Milwaukee Orthopaedics Overseas
Over the years, Dr. Grindel’s team and their counterparts in Nicaragua have developed a system of shared responsibilities. “The Nicaraguan team spends months on patient selection, sending us information via email for us to review ahead of time,” he says. “If imaging is available, they also get this to us while we are still in the U.S. We then develop a plan and procure the instruments and devices.”
“We do much of our work at Fernando Velez Paiz Hospital. When we arrive, we spend Sunday evaluating patients and organizing who is going to see which patient. We examine the available resources and do our best to ensure that we have the correct implants, hardware, plates, screws, etc. And in addition to the preselected patients, many more travel from all over the country to be evaluated. Unfortunately, only a fraction of those can be listed for surgery that week.”
The team works in two teaching hospitals in Managua, operating Monday through Friday and conducting as many surgeries as possible.
Dr. Grindel: “On a good day we can perform six surgeries. On the occasions when we can only do three then it is often because we may be doing more complex cases which require more operative time or we don’t have the necessary imaging or instruments to complete more on any given day. Much of what I do is shoulder surgery and because the head of Orthopedics at Fernando Velez Paiz Hospital, Dr. Pablo Carea, trained with us, their training program now has a surgeon who can perform these surgeries. They really did not have the necessary equipment to do these cases in Managua.”
Building an Enduring Legacy With Teaching and, Yes, Live Broadcasting
Nearly every year, says Dr. Grindel, Nicaraguan trainees come to Milwaukee to acquire vital surgical skills. “We have the resident or fellow work here at the Medical College of Wisconsin for six weeks. They select their area of interest—foot and ankle, trauma, sports etc.—and we pair them with a practicing orthopedic surgeon.”
Another approach to developing in-country talent is via a nationally broadcasted conference, surely more important now than ever.
“This February we did participate in routine care, but we also worked with our Nicaraguan counterparts to arrange a live national conference. There was broadcasting into an auditorium, and audiences from all over the country could view the surgeries we were performing. A Nicaraguan resident or visiting attending was scrubbed in with me for each operation. One of the surgeries we did was a Latarjet procedure where we cut the bone in the shoulder and moved it to another part of the shoulder to prevent dislocation. As for visualization, we had to rely on intra-operative landmarks and clinical judgement to confirm appropriate positioning of the bone graft and screws. The feedback on the conference was so positive that it will be repeated annually.”
OTW asked Dr. Grindel what his program needs most. “I would love to create a program that would enable us to have a steady stream of supplies that does not come through me but goes directly into these teaching hospitals. In addition, it is only by enhancing the educational component of our work that we will make a sustainable contribution to the musculoskeletal health of the Nicaraguan people.”
