My International Rotation

Lindley Wall

Hospital Fonseca, the public hospital where I spent my first week.

For my international rotation I traveled to Managua, Nicaragua, in conjunction with the organization Health Volunteers Overseas (HVO). During the first week, I worked with the Nicaraguan orthopaedic surgery residents at the public hospital in Managua. Each day was a combination of clinic and operating; beginning with fracture conference at 6:30am and ending with evening rounds on all the patients with all members of the orthopaedic team. While there were some elective surgical cases, most cases were infections and fractures. A few of the cases I participated in included fixation of femoral shaft, tibial shaft, hip, and distal radius fractures. The supplies available to the residents at the hospital were very limited, but they took great advantage of the accessible resources, using all instruments and implants available. Unfortunately, it is a common scenario that patients would have to remain as inpatients awaiting arrival of implants or depending on their family to find the money to purchase the appropriate implants.

Clinic waiting room at the children’s hospital.

At the start of the second week, I was joined by the HVO hand team, lead by Drs. Michelle James and William LaSalle. This was the third year HVO had sent a hand team to Nicaragua to teach and operate at the local hospitals. The group consisted of two hand therapists, three hand surgeons, one pediatric orthopaedic fellow, and two orthopaedic residents. We worked in two teams, one working at the military hospital, seeing adult patients, and the other treating children at the pediatric hospital. The week began with a full clinic of patients at each hospital; this included post-operative visits, therapy sessions, initial evaluation and diagnosis, and scheduling the operative cases for the week. Each of the following days that week, we were able to perform approximately four surgeries per day at each of the two hospitals. The range of cases was incredibly broad, from a 9-month-old baby with a cleft hand at the pediatric hospital to a 65-year-old woman with RA who underwent multiple MCP joint arthroplasties at the military hospital.

Distal radius fracture at Hospital Fonseca.

Drs. Michelle James and William LaSalle with the Nicaraguan residents.

Overall the goal of the trip was to help take care of the Nicaraguan population and to teach the Nicaraguan orthopaedic surgery residents how to diagnose and treat adult, as well as pediatric, hand conditions. Each morning a member of our team would give a lecture on general hand topics for the residents. Subsequently, we would proceed to the operating room where the HVO surgeons would take the Nicaraguan residents through the operative cases. This provided a great opportunity for the residents to see how we treat a wide variety of hand pathologies, including hand trauma, degenerative conditions, and congenital malformations of the hand and wrist.

The HVO Hand Team

In addition to the clinical aspect of the trip, the social and cultural experience was invigorating. While there was limited time for sight-seeing, given our clinical schedule, we were able to spend one afternoon in Granada, a beautiful, historic city. Our Nicaraguan hosts were more than accommodating. The residents and attendings with whom we worked were very welcoming and gracious, taking us to the local restaurants to experience their culinary culture.

The beautiful historic city of Granada.

Enjoying the culinary culture of Nicaragua.

I appreciated the opportunity to practice orthopaedic surgery in Nicaragua, to improve the patients’ lives there, and to learn how programs, such as HVO, are organized and implemented. Hopefully in the future I will be able to participate and contribute as an attending hand surgeon, treating the local population and teaching residents new tools to improve patient care in their own countries.