In 1972, in the wastelands of southern Texas, there was little that could be done for a child who broke a leg or a grandmother suffering with hip pain. And more recently, in the wasteland of post-earthquake Haiti, there was much to be done and few hearty enough to do it. In these and other situations, Dr. Kaye Wilkins, winner of the 2008 Humanitarian Award from the American Academy of Orthopaedic Surgeons (AAOS), ignored the obstacles and got to work and found ways to employ his skills and knowledge.
A pediatric surgeon, whose motto is, “leave skills in addition to scars, ” Dr. Wilkins is co-editor of the most widely used pediatric fracture textbook in the world—Fractures in Children. He is also a former president of the Pediatric Orthopaedic Society of North America (POSNA), and a recipient of a Distinguished Service Award from that organization.
Of course Kaye Wilkins could foresee none of this as he bent over his earliest charges—pigs—and went about castrating them in the 100 degree heat. “My father was a government agricultural economist who encouraged me to have a career where I could be independent. I enjoyed animals, and ended up attending veterinary school and then taking a job providing veterinary services to farm animals in rural Northern Indiana. Not only was my bride unhappy in this small town, but I could see that I would eventually become physically drained if I continued with a large animal practice…castrating pigs in the 100 degree heat and dehorning cattle in snow storms was pretty draining. We moved to Tyler, Texas, where I started a small animal practice—the problem was that the town didn’t need another practice. I was completely frustrated, and at the age of 28 walked through the doors of medical school.”
Years later his decision to switch careers would be validated in the smiles of his patients, who so often have very little. Citing his experience in Haiti as his most life-altering endeavor, Dr. Wilkins opens a window into his work abroad, “I wanted to be a missionary at one point, but I had a family so going abroad for short trips turned out to be a good compromise. I started going to Haiti in 1995 for visits of one week as a result of a connection with my church. Even before the earthquake, Haiti was not an easy environment…it took three years before I developed any credibility with any of the local orthopedic surgeons and other health care providers. Many well meaning individuals head down to Haiti arriving initially with grand plans. Once they see the myriad of problems that come with working in Haiti, they become frustrated and don’t return. As a result, the Haitians view anyone coming there with some skepticism until they see that these individuals are there for the long term.”
As much as helping means to Dr. Wilkins, he knows that there are limits and nuances to giving. “Before the earthquake, the Haitian orthopedic surgeons who had completed their orthopedic training faced the reality that the hospitals couldn’t provide the necessary equipment and people couldn’t pay for care. Thus, these newly trained orthopedic surgeons started leaving the country. After the earthquake, the country’s only residency program closed. In the chaos that followed, the approximately 35 remaining orthopedists in the country were dealing with lost practices and lost family members. And while it seems like help from abroad would be a good short-term answer, for the most part doctors who came to Haiti didn’t really involve the Haitians. This influx of free care provided by the visiting orthopedic surgeons destroyed what was left of Haitian private practices. Local people thought, ‘Why go to Dr. X when I can go to a hospital with foreign-trained doctors and modern equipment?’ One of my present goals in Haiti is to develop opportunities for the Haitian orthopedic surgeons to be able to earn a decent living in Haiti so they will stay there on a permanent basis.”
As for how he ended up in orthopedics, Dr. Wilkins says, “First of all, when I made the decision to leave veterinary medicine, I was a little delusional about medical school. I thought, ‘Four years…no problem.’ The fact that it was 11 years before I had an income was pretty tough. But I enjoyed it, and worked in a pediatrician’s office during medical school. It was the orthopedic rotations that really ‘got me, ’ however. The happy, engaged orthopedic surgeons I met were part of the reason I enjoyed it so much; the other reason was because of the overwhelmingly positive results as compared to other specialties. I could not have accomplished this goal without the support of my wife Sidney. She worked as a teacher and cared for our children while I was busy getting my medical education.”
And for 23 years he would take his positive results to “the people.” Dr. Wilkins: “I had a private practice in San Antonio, and at the same time had an appointment with the local medical school. When I left the medical school as a full-time faculty member in 1978, there were not many people doing pediatric orthopedics, especially private practitioners. All of my colleagues who worked with adults swore that I would never be able to make a living. How wrong they were. We were inundated with patients because no other orthopedists in the area took care of kids.”
Although he was pleased to be helping local patients, Dr. Wilkins eventually learned of a great need just south of him. “I found out that people living in the border towns had no access to an orthopedist. I’m really proud to have established several pediatric orthopedic outreach clinics in the area…over the years hundreds of patients have received treatment at these clinics.”
Because he ventured into pediatric orthopedics early in field, Dr. Wilkins encountered a wide open field with lots of room for growth. “I became involved in the organization of a pediatric orthopedic study group that eventually became The Pediatric Orthopedic Society of North America (POSNA). I also initiated the development of an Outreach Continuing Education Program in Pediatric Orthopaedics whereby POSNA members volunteer abroad, pay their own travel expenses, and share their wealth of knowledge. Over the years that program has organized over 30 postgraduate pediatric orthopedics courses in 20 countries.”
Dr Wilkins making rounds at the Benh Vien Nhi Dong Hospital
in Dong Nai, Vietnam/Source: Dr. Kaye WilkinsDr. Wilkins’ enthusiasm for his field is described in his wife Sidney’s frequent refrain: “Kaye, you are a big kid!” “Working with children is special for many reasons. They all want to get well, they heal rapidly, and there is a wider margin of error (the bone doesn’t have to be just exactly straight because it will remodel). And frankly, they are just fun…I have lots of toys that help to divert their attention away from the fact that they are in a doctor’s office. One of my most memorable patients was a young girl who was crossing the street when a car hit her; she had four fractures and a head injury. We secured her fractures with multiple intramedullary nails and she has gone on to great health and is quite the athlete now.”
As much as Dr. Wilkins loves his field, he is disappointed that others do not share his sentiment. “I think young surgeons shy away from pediatric orthopedics because it is not well reimbursed and there is a substantial liability risk. The fact is that there is a statute of liability that extends until a child is 21. The good news is that pediatrics orthopedists are more in demand than ever, the reimbursement is slowly increasing, and we can correct more pediatric conditions than ever before. My hope is that pediatric orthopedics will receive more attention…putting a child’s hip back into a socket, repairing growth plates, etc…these things prevent people from having a lifetime of disabilities.”
And wherever they live out those lifetimes, Dr. Wilkins is willing to help them. “I’m working to develop relationships in Sri Lanka, a country with 20 million people and no formal children’s orthopedics program. Last year several colleagues and I went and taught a course on standard techniques that they had never seen before. We are trying to coordinate efforts between POSNA, the European Paediatric Orthopaedic Society, and the Paediatric Orthopaedic Society of India. Also, soon we will have an orthopedist from Sri Lanka coming to train in San Antonio. Through the years we have had about 40 foreign physicians visit, and—through the generosity of the nuns who run Santa Rosa Hospital—stay at their convent.”
Hearkening back to his motto about leaving skills, Dr. Wilkins states, “There are many instances where doctors go to lesser resourced countries, perform surgery, and then leave nothing but scars. We have a responsibility to make such trips teaching situations. The goal of traveling to countries with limited resources should be to organize educational conferences and meet with your colleagues abroad…we have to teach ourselves out of a job. It is incredibly satisfying to return to these countries and see that they are doing things that I showed them.”
Love and habit, says Dr. Wilkins, got him where he is. “Persisting no matter what is one of my big ‘secrets.’ The other is the constant support of my wife. She has accompanied me on a number of these outreach trips and is a wonderful sounding board for my thoughts.”
Often, those ideas are flushed out as they relax at their house in Colorado. “We revel in the open air, and enjoy hiking in the mountains and ‘taking in’ the beauty. I also take a great deal of pleasure in meeting my colleagues abroad. I am looking forward to upcoming outreach education programs in Nepal, Spain, and eventually, Africa.”
Dr. Kaye Wilkins…a gifted orthopedic surgeon who keeps on giving.
