Small Country Church - Big Hearts

“The church is in Philadelphia, MS, my hometown. It's a small country church, with mostly country people, but they have big hearts” describes Terry Winstead a recent visitor to CURE International Dominican Republic. After visiting our hospital, Terry, an occupational therapist from Mississippi returned home inspired to make a difference. He presented the Bethsaida Baptist Church with a report of his trip and a challenge to donate for surgical care of disabled children in the Dominican Republic. In addition he promised to make a matching donation for whatever was placed in the offering plate. After doubling their Sunday morning offering the amount reached over $3500. Each and every one of those dollars will be again multiplied as the lives of the children and families that we serve are changed through medical and spiritual healing. By personal sacrifice, corporate equipment donations, and harvesting wasted excess of medical supplies in the United States we are able to provide state of the art surgical care for our patients at a fraction of the cost normally required. Not everyone is called to leave the shores of their comfort zone to serve, but these simple folk from Mississippi have stepped forward as an example of what Christ has repeatedly asked us to do. Call it an investment, moral obligation, or Biblical principle, the rewards of sacrifice are great.

Give and it will be given to you... Luke 6:38

Roynelis, a 4 year old girl born with a nonfunctional thumb on the left hand underwent reconstructive surgery to create a thumb by transplantation of her index finger. In addition to a wrist repositioning surgery a similar operation will be performed on the right side where she was born missing a thumb and one of her forearm bones. Thanks to support from people like the members of the Bethsaida Baptist Church CURE surgeons and staff are able to transform the lives of children around the world. Click here to see pictures of similar operations performed at CURE Dominican Republic.

Arrowhead Orthopaedics Sponsors Rotation in the Dominican Republic

On behalf of Loma Linda University and CURE International I would like to thank Arrowhead Orthopaedics for their generous financial support of the international pediatric and limb deformity rotation in the Dominican Republic. To our knowledge this is the only ACGME approved orthopaedic elective rotation in the developing world making it a unique feature of the Loma Linda orthopaedic residency program and CURE International. Because of the financial support of Arrowhead Orthopaedics and the administrative support of Loma Linda University and the orthopaedic department an important part of the mission of LLU has been reintegrated into the residency program and placed us at the forefront of modern humanitarian and outreach efforts in orthopaedic education.

Over the past several years there has been a growing interest amongst medical students and young physicians in medical missions and social responsibility. This has spread throughout secular universities throughout the modern world. In contrast to years past, most of these efforts are purely humanitarian as opposed to previous years where the large majority of this work was carried out by religious groups. Loma Linda University was established with the unique charter to train physicians for this type of work long before the secular world became interested. At LLU there is a resurgence of interest in this work as well as strong administrative support which has made possible the success of this orthopaedic rotation amongst other similar endeavors.

The rotation at CURE International in the Dominican Republic and Haiti is a unique opportunity to provide first world orthopaedic care for the challenging problems of the developing world. Due to consanguinity, environmental contaminants, and public health and safety issues we treat a wide variety of rare congenital deformities, developmental problems, post-traumatic disorders as well as other diseases such as polio and TB which are rarely seen in the US. As if many of these problems were not challenging enough, they often do not present themselves in a timely fashion and often have been mistreated at other centers making the challenge even more difficult.

Over the past 3 years a number of top quality visiting professors have greatly added to the resident education and quality of services we offer. This has given the opportunity for the residents to work and develop relationships with surgeons from other programs in the United States. (We are still awaiting a promised visit from Maestro Jim Matiko – possibly this will be realized in 2009.) In addition the armamentarium of equipment has substantially increased over the last several years. Spinal deformity corrections are commonly performed with the latest pedicle screw systems. As well, we have developed an in depth experience with external fixation and limb deformity correction and limb lengthening reconstruction. Residents are getting extensive experience with Orthofix external fixation, Ilizarov, and with the Taylor Spatial Frame which is a computer assisted six axis deformity correction device recently placed on the orthopaedic market.

Sam Chen MD quotes “Thanks to the sponsorship by Arrowhead Orthopaedics, I was given training not obtainable in my home program. I was able to see the effect of untreated pathology and the suffering it can cause. More importantly, I was also able to see the gratitude of people when they are provided with help from outside organizations.”

At CURE International Dominican Republic we have hosted residents from New York, St. Louis, Mayo Clinic, Riverside County Regional Medical Center and Loma Linda. We also have become a regular part of the curriculum for residents from two of the Dominican orthopaedic surgery residency programs. Although the rotation for US residents is ACGME approved, administrative support and financial support has been lacking at other institutions (aside from LLU) inhibiting the ability to formalize the elective for the residents from other programs many of whom have used vacation time for their visits. For this reason we owe a great degree of gratitude to Arrowhead Orthopaedics for financially supporting this endeavor and appreciating the importance of this educational experience and our heritage as educators and students at Loma Linda University.

Biomet Donation Saves a Leg in the Dominican Republic

Multiple surgeons in Santo Domingo had recommended amputation, but when 43 year old Marineris came to CURE International’s hospital she was given a new hope. She had been diagnosed with an advanced giant cell tumor which had completely destroyed the bone just above her knee. In spite of working in an environment of limited resources I very seldom compromise my surgical indications. But in this case I knew it would be difficult to provide state of the art limb salvage reconstruction surgery for this patient whose resources were already exhausted with a few simple preoperative imaging studies.

The first step was to confirm the ambiguous pathology report with Dr. Craig Zuppan at Loma Linda University a ‘virtual missionary’ who gives his time and expertise for people he never meets. Thanks to FedEx and email, one day later, Dr. Zuppan had received the specimen in southern California and confirmed the diagnosis. Lung metastasis were ruled out and with a marginal resection her prognosis would be good. I presented the situation to some of my contacts at Biomet who had helped one of our patients a couple of years ago. Not much hope was initially given due to new government restrictions on any donations that could be construed as physician enticement. After a month long approval process government monitors determined that my practice does not represent any lucrative incentives for corporate donations and Biomet approved the donation. When I announced the news to Marinerys and her husband, tears came to their eyes and hope of living a relatively normal life was restored.

Multiple emails were exchanged with Mark Bollinger and Troy Hershberger of Biomet, Warsaw, IN. Final preoperative planning was wrapped up with a meeting at Starbucks Santa Monica, CA between myself and Tyler Jolley the Los Angeles Biomet limb salvage specialist. I returned from my trip to California loaded with instruments and implants.

After maximal preparation and a prayer… the operation was initiated. The absence of a vascular surgeon, vessel clips and a Biomet rep added to the difficulty of the case. But after 3 hours of surgery the tumor was resected and the prosthetic reconstruction begun. The innovative Biomet Compress prosthesis addresses the problem of loosening at the implant bone interface by loading the bone with up to 800 lbs of continuous spring loaded force to invoke an incredibly strong biologic bond between the metal and bone. We released the spring loaded force and placed the $20,000 implant without difficulty. Her recuperation phase was begun.

It does not matter that Marineris knows nothing about Warsaw, Biomet, Loma Linda, Lemoyne, bone ingrowth, or all the work and resources that multiple people around the world have invested to make this operation a success. She appreciates her leg and her life. Worth more than a insurance reimbursement are the two mangos and a hug that I pass on to all who have given unselfishly to make this possible.

June 2008 Haiti Trip 13

Ou ban-m lespua You give me hope

Every 3 months we go to Cap Haitien and work at the regional government hospital – Hopital Justinien Universitaire with the intention of treating children with deformities, injuries and infections. This was our 13^th trip in just over 3 years of providing this consistent service to the people of northern Haiti. In just 5 days we saw nearly 200 patients and operated 36 people with various orthopaedic problems.

This trip I was privileged to be working with Dr. Howard Place (Spine surgeon, St. Louis University) and Dr. Sam Chen (ortho resident Loma Linda University) along with our hard working Dominican CURE staff and several other visitors. Dr. Place has worked in Haiti before and also come to CURE Dominicana twice to perform spinal deformity surgery. His technical abilities and compassionate service are a great asset to the mission of CURE and our work on Isla Hispaniola. We also owe a big thanks to Jim Forbes photographer from the St. Louis Post Dispatch newspaper who was with us on this trip as well. Not only will you notice some professional photos from this trip but he also mopped floors, operated the x-ray machine, and transferred patients amongst other things.

At the beginning of the week I often times feel overwhelmed and apprehensive about the magnitude and difficulty of problems that are likely to present themselves during the week. After finishing our 36^th operation in 5 days, Jim asked me how I felt. Always a bit shell shocked from the experience, I can only liken it to all the emotions a soldier must have when he is returning home from war. In spite of long work hours and little sleep we don’t feel tired until the last case is done. The suffering of the people and the love created by the giving and acceptance of acts of kindness fills the team with emotion that provokes deep thought and leaves one changed forever.

The urgencies and case volume leaves little time for personal interaction with the patients, making one of my favorite times of the week Saturday morning rounds when we visit with our patients and review their post operative care plan before heading home. The 67 year old man in bed 24 Monseur Luime said to me “Ou ban-m lespua” You give me hope. During our last trip in April this same man had been in bed 24. In fact he had been suffering for 10 months with a severe segmental open tibia fracture. Because of the severe infection and little hope for salvage we had left his care to the local doctors. Since they had done nothing the bone was still exposed, although the infection had somewhat improved. This trip we saw him still sitting in bed 24 begging us to help him. With a 2 hour reconstructive surgery we placed an external fixator, removed the nonviable bone and covered the wound with a muscle flap and skin graft. Thanks to the companies and personal donors that support this work we are able to come prepared to take care of a wide variety of injuries and deformities. Often only a couple hours of our time along with the healing powers of our creator can make a life changing difference in those that we serve.

March April 2008 Trip 12

Every time I return from Haiti I feel like reporting that it was our best trip ever. I am not sure if it is because each trip gets better or if it is just the ever present inspiration and excitement of working in Haiti. It is probably a combination of the two. Although in the big picture we are only making a small difference, we are making a big difference in many of the lives we touch. For us it may be only a one or two hour operation but for our patient it is a life changing event that affects them for their whole lifetime and hopefully beyond.

This trip was exceptional in that we had 12 team members which is the largest ever. Prior to the trip I feared that keeping everyone organized and busy in the chaotic work environment would be difficult. To the contrary each one of the following self-activated people played a special role, making it one of the easiest and most efficient trips ever. And most importantly the quality of our patient interactions and whole person care was unsurpassed.

• Janet Castillo (RN CURE Santo Domingo)
• Lucia Hernandez (RN CURE Santo Domingo)
• Dra. Maria Adrian (MD anesthesia CURE Santo Domingo)
• Dr. Scott Nelson (MD CURE Santo Domingo)
• Dr. Dan Ruggles (DO Orthopaedic Resident, Riverside, CA)
• Dra. Dielika Charlier (MD pediatrics, CURE Santo Domingo)
• Dale Brantner (VP Spiritual Life CURE Home office)
• Mike Wilson (Dir. Special Projects, Cross International, FL)
• Robbie Jackson (CURE Clubfoot Worldwide, Dallas TX)
• Jean Role (CURE Clubfoot Haiti)
• Arpy Soo (Plumber, San Luis Obispo, CA)
• Bernhard Ahrens (Architect, Santo Domingo)

No trip to Haiti begins or ends without some special stories to tell. Before we even reached Cap Haitian we were presented with our first patient. We typically stop for a late lunch at an elementary school run by the Bruno family before driving the last hour into Cap Haitien. It was there that several boys brought over there 3 month old injured puppy to see if we could do anything. The puppy had been attacked by a larger dog and broken her left hindleg. A local “veterinarian” had come and splinted the leg with some yucca leaves and wrapped a constrictive dressing. The leg lost its blood supply and eventually had fallen off leaving a stump of infected exposed bone. Anyone working in primitive countries knows that often times the treatments rendered are worse than the injuries. At least this time it was not a child and the pup had 3 other legs to run on. Nonetheless an operation needed to be done. I told Dra. Adrian that we had a 3 month old around the corner that needed an operation and to prepare some anesthesia. When she saw the furry little creature she was slightly surprised but did not bat an eye. The operation was successfully performed and 6 days later on our way home we made a post op visit. The pup was running around and the children were delighted that she was no longer suffering.

We operated an additional 31 human patients on this trip as well. Many of them just as sweet and innocent as the canine. We only worked until 4:30 am one night and finished by 9 or 10 pm on the other days leaving, us less fatigued than some of our previous trips.

One notorious case was Rosebeline. She is a 10 year old girl crippled by severe bowlegs caused by a poorly understood growth disturbance in the legs called Blount’s disease. Some short term missionaries from California had met her on one of their previous trips and had been trying for a long time to find someone that could correct this. They heard about us and brought her. The next day after a two hour operation her legs were straight. Thanks to the coordinated efforts of people like David Bell inventorying donated Orthofix clamps in Lemoyne, our donors, our founders, Haitians, Dominicans, and Americans we were able to offer this girl a standard only available in some of the most advanced centers in the world.

Thanks to Dra. Charlier, Mike, and Dale we were able to have much more interaction and better communication with our patients. Dra. Charlier is our new pediatrician in Santo Domingo and is fluent in English, Spanish, Creole, and French. She worked tirelessly during this trip and made sure that all the pre and post op care was rendered as intended. Robbie and Jean Role were able to launch the northern Haiti clubfoot center and coordinate solutions to a number of the challenges facing the clubfoot program in Haiti. Berni and Arpy worked on the physical plant around the OR building. These challenges equally as great as those required to perform quality orthopaedic operations, but significant progress was made. Not only does this enhance our work there, but also leaves something behind that enhances the work of the local people.

Although our patients were still suffering pain from their injuries and operations, they expressed an impressive gratitude and love for us and for God, saying that God had sent us and thanking us for helping them.