Women Orthopaedist Global Outreach in Cuba

May 10, 2018

What happens when 7 female surgeons travel to Cuba? 53 knee replacements in 3.5 days of surgery! Together with anesthesiologists, internists, nurses, scrub techs, physical therapists, and interpreters, we restored mobility and function to over 37 patients, all of whom left the hospital before we left the country.
WOGO – Women Orthopaedist Global Outreach – is a non-profit organization which seeks to transform lives in underserved global communities by reducing the chronic burden of arthritis through joint replacement. We also educate and train in-country orthopedic surgeons, serve as role models for women in medicine in developing countries, and give back to the communities we visit. Our previous trips have included Nepal, Guatemala, Tanzania, and Democratic Republic of Congo.

Cuba is a beautiful country. Colorful Spanish style architecture, music, dancing, great food, amazing coffee. The people are warm and welcoming. The streets are safe, even at night. The government provides housing, education, and medical care to the people. But this comes at the price of freedom. People here must be careful of what they say and do. Ninety percent of wages are given to the government in taxes. Even physicians are poor. There is a duel economy with tourists using a different type of currency then the Cuban people. Food and clothing are expensive. Many of the cars on the street are from the 1950’s and are preserved and rebuilt out of necessity. Most Cubans do not have cars and must hitchhike, walk, and/or ride buses to reach their jobs. This is the Cuba that the government doesn’t want tourists to see.

Despite adequate primary care, joint replacement as a treatment for is not available to the majority of Cubans. Even with their very arthritic knees, most of our patients were still working.
On these trips, we ship all of the equipment we need to care for the patients. Zimmer donates the implants. We have trays of equipment we use to perform the surgeries. Many hospitals and medical companies, including St Joseph Hospital, Catholic Medical Center, and Bedford Ambulatory Surgery Center, donated dressing supplies, gloves, and equipment that we needed. Before we can even start, all of this has to be unpacked and organized.

On the first morning, our team screened ever 60 patients for surgery, evaluating their medical conditions and their joints. We then conducted a case conference to review the patients and decide who would receive surgery. Surgeries began that afternoon, with the first 4 cases done by 7pm. The surgeries are done under spinal anesthesia with nerve blocks and local infiltration of anesthetic agents around the knee to provide additional long-term pain relief. An ultrasound machine (borrowed from NH Orthopaedic Center) improves the accuracy of the nerve blocks. The next day, the OR started at 7.30. Teams of surgeons, anesthesia, scrub techs, and circulators worked together to get cases done. Many on the team remarked that our teams worked more efficiently than in the OR at home! The families of patients were so grateful, they would kiss and hug the surgeons repeatedly when we told them the surgery had been successfully performed.

Nurses in the PACU and on the floor supervised the care of our patients and were assisted by the hospital nurses. The pain was managed with Tylenol and Tramadol only. Our physical therapists had the patients up and walking the first day after surgery and many were ready to go home on postoperative day 2. The patients were so grateful and appreciative. Many were dancing even with crutches! We had planned to give away shoes to children and people in the local community, but unfortunately, the government did not allow this to happen. However, we did provide all of our patients with new shoes to help with their therapy. We also provided new shoes to the nurses and their families who had helped us care for our patients during this trip.
We also spent time teaching. Local surgeons and anesthesiologists shadowed us in the operating room. We gave talks to the physicians, nurses, and physical therapists. We also had the opportunity to meet some female orthopedic surgery residents from Cuba, where just like in the US, the majority of orthopedic surgeons are men.

For me, the wonderful thing about these trips is knowing you are making a difference in the lives of individual people. For most Cubans, life is hard. They have no control over the decisions their government has made. But by replacing arthritic knees and improving mobility, we made a huge difference in so many people’s lives. To see the smiles and the tears, to be hugged and thanked repeatedly by patients, makes the challenges of these trips worthwhile.