June 2004 Bulletin

Teach, travel, learn

Workshop provides orthopaedists with skills, knowledge to volunteer abroad

By Carolyn Rogers

How will I overcome the language barrier?”

“Am I too specialized?”

“What are the legal ramifications of practicing in a developing country?”

“Am I too old for this?”

Course participants take part in a hands-on session on lower limb splinting.

Those are just a few of the questions posed by orthopaedic surgeons who took part in the recent workshop, “Teach-Travel-Learn: Volunteering with Orthopaedics Overseas.”

Whether they were committed to volunteering with Orthopaedics Overseas or simply curious about the program, nearly 80 orthopaedists turned out for the two-day comprehensive workshop, held April 23-25, 2004, at AAOS headquarters in Rosemont, Ill.

First “how to” course

Sponsored by Health Volunteers Overseas (HVO) in conjunction with the AAOS International Committee, the workshop was actually the “reincarnation” of an HVO course that was last presented in 1996, according to Richard C. Fisher, MD, course chairman and chairman emeritus of Orthopaedics Overseas.

“In the intervening years, potential volunteers have had many questions about the overseas experience,” he said. “Some want to be better prepared, or are unsure of their ability to handle the clinical caseload in a setting where resources are scarce and infrastructure is unfamiliar. It became clear that more guidance was needed, so we developed this course.”

Unlike the original multidisciplinary HVO course, this workshop was directed solely at orthopaedic surgeons. Orthopaedics Overseas is the most active division of HVO, sending approximately 100 volunteers overseas each year.

“By limiting it to orthopaedists, we were able to present a better, more focused course,” he said. “It also gave us the opportunity to work with the AAOS.”

Edward P. Fink, MD, leads a breakout group on cross-cultural communication.
The level of interest in the program among orthopaedists was even greater than organizers had anticipated. “We were hoping for 40 participants,” Dr. Fisher said. “We ended up with nearly twice that, so we were very pleased with the response.”

Registrants were evenly divided between general orthopaedists and sub-specialists. According to a pre-course survey, two-thirds of the participants had already visited a developing country, but had not necessarily worked in one.

Personal, professional preparation

“Being an effective volunteer requires considerable preparation—both personally and professionally,” Dr. Fisher says.

The workshop focused on:

Clinical sessions

The program included eight sessions on clinical topics. The 60- and 90-minute sessions, which included lectures and field-based case studies, addressed: trauma fracture management; demonstration of functional bracing and traction; hand surgery and burns; rehabilitation and physical therapy issues; infection control and treatment; spine and care of spinal cord patients; and pediatric conditions.

Cross-cultural communication

To be effective and “bridge the gap between cultures,” volunteers must be aware of the myriad factors and conditions that influence the worldview of people living in developing nations, said Edward P. Fink, MD, an orthopaedic surgeon who spoke about cross-cultural communication.

Dr. Fisher (left) looks on during a session on upper extremity splinting.
In much of the developing world, “children are not even given names until their second birthday because of high infant mortality rates,” Dr. Fink said. “Hundreds of thousands of children die each year by bathing in polluted water…and 1 million people die every year as a result of road traffic accidents.”

With so much trauma to attend to, “there’s simply no time for preventive medicine,” he said.

Government corruption permeates many of these societies, and ethnic rivalries rage—leading to unprecedented numbers of dislocated families living as refugees.

“Nothing is predictable in their day-to-day lives,” he said.

Understanding culture, beliefs key

“This picture may sound gloomy and desperate,” Dr. Fink said, “but these people live in closely-knit communities, with very close interpersonal contact.”

Like us, their perceptions of health, illness and disease are highly culturally determined. “What is logical and important in a particular culture may seem irrational and unimportant to an outsider,” he said.

He shared the story of a young girl with clubfoot who’d traveled to see a visiting American doctor. Upon seeing her, the orthopaedist assumed she wanted her deformity “fixed.” He performed complicated corrective surgery, but in the end, the painful surgery was unsuccessful. Only on a return trip did the doctor learn that the girl hadn’t come to him expecting a “cure.” She’d had little trouble walking and was not particularly embarrassed by the deformity—clubfoot was not uncommon in her community. What she’d really wanted that day was a pair of shoes that would fit her feet!

“The most important tool you can bring with you is your humility,” Dr. Fink said.

The Chinese proverb ‘Teach a man to fish, and you’ll feed him for a lifetime,’ holds true, he said, “But also take the time to listen to the fisherman. He can teach you wonderful lessons about life.”

Faculty receives high marks

Course faculty was comprised of several veteran volunteers of Orthopaedics Overseas and other HVO groups. “According to the evaluation forms, 100 percent of the participants agreed that we had selected the appropriate faculty for this course,” Dr. Fisher said.

In addition to Drs. Fisher and Fink, program faculty included James Waddell, MD; Augusto Sarmiento, MD; Eldin Karaikovic, MD; Kim Dunleavy; Loren Latta, PhD; David Speigel, MD, and Barry Gainor, MD.

30 volunteers soon

Post-course evaluations also revealed that 30 of the participants planned to volunteer with Orthopaedics Overseas “soon,” and another 40 indicated they will volunteer “at some point,” Dr. Fisher reported.

“About five or six of the participants said that while they really enjoyed the course, they didn’t plan to volunteer overseas,” he said. “That’s good, though. That’s what the course is for—to provide the information they need to sort that out. We don’t want people to get over there and run into trouble, or be unhappy with the experience.”

Although the number of Orthopaedics Overseas sites changes from time to time, there are currently about 15 programs in place throughout the world. Sites include Bhutan, Cambodia, Costa Rica, Ethiopia, Peru, South Africa, St. Lucia, Tanzania, Kenya, Tobago, Uganda, Vietnam, the Philippines and others.

Workshop CD, book available

For now, no decision has been made about repeating the course next year.

“There was a pent-up demand for the course this time,” Dr Fisher said. “When it looks like it’s really needed, we’ll do it again.”

In the meantime, potential volunteers can access the material presented in this course by ordering a handy CD-ROM that contains the course syllabus, most of the speakers’ PowerPoint presentations and additional reference materials. The book, A Guide to Volunteering Overseas, which provides further assistance in preparing for or deciding about volunteering abroad, is also available for purchase ($15) through the AAOS Web site.

For more information on volunteering overseas, visit the HVO Web site at http://www.hvousa.org/, or contact HVO directly at (202) 296-0928.

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