Managua, Nicaragua - April 2014

Dr. K. Linnea Welton completed an off-site elective at the public hospital (Hospital Escuela Antonio Lenin Fonseca - HEALF) in Managua, Nicaragua. This hospital provides free(or nearly free) healthcare to Nicaraguan citizens and provides medical services for a large catchment area. Here is what she had to say about her trip:

Treatment of subacute fractures and chronic osteomyelitis were common cases that are not normally encountered to the same severity as at my home program. The management process of fractures, arthritis, sports-related ligamentous injuries were often done differently because of the severely limited resources, ability for patient follow-up, and surgeon knowledge. So while many of the orthopaedic disease processes I saw were fundamentally similar to those back home, the methods by which they could be managed were unique. HEALF is a 90 bed hospital and in addition to caring for the indigent and low-income population, receives referrals of difficult or complex cases from hospitals around the country outside of Managua. Common cases at HEALF are complex articular fractures, open long-bone fractures, and machete injuries to the hand. The wards are inhabited mostly by open fracture cases in various stages of treatment. Clinics occur on a daily basis and are predominantly resident driven. The Orthopaedic Department also has a designated room in the ED that sees patients on a continuous basis and is staffed by both residents and an attending during the day (and by a resident all night).

I found out about Health Volunteers Overseas (HVO) through one of the other residents in my program. She had done a rotation in Malawi and after reading through the HVO mission statement and values online I applied to become a volunteer in Central/South America. Upon approval to volunteer, I then applied for an HVO Orthopaedic Travelling Fellowship and a travelling fellowship through the UMHS Department of Orthopaedic Surgery. I received funding through both of these sources.

The best part of this experience was absolutely the challenge of learning how to treat orthopaedic patients with limited resources. I realized how the thought process for fracture management is completely dependent upon what is available and the type of environment we anticipate the patient returning to postoperatively.

The worst part of the experience was dealing with my own personal shortcomings (likely a mixture of perceived and true). Reflecting now, I anticipated that more of the medical staff would have some grasp of the English language than was actually the case. I was glad for the background in Spanish that I had and for taking the time to refresh my language knowledge both before and during my time abroad. However, if I had been more fluent I think my volunteer-work would have been even more fruitful for everyone involved.

I definitely would recommend volunteering with Health Volunteers Overseas to another resident and felt that I made a useful contribution to the orthopaedic residency program at HEALF.

Not only am I more appreciative, but I am more cognizant of the immense resources that we have at our disposal at the University of Michigan. The experience increased my drive to become the best orthopaedic surgeon that I can, not only for my patients, but also for my ability to one day pass along knowledge in the field.