With the memories and impact of last year’s Operation Walk mission to Nicaragua still firmly embedded in our minds, Brandon operating room nurses Rachelle Lesy and Stephanie Phillips, surgeon Dr. Norm Klippenstein, and newly recruited nurse Lisa Cobbe once again joined the Winnipeg team and returned to that Central American country to provide life-changing knee replacements to those who otherwise could not hope for such transformative surgery. We spent another intense and unforgettable week in an inner city hospital in Managua to help the team of about 60 achieve its humanitarian goals, once again reaping the intangible rewards that such service often brings. The spirited solidarity of medical personnel, support workers, and volunteers was a tribute to the common commitment to this mission and the people of one of the poorest countries in the Americas. This year we targeted an even larger number of debilitated patients, continuing to build up the hospital’s depleted and outdated equipment needs, and once again going outside our medical mandate to visit several schools and social agencies. This ambitious agenda required a full year of fundraising, a collection of donated supplies, and development of a medical and volunteer team to address the many facets that such a complex joint replacement service requires. Once again the team rallied the necessary support, overcame unpredictable yet seemingly perpetual challenges, and at the end of the week declared this year’s mission to be the best of the 6 annual trips yet.
A shipping container of donated equipment and supplies arrived in Nicaragua about a month ahead of the team, once again requiring negotiation and management of red tape to allow it to be unloaded. The drugs we brought for the anaesthetics were initially considered illegal but were eventually cleared. An advance group arrived several days prior to the rest of the team to preview and select those patients most in need of surgery and ensure the safe transfer of the shipped supplies. One of the 10 donated hospital beds had been diverted by a high-ranking government official and had to be delicately retrieved, and a critical set of knee implants which didn’t arrive had to be brought with the Brandon team’s air luggage at the last minute. The local wards were cleared to prepare for the dozens of new post-op patients. A lost passport and a last minute scheduling conflict left the team without two anaesthetists, requiring the recruitment of local staff to fill in on short notice.
Once we started operating the first day, it became evident that workflow would be an additional challenge. The minimally equipped and outdated sterilizing facilities at the hospital were unable to accommodate the high pace, significantly restricting the availability of clean operating equipment. This resulted in delays and the need for some staff to work 18 hour days to support the planned procedures. Cats in the hospital and flies in the OR were accepted as unavoidable local conditions. Supplies that we would normally discard after each case at home were carefully collected by their staff for recycling. The limited air conditioning in the crowded hospital seemed to only minimally temper the 30 plus degree heat. The roads to the rural schools we visited had been washed out by torrential rains the week before and were just being rendered passable by road crews on our arrival. Each day additional challenges required ingenuity to ensure the ongoing success of the mission.
Despite these and other obstacles presented by the realities of working in a developing country, the Operation Walk team performed 69 joint replacements in three days, in a hospital that typically performs 40 or 50 joint replacements a year, and only for those that can pay. This represented the most ever by our team, and for what were probably the most challenging deformities encountered by our Nicaraguan missions to date. Some patients had not been able to walk for several years. Many could not work or look after their families. Working dawn to dusk, disregarding the usual division of responsibilities we maintain in our Brandon OR, innovating and substituting for gaps in equipment availability, constantly working through Spanish interpreters, and feeding off a high level of group energy and encouragement, we pushed the pace with minimal breaks and our usual conveniences.
This year we brought previously used knee braces and other orthopaedic appliances which had been donated through the Brandon Clinic for distribution in Nicaragua. It is hoped that this project can be further developed to help those who cannot make it onto operating lists or who might not be candidates for surgery. There were many conversations around ideas for introducing resources and initiatives into a society that has a seemingly endless need for medical and other support.
Incorporating local medical personnel into our work has become an appreciated hallmark of Operation Walk, distinguishing our Canadian approach from other groups who have preceded us. Once again the outpouring of gratitude from the patients and their families was overwhelming and humbling. Embraces, tears, and prayers were offered in thanks to our members. And again the individual stories and personalities gave the surgical and rehabilitative component of our mission a profoundly unforgettable human element that can’t be measured by straightened limbs or extended walking distances.
A parallel initiative to visit an orphanage, a centre for troubled young mothers and several schools gave additional opportunity to bring donated supplies and encouragement to areas of need that were a sober reminder of the vast disparity between our respective societies. A festival put on for a rural school, with piñatas, pizza and face painting was just as joyous, however, as any school party in our country, and donated baseball and soccer equipment allowed the children to show off sporting skills that had been honed on much shabbier gear. There is no greater stimulus to inspire hearts and humanitarian efforts than seeing needy situations where such a small contribution can make such a big difference.
And so the four of us returned to Brandon the richer for the experience and the happier for the opportunity to serve an area of need in such a unique way. Back home our Canadian jobs take on new meaning in light of the unforgettable experiences of this short but intense surgical mission and the wonderful people of Nicaragua we were able to engage. We are most grateful for the generous donations made in support of this trip, for the backing and encouragement we have received from our medical community, and for supportive friends and family who will be hearing many more stories from our adventure.
Submitted by : Dr. Norm Klippenstein, Orthopedic Surgeon
|Patient before surgery.||
Patient after surgery