Floating Island of Hope
It’s a floating OR (five of them, actually) that roams the world helping the globe’s neediest citizens. This state-of-the-art floating island of hope is named Africa Mercy and is owned and operated under the auspices of Mercy Ships, a 37-year-old entity that offers the chance of a new life to those who have no other help. In total, Mercy Ships has visited 587 ports and their volunteer surgeons have performed more than 81, 000 life-changing or life-saving operations.
Mercy Ships is committed to serving countries in the lower third of the UN Human Development Index. Mercy Ships goes where it is invited to serve in a country, and where the government must agree to full participation.
The Africa Mercy is currently docked in Toamasina, Madagascar. That is where OTW found Frank Haydon, M.D., an orthopedic surgeon and longtime volunteer with Mercy Ships. He said, “My wife is a nurse, and serves as the orthopedic team leader on the ship. In nursing school she had a roommate who toured a Mercy Ship and got her interested in participating. We have been volunteering with this fantastic organization for seven years. I am the lead orthopedic surgeon and we have two new surgeons coming soon. We primarily treat angular deformities of the lower leg (tibia vara and tibia valgus). In Madagascar we are seeing quite a lot of rickets because the kids are surviving on white rice three times a day and are thus deficient in calcium and vitamin D. We also treat clubfeet and just this year we have started an off-ship Ponseti program for those under the age of three.”
“I am doing an average of four surgeries per day, most of which are bilateral procedures. The patients range in age from 4-17, with an average age of 5. We would love to have more surgeons who are willing to come for two weeks at a time. We have a CT scanner, X-ray capability, a lab, and a Nikon Coolscope for remote diagnosis.”
“The transformation that you get to participate in is life-changing for all involved. These are people who have no access to healthcare and who live on a few dollars a day. Their deformity has separated them from the rest of society for perhaps their whole lives…and we get to change that!”
“Each year there is a child that stands out for me. There was a boy who walked for two days to reach the ship, despite having a horrible foot infection. He was close to death when he arrived; we amputated his foot and within 24 hours he began to recover. We provide miracles for those who can’t do it for themselves.”
The goal of Mercy Ships is to have is to have two orthopedic surgeons working together during each field service.
If you wish to find out more information about how to volunteer please visit https://volunteer.mercyships.org/. To make a donation to Mercy Ships, please visit https://www.mercyships.org/ways-to-give/
NYU Langone Upping Ante on Research
In what is a trailblazing twist, surgeons from NYU Langone Medical Center are changing the face of research at their institution. Thomas Errico, M.D. is chief of the Division of Spine Surgery at NYU Langone Medical Center. He told OTW, “Ten years ago I considered having a more formal research lab which would include varying levels of researchers. The idea was to provide more evidence of the effectiveness of spine surgery, but also to have an environment that is essentially a launching pad for academic careers. After two years of searching I secured real estate across the street from the Hospital for Joint Diseases and we took the opportunity to set up a research lab on the first floor of a Brownstone. Our existing research team, directed by Alex Lee, R.N, began with the SPORT Trial (Spine Patient Outcomes Research Trial); Frank Schwab, M.D. and Virginie Lafage, Ph.D. came on board and started an extremely prolific collaboration. Ground breaking progress was made in many areas, including sagittal balance and pelvic parameters. We train four spine fellows a year, most of whom are busy doing surgeries, trying to find a job and raise families. We realized we needed more help than just spine fellows to do meaningful research so we expanded our team. It is now a place where a college premed student can come because he or she wants to do a year of research to amplify their medical school application. Or one of our researchers might be someone who graduated from medical school, but did not get the residency of their choice. And we sometimes take orthopedic residents in the middle of residency. Many of our early researchers are now well into medical school, residencies and fellowships. Our mantra is, ‘The Brownstone is a launching ground—not a landing spot.’ Take what you learn here and ‘fly with it!’”
“It is a boost rather than a magic pill; if someone was lousy in college that can’t be erased. If a medical student is not a great applicant to begin with then working in our lab can’t help him or her get into an orthopedic residency.”
“In order to keep this initiative underway, we are seeking better funding. Twenty years ago I founded a nonprofit spine scoliosis research entity called Spine and Scoliosis Research; over the years we have collected money that can now be used for this laboratory. We also fund the research via gainsharing obtained by cost savings for the hospital. Other grants have been obtained but we are constantly seeking more.”
Shay Bess, M.D. is chief of the Adult Spinal Deformity Service for the Division of Spine Surgery and Director of Spine Research in the Department of Orthopaedic Surgery at NYU Langone Medical Center and Hospital for Joint Diseases. He told OTW, “The research Brownstone is an ideal setting for collaborative research because it creates an environment that thrives on finding synergies, and brings together a critical mass of people who are interested in getting things done.”
“We are working on a number of projects, including our efforts with the International Spine Study Group, which is an incredibly productive multi-center research group that has the same approach to research that exists within the Brownstone at NYU; namely productivity through collaborative efforts and combined intelligence. Additionally, we have access to large national databases that allows us to examine larger questions and provides the impetus to hone in on the granular aspects of the questions with more detailed databases. We are also combining efforts with the Orthopaedic Trauma and Adult Reconstruction services at NYU to investigate what determines patient satisfaction during the hospital stay and the interplay between pain control, patient satisfaction and postoperative discharge status. The future thrust of our research will be aimed at refining the methodology by which we assess patient reported quality of life. This will involve implementing more advanced questionnaires into our patient assessment practices. These advanced questionnaires will be more accurate than the standard forms that are traditionally used and, of equal importance, will reduce patient question burden and save patient time. In the end, this vast array of collaborative efforts helps foster the careers of the budding academicians at the NYU Brownstone as they strive of answer the he specifics of ‘what’ ‘how’ ‘when’ and ‘why.’”
Rush Ortho: Automated Program Preventing Secondary Fractures
At Rush University Medical Center physicians are elevating fracture prevention to a new level. Sanford Baim, M.D. is director of the Bone Metabolic Disease Program in the Rush Section of Endocrinology. Dr. Baim, who established and leads Rush’s Fracture Liaison Service (FLS), and is working with orthopedic surgery at Rush told OTW, “After having implemented this program at another university we found it made a real difference in preventing additional osteoporotic fractures. The chair and executive vice chair of the department of medicine recruited me to develop the program at Rush and thus establish a comprehensive approach to identifying patients at risk for re-fracture.”
“This totally automated program is actually part of the Epic electronic health records system at Rush. It identifies patients 50 years and older who have sustained a fracture at the time of admission or who have had a fracture since the age of 50 in their medical record. If a patient meets either of those criteria, a FLS alert is generated by the patient’s orthopedic surgeon, hospitalist, neurosurgeon, or medical team to decide whether a fracture liaison consult is required. This includes all patients admitted through the ER, those who come to the ER, but are not admitted and sent to orthopedic surgery in the outpatient setting for follow up, and those who go to the Rush rehabilitation center. Since this is specific to a fragility fracture that is synonymous for an osteoporotic fracture, someone who, for example, comes into the ER due to a car wreck and has a fracture, does not usually require a consult unless the patient’s orthopedic surgeon finds skeletal fragility at the time of surgery or additional medical reasons for a consult are apparent.”
“The other great aspect of the Rush Fracture Liaison Service is that it serves as a training program since physicians in general are not aware of fragility fractures being consistent with the clinical diagnosis of osteoporosis irrespective of the bone density scan diagnosis. Patients are seen in consultation with fellow and residents and are assessed to determine if the patient has underlying secondary reasons for osteoporosis inclusive of metabolic bone diseases and mineral disorders. An essential feature of the service is education of the Rush attending staff (orthopedics, neurology, rehabilitation, etc.) about secondary fracture prevention.”
“Unfortunately, greater than half of fractures occur in patients not identified as osteoporotic by a bone density scan and as such many physicians say, ‘My gosh…we just fixed a hip fracture and we need to do something so that the patient doesn’t have another fracture.’”
“At present we have almost completed collecting the first 100 patient consults and are analyzing the data that will soon be presented to our medical staff as part of a quality improvement program at Rush. Following this, we will publish our results and explain how important this is for secondary fracture prevention. Once we are have completed this aspect of our secondary fracture prevention program, we will turn our attention to primary fracture prevention across the entire Rush system.”
