of fracture. Although they are trained in some surgery, no high-tech procedures such as arthroscopy or total joint replacements are performed.

Three years ago, the OCO training program disbanded when the executive director resigned. One of the country's full-time orthopaedic surgeons sent a message to Orthopaedics Overseas volunteers asking for a volunteer to help reinstate the program. Dr. Kemme agreed to a six-month assignment. Aside from planning the curriculum, Dr. Kemme has taken several 200-mile trips to the country's Ministry of Health to gain approval for the program. It's a cumbersome process. "Things such as setting up an appointment by phone, which in the U.S. takes a matter of seconds, can take numerous hours or even days to accomplish due to the marginal phone system," said Dr. Kemme in an e-mail interview. Once approval for the program was granted, Dr. Kemme set about interviewing potential candidates for the program.

Although on this assignment, he is working on a special project, Dr. Kemme says on a typical one-month assignment, a volunteer would spend four days of the week in one of the major Malawian hospitals, making rounds with OCOs and students, attending clinics, and assisting the OCOs and students in surgery. They also present lectures. Toward the end of the week, volunteers travel to various district hospitals where they make rounds and assist the OCO with any scheduled surgeries.

"The first year I served, I did about 50 surgical cases," says Dr. Kemme. "I felt good. Not only had I helped these few people, but I also served as a cog in the wheel of orthopaedic surgeons that help train the Malawians who care for additional orthopaedic problems well after the volunteer returns home."

In fact, Dr. Kemme says that his greatest reward came recently at an X-ray conference. The patient had a displaced fracture of both bones of the forearm, which Dr. Kemme says would have been treated by open reduction in the U.S. In Malawi, the risk of postsurgical infections and the shortage of metallic implants and technical know-how, made closed reduction the first line of therapy. One of the students trained by Orthopaedics Overseas had managed an almost perfect closed reduction of the forearm. Dr. Kemme was pleased to hear the praise showered on the OCO by conference attendees. "It is particularly rewarding to know that James (the OCO) and the other 40 OCOs posted at the district hospitals in Malawi have the ability to provide excellent conservative orthopaedic care for the Malawian population, even long after I and other Orthopaedics Overseas volunteers have returned home to the U.S.," he says.

Dr. Kemme advocates volunteerism for retired surgeons, "It is such a waste of talent for a person having the knowledge and experience that a retiring orthopaedic surgeon has to suddenly quit using this knowledge and experience at retirement," he says. "Since orthopaedic surgeons work hard during their career, they have earned the right to enjoy retirement. However, they could easily spend a month or so helping out as an Orthopaedics Overseas volunteer, especially when the knowledge and experience they have can be put to good use improving the orthopaedic care in developing countries."

Membership in Orthopaedics Overseas is crucial for the success of the program, Fincham said. For further information about Orthopaedic Overseas contact Health Volunteers Overseas, PO Box 65157, Washington, D.C. 20035; call (202) 296-0928 or e-mail, hvo@aol.com; or visit Orthopaedics Overseas website at www.concentric.net/~Hvousa.

About Orthopaedic Overseas

Orthopaedics Overseas was founded in 1959 and was one of the original specialty groups to join MEDICO, which later merged with CARE. In 1981, Orthopaedics Overseas became an independent organization. In 1986, when other health care groups (dentists, nurses, pediatricians, etc.) became interested in similar volunteer opportunities, Health Volunteers Overseas (HVO) was formed, and Orthopaedics Overseas became a division. Orthopaedics Overseas remains the largest HVO division. Since 1986, nearly 900 of 2,000 HVO assignments were filled by orthopaedics surgeons. Following are Orthopaedics Overseas programs seeking volunteers:

SiteProgram DirectorLength of Assignment
BhutanRobert Stein, MD1 month
(615) 329-6633
EthiopiaRobert Feddis, MD1 month
(301) 724-7146
IndonesiaJohn Dormans, MD1 month
(215) 590-1534
Morris Schultz, MD
(301) 774-0484
MalawiRichard Kemme, MD1 month minimum
(970) 352-0250
PeruJames Bennett, MD2 week minimum
(713) 799-2300
St. LuciaDarrell Fisher, MD1 month
(515) 421-6630
South AfricaDavid Francisco, MD1 month minimum
(913) 642-7676
TanzaniaW.W. Schaefer, MD1 month minimum
(414) 458-9274
UgandaDavid Denzel, MD1 month
(716) 434-2697
VietnamLewis Zirkle, MD2-4 weeks
(509) 946-1654
(Volunteers should write to him at 875 Swift Blvd, Richland, Wash. 99352.)


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