AAOS Bulletin - December, 2005

Building bridges to Cuba

Shoulder arthroscopy courses teach new skills to Cuban surgeons

By William B. Stetson, MD

On a recent medical humanitarian trip to Cuba, I had the opportunity to combine my skills in arthroscopic shoulder surgery with my commitment to build professional relationships with fellow orthopaedic surgeons practicing on the Caribbean island.

I visited Cuba in September 2004, along with four other North American orthopaedic surgeons— Scott E. Powell, MD, of California; Gene L. Muse, MD, of Oklahoma; Donald H. Johnson, MD, of Ontario, Canada; and Brian Day, MD, of British Columbia, Canada— to attend the International Society of Orthopaedic Surgery and Traumatology (SICOT/SIROT) Annual Conference. It was the first time the SICOT/SIROT Conference was held in Cuba, and we received special permits to travel to this international conference.

During our visit we taught two arthroscopic surgery courses, presented several papers and visited with orthopaedists in our host country. We also discovered a beautiful country and wonderful people.

A mission is born

The purpose of our trip was to create awareness among health providers of the effects of the U.S. trade embargo against Cuba and to try to improve relationships between the two countries. We also wanted to highlight the current status of Cuba’s orthopaedic services and its dire need for orthopaedic equipment and knowledge. As an orthopaedic surgeon dedicated to the art of shoulder arthroscopy, I was disheartened to learn that Cuba, a country less than 90 miles away from the United States, had very little in the way of arthroscopy equipment.

I first became involved in humanitarian efforts in Cuba in November 2003, when I visited Havana during a meeting of the Cuban Orthopaedic Society with John A. Feagin, MD, a recently retired orthopaedist from Duke University. Dr. Feagin and I met with Rodrigo Alvarez Cambras, MD, president of the Cuban Orthopaedic Society; his son, Rodrigo Lorenzo, MD; and Tony Castro de Valle, MD, the son of Cuban President Fidel Castro. Our master plan was to develop a relationship with these orthopaedists through shoulder arthroscopy and build bridges between our two countries.  

We discussed the medical needs of the Cuban people, as well as the shortage of medical supplies and equipment, including arthroscopy equipment. Dr. Feagin and I committed ourselves to helping them obtain the much needed medical equipment. By teaching shoulder arthroscopy, we saw an opportunity to improve both the health of patients as well as the relationships between U.S. and Cuban orthopaedic surgeons.

Overcoming the obstacles

Between my initial visit in 2003 and the SICOT/SIROT Conference in 2004, my wife, Erica, and I spent considerable time contacting equipment vendors, doctors and hospitals to ask for donations. Many of them had new and used medical and arthroscopy equipment that they were willing to donate. In total we collected 75 boxes of arthroscopic surgical equipment and accessories. We obtained a special shipping license to deliver the equipment to Cuba.

However, securing the equipment proved to be a challenge. When the shipment arrived at the Havana airport at 2 a.m. on a Sunday, Dr. Lorenzo spent three hours convincing airport officials to release it to him. No easy task, but somehow he convinced them and transported the boxes to Frank País Hospital in Havana that morning in time for the conference. We spent our free time over the next five days organizing the equipment and making sure everything was in working order.

We used the equipment during a one-day symposium on shoulder arthroscopy for the Cuban orthopaedic surgeons, which went very well. We gave several lectures and then did demonstrations on shoulder models.

The following day we performed the first arthroscopic shoulder surgery at Frank País Hospital. The operating room was set up with a live video feed to the auditorium, where about 100 surgeons were watching. Even though we’d brought multiple boxes of arthroscopic equipment, there were still things we needed that we hadn’t anticipated.

For example, the Cubans had no sterile tubing for inflow to the camera; they thought we could use intravenous tubing. Luckily, we had extra tubing so we were able to perform the surgery, although visualization was a challenge. After this surgery, I probably hold the record for the longest arthroscopic subacromial decompression ever, but all went reasonably well. The audiovisual equipment was makeshift and jury-rigged but the live video feed to the auditorium worked, and all the doctors were able to see what we were doing.

(Left to right) Dr. Stetson and Brian Day, MD, discuss health care with Cuban President Fidel Castro and his son, Dr. Tony Castro de Valle

Building relationships

During our stay we found that building a working relationship with Cuban orthopaedists was just as rewarding as teaching them new skills. I have been working primarily with Dr. Castro de Valle and have agreed to teach him shoulder arthroscopy so that he can teach these skills to his colleagues. Erica and I had the pleasure of spending much of our time with Dr. Castro de Valle and his wife, Yolanda.

In addition, Dr. Lorenzo and his wife, Alina, were our primary hosts for the two weeks we were in Cuba, providing our transportation around Havana and through the beautiful countryside, and serving as translators. By the end of the trip, we had developed a special bond with both doctors.

On our last night in Havana, Dr. Castro de Valle arranged a meeting with his father, President Fidel Castro, who was very interested in our work. We spoke with President Castro for more than five hours (until 5 a.m.) about health care, education, the environment and the devastating effects of the 2004 hurricanes. Politics was never discussed, and he was very gracious and accommodating during our visit.

Returning to the island

Our 2004 Cuban trip was such a success, we returned in September 2005 for the Cuban Orthopaedic National Annual Congress, which was co-sponsored by SICOT/SIROT. We held a two-day symposium on all facets of arthroscopic surgery, including procedures to the shoulder, knee, elbow, ankle and hip.

This time our contingent was a larger group of 45 health professionals, including 38 orthopaedic surgeons—33 from the United States, three from Switzerland and two from Canada. This turnout was a testament to how interested doctors are in helping the Cuban people. Each physician brought a bag of medical equipment to donate to the local orthopaedists.

The group also included seven other medical specialists—including nurses and physicians’ assistants—and a videographer who made a documentary of the trip.

We would like to return to Cuba to continue our mission of teaching arthroscopy and improving the relationship between our two cultures. We are researching future visits to other countries as well. We are simply a group of orthopaedic surgeons who have a love of humanity and arthroscopy and want to share it with other orthopaedists around the world. If you’re interested in learning more about future humanitarian medical trips to Cuba, contact us at orthopedicsincuba@hotmail.com.

William B. Stetson, MD, has a private orthopaedic practice in Burbank, Calif. He specializes in arthroscopic surgery and sports medicine and is an associate clinical professor of orthopaedic surgery at the University of Southern California Keck School of Medicine.

A picturesque island with friendly people

Our 2005 trip to Cuba wasn’t all about work. The day after we arrived we spent a little time walking through Old Havana, which is filled with history and lovely buildings. Driving through Havana is like driving through the United States during the 1950s. The cars are all classics from the United States and Russia, and many of the buildings have elaborate, beautiful architecture. While everything is clean, it does not appear as if any buildings have been built, or painted, since 1950. There are a few streets in old Havana that are undergoing restoration for the first time in more than 100 years.

While the countryside is lush and the beaches are beautiful, the people of Cuba are the most amazing jewel of this Caribbean island. Given the strained relationship between the United States and Cuba, it would not be unreasonable for the Cuban people to be angry or unwelcoming toward us. However, from the moment we arrived, we encountered nothing but smiles, friendship and open arms. The people were generous, kind, friendly and curious about us and our country.

The people have all the basic necessities of life: food, clothing, medical care and housing. We saw no homeless people, gangs, graffiti or malnourished people, and crime appears to be low. However, we found that even the smallest of luxuries, such as toilet paper, were scarce. Most people live with multiple generations of family within a small house because it is virtually impossible to buy a home.

Wherever we went, the heritage of music could be found. Whenever a group of musicians started playing, the Cuban people would sing and dance joyfully and passionately. It was beautiful and inspiring.

Every moment was a reminder that we are all people who want the same things from life: healthy friends and family, peace, friendship, love, joy and laughter. And we all share the hope that we can give our children a better world.

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