Tuesday, June 15, 2010

Bologna, Italy and Ghent, Belgium

By: Nirav Shah

During the last year of my residency, I was fortunate to be able to travel abroad and participate in orthopedic care internationally for two weeks. I recently visited the European cities of Bologna, Italy and Ghent, Belgium to work with sports specialists focusing on cartilage restoration. As many of our surgical procedures are derivatives of European techniques, I welcomed the opportunity to interact with surgeons who are contributing novel ideas to the orthopedic field.

My travels began in Bologna, a city in Northern Italy and home to the oldest university in the Western World, founded in 1088. Its location as a central hub for European travelers throughout history led to its development into a major academic and cultural center. Unfortunately, its location has also led to numerous episodes of near complete destruction throughout history, most recently with Nazi bombings in 1944. Every episode, however, was met with resurgence by its populace, regenerating itself as a commercial, industrial, and communications center. It is a city that prides itself in its history, wine, and food. With 375,000 inhabitants in the city currently, and another 600,000 in the surrounding countryside, it is a city that bustles from dawn until well past sunset.

During my time there, I was able to explore the city both historically and gastronomically. It is a predominantly Catholic city, filled with churches, seemingly at every corner. As I visited during the Easter holidays, I observed many parades, celebrations, and ceremonies. After leaving church, the people like to gather in one of the many piazzas to have a drink or a cup of gelato. Gelato is such an integral part of Bolognese life, a “university” dedicated solely to training chefs on its production has been established in the city. The people also take pride in their unique flare to Italian cooking, a treat of which I was happy to partake.

When I was not exploring the city, I was at the Rizzoli Orthopedic Institute, a hospital specializing in orthopedics and musculoskeletal care founded in 1896 within the confines of the historic monastery of San Michele in Bosco. The hospital consists of nearly 100 faculty members with 60 supporting residents who see 150,000 patients and perform 18,000 surgeries annually. Historical contributions include bone tumor classification and management by Dr. Campanacci, treatment of spondylolisthesis by Dr. Marchetti, and shoulder stabilization techniques by Dr. Putti. Current work at the Rizzoli Orthopedic Institute, as evidenced by its presence as the largest tissue bank in Italy, includes allograft reconstruction following extremity sarcoma. The faculty is also in the midst of developing implantable biocomposite materials to repair articular lesions as well as replace previously resected meniscus.

I was thankfully able to observe several gifted knee surgeons such as Dr. Stefano Zaffagnini and Dr. Maurilio Marcacci and engage in enlightening conversations regarding their ideas and thought processes on ligament and cartilage reconstruction. In addition, their residents were extremely welcoming, escorting me around the hospital as well as the city. Seeing Bologna from a resident’s perspective was certainly a welcome and inebriating experience.
After my week in Bologna, I took a short flight and long train ride to Ghent, Belgium by way of Brussels. Despite having Dutch as the official language, the region of Fleming in the northern half of the country, where Ghent is located, has a preponderance of English-speakers, to my relief.

The city of Ghent was first inhabited as far back as the Stone Age due to its location at the confluence of two large, Northern European rivers. Today, it is home to 250,000 citizens and 600,000 total people in the metropolitan area. It has served as the center of the wool trade in Europe (leading to the good relations between Belgium and both England and Scotland), the seat for the high court of Belgium, and most recently the location for the Treaty of Ghent ending the War of 1812 between Britain and the United States.

The city of Ghent is extremely navigable, either by foot, or by its extensive public transportation system consisting of trams and buses. This was extremely helpful as I wandered the streets of the city center, taking in the preserved medieval architecture. One of the most scenic locations is the Graslei, site of the old harbor, where the old post office is flanked by St. Michael’s bridge, and the towers of several churches can be seen in the background.

But the city is not one large museum devoted to past architecture; the inhabitants reside in those same ancient buildings. They come out in droves in the afternoon, as early as 3 pm, to indulge in their favorite drink: beer. The region is famous for its Trappist ales, beers produced entirely within the confines of a monastery to fund the monks’ works. As a charitable citizen of the world, I was more than happy to contribute my fair share to their good cause. The appreciation for the food of Ghent, however, required pride that could only come from Ghent citizenship. The diet focuses on soups and stews to carry through the long, cold winters. Thankfully, its presence as a major port city as well as home to a large university has brought international flavors and cuisine to its people, including a new Subway fast food restaurant.
During the days, I was able to spend time with Dr. Peter Verdonk, an acclaimed sports surgeon whose research focuses on meniscal transplantation. He is part of the faculty at the Ghent University Hospital, a center that is committed to orthopedic resident education and excellent patient care. That philosophy parallels that of my experiences at Washington University. The resident participation in clinical care was nearly identical to that of Washington University, with morning conferences dedicated to education, autonomy in clinic, and supervised progression in the operating room. Our treatment algorithms were also nearly synonymous, save for the differences inherent in a socialized health system compared to our private insurance system. As the healthcare bill had just recently been passed by Congress at the time of my visit, this opened up a lively debate about the merits of each system. I was happy to see our European counterparts considered their system to be broken and unsustainable and looked to the U.S. system for solutions.

I am extremely grateful to everyone who extended their hospitality in both Bologna and Ghent. Over the two weeks abroad, I came to an appreciation for the differences in healthcare, both clinically and economically, that exists across the Atlantic. I found the entire experience enriching and am very thankful for the opportunity.

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