By: Julienne Boone
During the last year of our residency training, we are supported by the department to partake in an international elective for 2 weeks. I recently traveled to Lyon, France to work with internationally acclaimed shoulder surgeon, Dr. Gilles Walch. Ironically, while this experience was not in a third world setting, I was the only chief this year to have significant travel problems and spent an extra week in Lyon due to multiple fight cancellations from the ashcloud of the erupting Icelandic Volcano Eyafallajokull.
Lyon is a vibrant city with a unique architectural, cultural and gastronomic heritage. The city proper has about 470,000 inhabitants, but the area of Greater Lyon has a population of about 1,200,000. It is shaped by its two rivers, the Rhone (to the East) and the Saone (to the West). It is located approximately 285 miles Southeast of Paris, 98 miles West of Geneva, and 200 miles North of Marseille and the Cote d'Azur.
During the renaissance, Lyon was one of Europe's largest cities and its first financial place. It's main industry was silk weaving which remained prominent until the end of the 19th century, and it was interesting to explore Vieux Lyon (Old Lyon) to see the traboules (corridors which link two streets through a building) where the pieces of silk were carried amongst the workshops and to the river. These notable architectural features also played a significant role during World War II under the German occupation as they permitted la Resistance to travel undetected and exchange information/weapons since the Germans did not know them very well. As an interesting fact, the head of la Resistance, Jean Moulin, was arrested in Lyon on June 21, 1943 during a meeting with Resistance leaders and notably interrogated in Lyon by the head of the Gestapo, Klaus Barbie (famously known as "the butch of Lyon").
Lyon is a very easy city to navigate on foot and the public transportation system is unparalleled as well. The metro runs city-wide and made it very easy for me to get to the hospital and clinics as well as explore. I was able to see a multitude of cultural landmarks both historical and present day that speak to Lyon's character.
Food is a very important part of the French culture here and Lyon as been called by many the capitol of gastronomy. Everyone here closes their shops and takes a long lunch break (usually from noon to 1:30ish) to eat at a local Bouchon.
I sampled many of the Lyonnais specialties, including quenelles de brochet (a souffle-like dumpling with pike fish), saucisson Beaujolais (local sausage cooked in red wine), and salad lyonnaise (mixed greens with lardons, croutons, a shallot vinaigrette, and topped with a poached egg - delicious!). All meals are typically served with wine and I was able to taste many fantastic wines produced from the nearby regions of Cotes du Rhone, Burgundy and Beaujolais.
France has universal health coverage through the public health insurance system which pays for about 75% of the total health expenditures. Supplemental private insurance and patient costs contribute to the remainder. There are both public hospitals (non-profit) and private hospitals (for-profit). I spent two weeks with Gilles Walch seeing patients in clinic, assisting with operative cases and attending morning conferences. The hospital he predominantly operates out of is Hopital Prive Jean Mermoz, which is a private 260 bed hospital which opened in 2008. He operates on Tuesdays and Wednesdays and usually does 5-6 cases each day.
He is a shoulder specialist, so the majority of the patients we saw had shoulder arthritis, instability or cuff pathology. Interestingly, all of his patients are admitted the night before surgery for their "pre-op" workup, and then they all stay at least one night post-op (even the cuffs!) since it costs the same regardless of length of stay.
During my time in Lyon, I assisted with many arthroscopic cuff repairs, a couple of Laterjet procedures, and a few total shoulder arthroplasties.
Each morning, prior to the OR, Dr. Walch met with his fellow, Allan Young from Australia, and his partner's fellow, Roberto from Brasil, to review the day's indications and provide some informal teaching. (This was also the time for everyone to have their morning espresso!)
On Mondays and Thursdays, I accompanied Dr. Walch during "consultation" (clinic). He belongs to a private group of 11 (soon to be 13) MD's, including 4 shoulder surgeons, knee surgeons, spine surgeons, a rheumatologist, and a few rehabilitation physicians. They own their own building, Centre Orthopedique Santy, and have in-house radiology and physical therapy.
Consultation occurs in Dr. Walch's personal office, where he has an exam table. Patients are called in one at a time and about 20-30 are seen each day. He works very closely with Dr. Jean-Pierre Liotard, a rehabilitation physician who focuses exclusively on the shoulder, and who sees all of his post-op patients. On Fridays, I worked with Dr. Liotard doing injections and post-op visits to assess rehabilitation progress.
My trip to Lyon was a wonderful experience. Dr. Walch is not only a tremendously talented
surgeon, but he is also an amazing teacher. Everyone I met, from his OR staff to his partners, were very welcoming and made me feel as through I was a member of Dr. Walch's team.
Dr. Walch also welcomed me to his house several times. As football (soccer) is huge in Europe and one of his favorite sports, he had the fellows and me over to watch the matches (we watched Lyon beat Bordeaux in the European Champions League quarterfinals)! Overall, I am very grateful for this opportunity to work with Dr. Walch. Both his professional and personal hospitality were quite gracious and this will hopefully be just the beginning of a wonderful collegial relationship.