February 2001 Bulletin

Improving the lives of those in need

‘Seeing the patients get better is the greatest reward.’

Humanitarian efforts to be honored at Annual Meeting

By Carolyn Rogers

Many orthopaedic surgeons go above and beyond the call of duty every day–reaching out to others and using their skills to help the disadvantaged, whether those "in need" live down the road, across the state line or on the other side of the world. For the majority of these dedicated physicians, their reward lies solely in the intangible feeling of satisfaction that comes from knowing that the lives of others have been touched, and made better, as a result of their efforts.

This year, however, two of these humanitarians have been singled out by the Academy to receive another reward–the AAOS Humanitarian Award. In recognition of their outstanding efforts, the second annual AAOS Humanitarian awards are being presented to Charles Hamlin, MD, for his work in the United States, and to the late Ernest M. Burgess, MD, for his work abroad.

Dr. Hamlin’s years of work with the Navajo Indians in Chinle, Ariz., demonstrates that one need not travel beyond the borders of the United States in order to serve a deserving population. As Dr. Hamlin has often said, "you don’t need a passport to provide orthopaedic care for a Third World country."

On the high plateaus of the Navajo Reservation more than 50 percent of the adult males are unemployed. Diabetes, heart disease and alcoholism are endemic and more than half the residents of this community have no electricity or running water–80 percent are without telephones.

Dr. Hamlin became acquainted with the Navajos through his work with patients with spinal cord injuries. "Many of the Navajos have alcohol problems and don’t use seatbelts when they drive, so I went down there in 1993 to see some spinal cord patients." While there, he discovered that the nearest hand surgeon was five or more hours away in Albuquerque or Phoenix. Many of the Navajos are farmers and ranchers, so hand injury is quite common.

"I thought…wouldn’t it be nice to start a hand clinic here?" Dr. Hamlin explains. At first, he was told that a clinic wasn’t needed and that the Navajos couldn’t afford it. But when Peterson Zah, the chief of the Navajo Nation at the time, heard of Dr. Hamlin’s idea, a private audience was arranged. At the meeting, Dr. Hamlin explained that he and his friends from around the United States were committed to providing expert care on a monthly basis, free of charge. The chief was skeptical at first, asking what Dr. Hamlin wanted from him. "Nothing," Dr. Hamlin replied. "Just say we can do it." Zah agreed, and the Chinle Hand Clinic opened four months later.

While that may sound simple, in reality it took a lot of hard work and ingenuity on the part of Dr. Hamlin.

"Charlie personally arranged for staff privileges for all of us at the U.S. Public Health Service Hospital in Clinle," says Peter R. Carter, MD, a colleague at the Chinle Hand Clinic. "He pleaded and cajoled the OR nurses and clinic nurses into building an efficient clinic and operating day. He donated his own instruments, got his colleagues to bring others and twisted the arms of orthopaedic companies to give even more.

He enlisted his surgeons to give lectures on the emergency care of hand injuries as well as how to treat other day-to-day hand problems. These lectures continue to be well attended by the pediatricians, emergency room physicians, general surgeons, therapists and nurses stationed at the remote U.S. Public Health hospital in Chinle. Therapists were trained in splint-making and exercise routines and the essential philosophy of hand postop care. By doing this, Charlie provided for continuity of care between the monthly clinics–an essential element often missing in medical mission work"

So on the third Thursday of every month, either Dr. Hamlin or one of his friends is there to staff the clinic. The following day, patients who require surgery are operated on by that same hand surgeon in their local hospital in Chinle. The clinic has taken place every month without fail for the past seven years, which is especially noteworthy due to its remote location; the reservation is located in an area of Arizona that is difficult to reach other than by travel through Albuquerque and an extended drive.

So what benefits does Dr. Hamlin derive from his humanitarian efforts?

"The tangible rewards are seeing these people, who are very quiet and don’t even have a word for ‘thank you’ in their vocabulary, getting a tremendous emotional return from some of their procedures," he says. "They can get back to work, they can take care of their families. And while they are not a very verbal people, they’re very generous. They often show up with small rugs as a gift. It’s also a very beautiful place to visit–the Canyon de Chelly is truly breathtaking.

"So seeing the patients get better is the greatest reward, but visiting this beautiful and sacred place is another."

Dr. Hamlin was recognized by the Navajo Nation in 1997 when he was presented with the Navajo Indian Health Service Directors Award. After hearing word that he would be receiving the AAOS Humanitarian Award, Dr. Hamlin says, "I was a little overwhelmed that a project that started so small was being recognized by such a large organization. I’ve joked to a lot of my colleagues over the years that ‘We’re old enough now to be either rich or famous, or we’re going to be neither.’ So this effort has been quietly done, without much publicity. Little steps make for big distances, I guess, but I never thought this clinic in the northeast corner of Arizona would come to anybody’s attention."

A clinic on the other side of the world is also receiving attention from the Academy this year–the Prosthetics Outreach Center in Hanoi, Vietnam, is the brainchild of Ernest M. Burgess, MD, who passed away this past year. Dr. Burgess is being honored for his work improving the lives of thousands of amputees in Viet Nam and other developing countries.

While serving in the Pacific during World War II, Dr. Burgess became deeply interested in rehabilitating amputees. In 1964 the U.S. Veterans Administration chose Dr. Burgess to establish the Prosthetic Research Study (PRS), a leading center for post-operative amputee treatment. He later invented the Seattle Foot ®, which has an internal spring to enable amputees to be active. Under Dr. Burgess’ direction at the PRS, the Seattle ShapeMaker ® software and related techniques to improve the design and production of prostheses were developed.

In 1998, a group of Vietnam veterans returned to Vietnam for the first time in an attempt to put to rest their nightmares of that tragic war. Several of those veterans were amputees and patients of Dr. Burgess. When they returned to the United States, they came to Dr. Burgess and pleaded with him to do something for the many Vietnamese men, women and children they had seen who were in need of a prosthesis. There were approximately 300,000 amputees in Vietnam at the time, many of whom had never been fitted for prosthetics after the war. In response to the veterans’ plea, Dr. Burgess started the Prosthetic Outreach Foundation in 1988, and opened the Prosthetics Outreach Center in Hanoi in 1990.

"The humanitarian work that my father did in the last 10 years of his life was really the fruit of his entire career as an orthopaedic surgeon," says his daughter Donna Burgess, who serves on the foundation’s board of directors. "He devoted all of that time to the service of people in developing countries who wouldn’t normally have access to any prosthetic devices, much less high-quality devices."

The main project has been in Vietnam, Burgess explains, with the Prosthetic Outreach Center that Dr. Burgess started in Hanoi. The foundation has since established and equipped outreach clinics outside of Hanoi, and as a result, over 11,000 Vietnamese have since been fitted with high-quality, lower limb prosthetics free of charge.

Another aspect of Dr. Burgess’ vision was that, eventually, the Vietnamese would be able to take care of the needs of the Vietnamese amputees themselves. During the first six of seven years of running the clinic in Hanoi, the American-made prosthetic components were shipped to Vietnam at great cost. Then, using the computer-aided design, limb sockets were created at the clinic.

"But my father realized the Vietnamese would never be able to afford these limbs for their own people unless the components could be made more cheaply," Burgess says "Continuing to ship the components would mean ongoing charitable dollars. So in 1998, he helped to renovate the only prosthetic component factory in Vietnam, which had been in Ba Vi. With the help of an American engineer, the factory was redesigned to produced low-cost, high-quality components that now are being used in clinics throughout Vietnam, including the clinic established in Hanoi."

The Ba Vi Orthopaedic Technology Center has also been able to supply prosthetic components to other developing countries, Nicaragua, Honduras and Sri Lanka. In March 1998, at the dedication of the Ba Vi facility, the Vietnamese government presented Dr. Burgess with their "Medal of Honor" in recognition of his dedication and help to the disabled of Vietnam. Last Spring, the U.S. Senate commended Dr. Burgess for his five years of "exceptional service and unfailing dedication to improving the lives of thousands of individuals," by passing Senate Resolution 278 in March of 2000. The resolution was submitted by Sen. J. Robert Kerrey (D-Neb.), a Vietnam veteran amputee and the only member of Congress to earn the Congressional Medal of Honor.

In November 1999, Dr. Burgess wrote: "By sharing my many travels and experiences with medical students, doctors, staff, family, friends, and local and national civic groups, many people have become aware of the conditions of the disabled in so many corners of the world. People who provide this type of care see the wonderful satisfaction of a job well done by the smile on a young child’s face; a father with his new prosthesis is now able to walk to work to provide for his family; or the young mother is now able to care for her children. Those who have traveled with me and have seen these changes for themselves have gone on to continue helping the disabled around the world. They have recognized that there is no greater act than giving people the tools to improve their own lives."

Donna Burgess says that the family would like the $5,000 donation that goes with the AAOS award be given to the Prosthetics Outreach Foundation. "We’re very committed to carrying on his work," she adds.

The 2001 Humanitarian Awards will be presented at the Opening Ceremony of the AAOS Annual Meeting in San Francisco.

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