Traveling physicians share
expertise, skills, supplies
BY KRISTIN WEIDENBACH
Stanford physicians spend
the majority of their days ministering to residents of
the Bay Area, but during vacation and special leave some
of these doctors volunteer their medical skills and
expertise abroad.
A sampling of the recent
adventures of some of these world-travelers follows.
Orthopedics in
China
Over seven years of
visits, members of the division of orthopedic surgery
have forged a strong relationship with Chinese surgeons
in Shanghai and Beijing. Professor Stuart Goodman, MD,
head of the division, and/or Christopher Mow, MD,
Stanford community physician and clinical assistant
professor of orthopedic surgery, have been visiting
Shanghai's Rui-Jin Hospital in alternate years since 1993
to host two- to three-day symposiums on hip and knee
replacement surgeries. They have also established a
fellowship program that allows Chinese surgeons to spend
up to a year at Stanford participating in an educational
program that includes attending rounds, conducting basic
and clinical research and observing orthopedic surgeries.
The fellows then transfer their knowledge to their
compatriots when they return to China.
Technically, the surgeons
in China are very good, but the facilities and
opportunities are limited, said Goodman.
When he and Mow, sometimes
accompanied by other Stanford medical staff, visit China
they are always well received, said Goodman. "The
Chinese doctors are very appreciative of hearing about
our cases and discussing theirs with us," he said.
And the doctors from both countries feel they have
learned from each other.
During the symposium, the
Stanford doctors offer tips and techniques gleaned from
their experience with many hip and knee replacement
operations, and they oversee several procedures. The
Chinese surgeons have largely mastered hip surgeries but
are eager to learn more about knee surgeries, Goodman
said.
However, the Chinese
doctors regularly confront cases that are not commonly
seen in the United States. "The conditions, in
general, are much more advanced," said Goodman. This
may occur because of neglect or because the patient is
too far away from medical care, he explained.
According to Mow,
"It's a matter of matching resources with the
population, and trying to equip the doctors with the
skills and facilities to meet any sorts of needs that
arise."
The Stanford symposium and
fellowship program is sponsored by Rhone Poulenc Rorer,
Inc, and Stryker Howmedica corporation.
Biopsying a health
care system
Eric L. Weiss, MD,
assistant professor of surgery and associate chief of
emergency medicine, recently went on a medical mercy
mission of a completely different kind. Weiss spent five
days in Kosovo in August conducting a "health care
biopsy." His job was not to provide medical care but
to assess the health system and determine what medical
supplies were needed in different parts of the province
following the NATO-led war against Yugoslavia.
"It was a very
provocative few days on many levels," said Weiss.
The trip began with a call
from a representative of AmeriCares a nonprofit
disaster relief and humanitarian aid organization that
responds to emergency medical needs and supports
long-term health care programs around the world. A few
days later Weiss was on board a Hercules C-130 Belgium
military aircraft bound for Pristina.
During the short time he
was there, Weiss visited State-run hospitals and medical
clinics that are part of a network run by the Mother
Theresa's Society. Weiss was told that only 10 or 11 of
the network's 96 clinics remained open. His job was to
meet with the directors of each medical facility and
compile a "needs list" of equipment and
pharmaceuticals. AmeriCares staff would then fill the
lists and distribute supplies to each site.
Weiss also had to
ascertain patient demographics. For example, a visit to a
medical clinic in the northern city of Mitrovica
highlighted the difficulties in providing health care to
the population of war-torn Kosovo. According to Weiss, a
river divides the city, with Serbs traditionally living
in the northern section and Albanians in the south. A
medical clinic in the north was the only remaining
functional clinic, so just getting there was a major
obstacle for some people. Weiss says that the city's
mayor identified the need for people to be able to move
safely about the city as more important than basic
medical supplies.
In his account of his
trip, Weiss writes, "the staff impressed upon us
that they are seeing 'all patients,' Serb and Albanian
alike, but they don't feel safe going to Pristina for
either meetings or supplies."
Weiss completed his
report, wishing that he could stay longer. "The
opportunity to work with the local administration to
build up the health care system virtually from scratch
would be both very challenging and very exciting,"
he wrote.
Continuing
Education in Cuba
Stephen Schendel, MD,
professor and chair of functional restoration, went to
Cuba in April, the most recent of many service trips to
Latin America. Schendel and his colleagues aimed to
educate Cuban health care teams about treating complex
craniofacial deformities.
"The physicians we
worked with in Havana, I feel, have had good solid
training in medicine and are seeking continuing medical
education," said Schendel. "As new techniques
and procedures have developed, the Cubans often haven't
had a chance to learn or practice them," he added.
Working with Cuban
surgeons, the Stanford team performed several complicated
procedures while they were there, including a number of
jaw distractions repair of a deformity that involves
cutting the jaw bone and applying a brace that allows new
bone growth to occur correctly. The program is based at
Juan Manuel Marquez Children's Hospital in central
Havana, but health care professionals from throughout
Cuba attended the six one-hour lectures given by the
visitors.
Stanford colleagues Terri
Homer, MD, clinical assistant professor of
anesthesiology; Elena M. Hopkins, pediatric nurse
practitioner and coordinator of the Lucile Packard
Children's Hospital craniofacial center; Mary
"DeDe" Moll, recovery room nurse; Bodil Grodum,
operating room nurse; and Scott Cohen, MD, a pediatrician
from Oakland, joined Schendel in Havana.
The trip was sponsored by
Stanford's division of plastic surgery and by Disarm
Education Fund, a New York-based non-profit organization
that assists in health care missions and other cultural
exchanges with Latin America.
"Key-hole"
surgery in Nicaragua
Kevin Scott Smith, MD,
staff physician in gynecology and obstetrics, also made a
recent trip to Central America. In August, Smith visited
Nicaragua on a fact-finding mission with a view to
establishing a laparoscopic gynecologic surgery program.
According to Smith, in Nicaragua "keyhole
surgery" in which surgical repair is done through
a tiny incision using thin, long-handled instruments
is not available in the field of gynecology. During such
procedures, a telescopic camera inserted through a
separate one-centimeter incision in the navel allows the
surgeon to see what is happening inside.
Smith envisions the
program as a weeklong workshop that will incorporate
lectures, a review of the pelvic anatomy from a
laparoscopic angle which he admits can be a little
disorienting and supervised surgeries. He hopes to
train doctors in simple laparoscopic procedures, such as
tubal ligations and diagnostic laparoscopy.
"These people are
qualified gynecologic surgeons; they just haven't had the
equipment to do laparoscopic surgery," said Smith.
During his August visit,
Smith performed several procedures, including using
laparoscopic surgery to diagnose and treat the cause of
infertility in a
19-year-old woman. Like most gynecology patients treated
by laparoscopy, she was able to go home the following
day. The small incision also means less post-operative
pain and a shorter recovery period for most patients,
said Smith.
Smith's visit to Nicaragua
was sponsored by Medical Training Worldwide, a nonprofit
organization dedicated to sharing current practices in
Medicine and Surgery. After finishing his fellowship with
Camran Nezhat, MD, clinical professor of surgery and of
gynecology and obstetrics, Smith was invited by the
organization's president, Ramon Berguer, MD, associate
professor of surgery at the University of California,
Davis, to direct the gynecology portion of the program.
Before returning to the country in February, Smith hopes
to raise funds and gather laparoscopic equipment and
surgical instrumentation for the program. SR
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