About 60 miles west of the Brazilian border, on the edge of the Amazon jungle, there is a robust nonprofit organization providing advanced surgical services, medical training, and something rare among such non-profit charitable medical organizations—outcomes tracking.
Indeed, that attention to data collection has made the work of Scalpel At The Cross acclaimed—not only for delivering orthopedic and spiritual care, but, uniquely, a steady stream of patient outcome insights which has found its way into such leading orthopedic journals as JBJS (Journal of Bone & Joint Surgery).
The Genesis of Scalpel At The Cross
“We started in the early 2000s as a small family mission,” said Peter Cole, M.H.A., to OTW, executive vice president of Bone Foam, Inc. and head of strategy for Scalpel At The Cross, a nonprofit Christian orthopedic foundation serving Pucallpa, Peru, and the surrounding region.
Cole’s father, Dr. Peter Cole, Sr., is professor of orthopaedic surgery at University of Minnesota and chief of orthopedics at Regions Hospital, while his mother Nancy Cole is a practicing clinical psychologist. Dr. Cole’s upbringing in Venezuela facilitated his fluency in Spanish, and his understanding of Latin American culture and training in orthopedics made his involvement in mission work a natural next step in his service to Peru.
When the Cole family founded Scalpel At The Cross, Pucallpa consisted of around 175,000 inhabitants. “The city’s growth has been explosive over the last 20 years,” says Cole. “There are now over 600,000 people in Pucallpa and its surrounding areas…but there are still only two hospitals with eight operative beds serving that population.”
The first time Peter saw Pucallpa he was 6-years-old, and his father was just establishing the early relationship with the chairman of surgery at the regional hospital. That foundation led to facilitating educational courses, tackling complex orthopedic cases and much more.
“Over time we kept going back, bringing other surgeons, and eventually building a board and establishing a more sophisticated infrastructure of surgeon leadership. All along, we have steered away from the ‘relief organization’ model, instead focusing on the development of an ecosystem where training and knowledge exchange is routine, and outcomes are closely tracked.”
Heavy on Motor Vehicle Trauma, Neglected Injury, and Deformity
What types of orthopedic cases present themselves on the edge of the Peruvian jungle in a rapidly growing city? “We treat people who have been in vehicle accidents, those who have congenital deformities or those whose prior surgeries resulted in a nonunion.”
“Traditionally, these patients have had to pay for the implants, anesthesia, orthopedic care, and the hospital stay—and the majority of them are below the poverty line. What this means is that we see a lot of neglected injuries and deformities that worsen over time and then require surgical intervention.”
Roughly 4-5 times per year a team from Scalpel At The Cross heads to Pucallpa, where they typically stay for 10 days. “The group usually includes surgeons, nurses, physician assistants, and nonsurgical members to support the administrative aspects of the project,” stated Cole. “In July we saw 150 clinic patients in one day (already triaged). On an average trip about 20-35 patients are able to undergo surgery, all of whom are closely tracked for any problems.”
Because they also track the mechanism of injury, Scalpel At The Cross knows that approximately 40% of the patients they treat have been involved in motor vehicle accidents. “These are high-energy trauma wounds, largely from motorcycles or ‘mototaxis’ with cartons strapped to the back.”
“When we began working here there was one main road with deep potholes. Now there is a federal highway to Pucallpa, meaning that the speeds are higher, and the adherence to traffic regulations has not necessarily caught up to the increase in infrastructure.”
“In addition, this is an area where people are dependent on hunting game for a living and thus use traps. It is not unusual for someone to walk into a shotgun trap suffer a shattered tibia. Overall, not only do we see patients for their initial injuries, but we also see people who received treatment elsewhere and then had a nonunion. So often these are situations where the condition has been neglected due to life circumstances and has thus worsened.”
With a dedicated board of 11—half of whom are surgeons—as well as U.S.- and Peru-based employees, Scalpel At The Cross has established a solid foundation for the future. “The model is unique in that we don’t just fly there, treat people, and leave,” said Cole to OTW. “We are serving the same environment for a lifetime, investing both in the local infrastructure and knowledge transfer. We have developed our own electronic medical record system and our outcomes model has been published in The Journal of Bone & Joint Surgery.”
Not a U.S.-Based Vision
As a true, hand-in-hand collaborator with their Peruvian counterparts, the Scalpel At The Cross team has performed a mission reboot to build a clinical campus. “We have strong leadership in Peru who understand the difficulty that the local people have in accessing orthopedic care. Our model consists of giving care and investing in orthopedic education whereby we train local professionals and foster a sustainable environment. This is not a U.S.-based vision.”
Known as the “Miracle Campus,” the project is in Phase 1 where they are addressing the community’s needs both up and downstream to the surgical environment. “This includes orthotics and prosthetics,” said Cole to OTW. “Amputees in Peru have zero access to this type of care. Phases 2 and 3 will involve scaling up to surgical offerings.”
Miracle Campus Vision
The mission of the Miracle Campus is to extend the impact of Scalpel At The Cross through the development of a clinical campus that supports the spiritual, orthopedic, and socioeconomic needs of its patient population and the people who serve them. It is by intent that each of these three pillars advances a principle of strategic investment in Peruvian leadership, mission partners who have played critical roles in the growth of Scalpel At The Cross during various stages of its history.
Peter Cole told OTW, “Originally introduced to Scalpel At the Cross by virtue of their talents and desire to serve Christ, the organization’s Peruvian leadership has helped define and extend the ministry’s vision by providing locally led insights into how we can best address the needs of patients and the ecosystem of organizations who exist to empower them.”
“As Scalpel At The Cross embarks on the beginning stages of the Miracle Campus for what will be an historic event for the city and people of Pucallpa, we are consistently struck by the talent of our local partners and the divinely-placed roles of each in carrying out such an impactful vision.”
“The Miracle Campus has three areas of focus,” stated Cole to OTW. “The first is spiritual as we want to bridge our clinical work with discipleship and infrastructure to welcome the patients and providers we serve into an all-encompassing campus home.”
“The second is to elevate the level of orthopedic care provided in the Ucayali region by supplying local clinicians with a broader continuum of facilities, resources, and training to offer patients the best possible experience and outcome.”
“The third focus is socioeconomic and will involve working collaboratively with local leaders to identify community assets and support sustainable development through educational exchange and job development in the areas of physical therapy, orthopaedics, as well as orthotics and prosthetics.”
One Patient’s Journey With Scalpel At The Cross
There are numerous powerful patient stories underscoring the impact of Scalpel At The Cross. One such story is that of a young woman named Karen, a rising professional motocross star prior to shattering her femur in a traumatic motocross accident in 2018. After four years of failed surgeries at local hospitals in the midst of COVID-19 government shutdowns, Karen received surgical treatment from Scalpel At The Cross which also addressed her femoral nonunion in July 2022.
Karen now walks after four years of immobility.
Karen told OTW, “In a race that wasn’t my specialty of motocross—termed a ‘rally’—consisting of routes in the mountains where you would go up hills and slopes, cross rivers, go through mud, the bike bucked almost as if it were a horse. As I was in the air, I had a feeling it was coming towards me, and it fell right on top of my head. I only remember up to that moment: the bike was on top of me, and my leg (femur) was broken. I don’t remember anything else from then on as I was in shock.”
“Scalpel At The Cross took excellent care of me, for which I am extremely grateful. I particularly appreciate the support, the moral support, because that period of time was so difficult, and I even thought about taking my own life. I felt like my life was falling apart, and I felt like they were the light I needed. I know that it’s God working through them, as they are God’s instruments. They arrived in my life at a moment that I was awaiting them.”
$8.1M Dollars in Care Delivered
To date, Scalpel At The Cross has provided over $8.1 million dollars in total medical care, along with more than 500 medical volunteers on over 40 surgical campaigns/trips since 2004. We have raised more than $800,000 of our $2 million goal,” Cole explained to OTW. “And we welcome any additional donations so that these deserving patients can be healed, and this population can have a sustainable model of orthopedic care.”
Scalpel AT The Cross Vice President Dr. Clayton Nelson, said to OTW, “When patients present with old injuries, there are specific challenges because fractures may have healed in an incorrect position, injuries may be infected, or tendons/nerves may not have been able to be addressed in a timely fashion and they are left with essentially nonfunctional limbs. If patients have surgery, they often need physical therapy or a prosthesis to ensure the surgery is successful.”
“The Miracle Campus will provide the ability to meet these needs and help the patient complete their recovery process. It also allows for continued development and deepening of patient relationships and opportunities to share the love of Christ.”
Laines Schaff, Head of Peruvian Strategy and Legal Affairs, added, ““I have spent the last three decades serving as a pastor and lawyer in Pucallpa, Peru, and have seen firsthand the effects of poverty on the local population: lack of access to sufficient insurance options, economic resources and medical services has hurt the overcrowded city that often sees casualties from traffic accidents.”
Laines sees something unique in Scalpel At The Cross’ ministry: a permanent investment in the community. “During the course of my life, I have seen so many short-term medical teams from other organizations who come and go, and never come back. What I have come to see, what our patients have come to see, is that Scalpel At The Cross is here to stay in Pucallpa, is here to invest in Pucallpa. The next generation of Scalpel At The Cross leaders is just as invested as the one prior. One day I will be gone, but Scalpel At The Cross will still be here.”
Editors Note: We fully support Scalpel At The Cross and encourage our entire community of surgeons, business executives and others to donate to this very worthy, well managed and impactful organization. If you are planning your end of year donations, please make room for Scalpel At The Cross.
Here is where you can make your donation. https://scalpelatthecross.org/donate/
Thank you,
Robin Young, Publisher
RRY Publications LLC.
References:
- Maki J, Qualls M, White B, Kleefield S et al (2008) Health impact assessment and short-term medical missions: a methods study to evaluate quality of care. BMC Health Serv Res 8:121
- Lin Y, Dahm JS, Kushner AL et al (2018) Are American surgical residents prepared for humanitarian deployment?: a comparative analysis of resident and humanitarian case logs. World J Surg 42:32–39. https://doi.org/10.1007/s00268-017-4137-x
