Dr. Parker's blog

September 29th, 2016

Today, 44 people traveled from the US to Antigua, Guatemala for Operation Walk New York (also known as Operation Walk Syracuse). Doctors, nurses, scrub techs, physical therapists, anesthetists, equipment reps and personnel... here we go again!

But how does this happen?

The world wakes up slowly. Its true for all of us, for each of us. We stir, we wake, we take the first breath of this day, our next day. It's dark. Our eyes open, and consciousness arrives. What's today? Thursday. What am I doing today?

Oh. Airport. It's time to go to the airport.

Most of us are familiar with early-morning travel. It's dark. It's dark when you wake up, it's dark when you get to the airport, it's dark when you board your first flight. You squint at your boarding pass with tired, hollow eyes. Coffee.

It's a remarkable thing, then, to arrive at your gate, still in the dark wee hours, to find 44 friends and colleagues congregated, smiling and energetic. Excited.

Once again, I am left to marvel at the fact that it's possible to wake up in New York, and have dinner in Guatemala. Seriously... take a look at a globe. Find Syracuse, and then find Guatemala. If this fact doesn't astound you, at least a little, then you're not really thinking it through all the way.

And I am left to marvel at the commitment that these individuals share for the betterment of others.

Over the next 8 days, OpWalkNY will meet and engage the Guatemalan culture, turn our attention to those with the most profound orthopedic needs, and then - replace joints, replace joints, replace joints.

Here we go again.

October 1st, 2016

In a typical week at home in the SOS office, it's likely that we will see one or two people with some really profound orthopedic pathology. A really crooked knee, or a really deformed hip. It's not exactly rare, but it's unusual... mostly because in the US, really bad pathology gets fixed early on.


Not so in Guatemala (or Ghana, or Nepal...). In underserved countries such as these, profound orthopedic pathology just gets lived with, sometimes to an astounding degree.


The take-home: a high percentage of patients we see here present with really impressive pathology. Their knees and hips are truly awful. Crooked, painful, and profoundly dysfunctional. And they are truly disabled.


Today - our first full day in Antigua Guatemala - was Screening Day. By 7 am, the hospital filled to overflowing with potential patients, the hallways a jumble of crutches and canes and walkers. Then, one by one, each patient was interviewed and examined by our Med/Surg teams, and their potential to have a safe and effective surgery was assessed.


This all sounds simple enough... until one considers that each team consists of two surgeons, an anesthesia provider, a medical doc, a nurse, and an interpreter. X-rays are reviewed, patients are examined, the medical chart and history are reviewed, any necessary additional tests are ordered, surgical risks are reviewed, and consent forms are signed. And all the while, every piece of related information is being translated from Spanish to English, and then translated back again. And this process is repeated over 100 times. This is then followed by a conference where each case is discussed and the details of each surgery are considered.


So... it's a busy day.


The single most impressive feature of this patient population is simply this: the patients and their families are so nice. So appreciative. So thoughtful and patient. They are, without exception, a pleasure to care for. And this sentiment is repeated among our staff over and over again.


At one point, we apologized to a woman who had waited over three hours to be screened. She smiled and said "It's okay. I have already waited 10 years to have this operation."


Inevitably, there are patients who are turned away. Either their pathology is too complex, or their medical status is too compromised, and they are simply sub-optimal surgical candidates. We do what we can for them - new crutches, a brace - but we have to send them away without the operation that may improve their lives. And even those patients smile, and shake hands, and express profound appreciation. This is perhaps the most moving demonstration of this culture's perspective on Operation Walk.


Screening day is over. The surgical schedule for the next four days is being finalized. Tomorrow morning, we begin our surgical interventions in earnest. But already, the trip feels like a tremendous success - mostly because of the nature of the Guatemalan people.


Tomorrow: surgery day numero uno. Respiré profunda, Señor!

October 2nd, 2016

It's about the people.

Hard to elaborate. But I will try...

In April, Operation Walk Syracuse went to Ghana, in sub-Saharan Africa, and traveled deep in-country to provide joint replacement surgery to a population of people who otherwise would never have access to that kind of technology.

And, this fall, currently, Operation Walk has traveled, once again, to Antigua Guatemala, to provide the same life-altering joint replacement surgery to a population that otherwise might never experience the benefits of that technology.

Over the past six months, I have tried to write objectively about this experience, because it is an incredible experience, and words simply don't describe it adequately. No, really... it's AMAZING.

However, as I walk upon the cobblestoned streets of Antigua Guatemala, a city renown for being one of the oldest in the Americas, I must face the truth that this Operation Walk trip is very different from that which visited Ghana in the spring.

There. I said it.

Ghana, as a nation, is perpetually at risk,: from poverty, from governmental disruption, from radical religious fundamentalism... but Ghana possesses a populace that is overwhelmingly appreciative of our contributions. The people of Ghana were truly indescribably appreciative of our efforts.

72 short hours in Antigua Guatemala, Guatemala have demonstrated that this is a nation with resources. I just spent an hour in a bustling nightclub in Antigua Guatemala.

*(OK. I am going to clarify one thing: the name of this city is "Antigua Guatemala, Guatemala." There is NO COMMA between those first two words. Listen: I was an English major back when correct pronunciation and punctuation really mattered. I am getting it right. Wlads: trust me.)

Antigua Guatemala It is among the most beautiful and charming cities on the globe, and its populace, driving their Volkswagen GTIs and Lexus crossovers... they get it. Seriously. They get it.

Remember Columbus? (See also: Columbus Day...). Columbus came through here. Granted, Columbus was a busy guy. He sailed from Spain... he enslaved hundreds...). He saw a lot of central America, and he probably saw more than he documented. But when you hear that Antigua Guatemala is one of the oldest cities in the Americas, you can believe it. It's amazing, and you should check it out.

Today, our first surgical day, we replaced 16 joints, in patients who otherwise would have never experienced joint replacement technology. Some had postoperative pain. Some had postoperative nausea. One guy, in his 70s, had both. Not pretty. But his right knee was straight, for the first time in 50 years.

It's about the people.

In Ghana, we replaced joints in people who had no money. They had no opportunity for advancement. They had nothing but a wildly crooked knee, or a horribly dysplastic hip, and pain. And when we left, they had none of those things.

In Guatemala, the same people had hip or knee replacement surgery, and, for the first time, they had a straight leg, they had a knee or hip that moved normally, and they had pain.

And that is literally all they had in common with their Ghanaian counterparts.

In Ghana, we rode in a van from the barbed-wire-reinforced hotel to the barbed-wire-reinforce hospital, and back.

And we replaced joints.

In Antigua Guatemala, we have walked the charmingly cobblestoned streets of Antigua Guatemala, from a lovely Italian restaurant, back to our four-star hotel with a feather bed and 102 channels of cable...

...and we have replaced joints.

... and I can tell you… our interaction with the patients has been EXACTLY THE SAME.

It's about the people.

They get it.

Maybe they have nothing. Maybe they have a little more than that. But not much more.

But they have need. They have a bad hip or knee that's simply impossible (no... IMPOSSIBLE) to live with. And we fix that.

Hey: We FIX that.

Today we replaced 16 joints. They all did great. That's pretty cool. Tomorrow, we are going to replace 20 joints. That's about 20% more cool. Anyway you slice it… It's pretty freaking cool.

It's about the people.

Whether they have nothing, or whether they have a little something... they need our help. And we can provide it. That's amazing. That's a gift that few people can provide. We are incredibly, immeasurably lucky.

By giving, we receive. (Come along with us...)

Today was surgical day number one. Tomorrow is surgical day number two. I am sitting on a dark street curb, on a beautiful, cobblestoned street, in the oldest city in the new world. And tomorrow, I will help replace 20 joints.

It's about the people.

October 3rd, 2016

Our time at San Obras Sociales del Hermano Pedro is passing quickly, and tomorrow (Tuesday) is our last surgical day. Today we did another 21 surgeries, for a total of 57 so far. The OR had been bustling, and as the days have passed, the Hopital San Obras Sociales del Hermano Pedro has gradually filled with post-operative patients.

It's an interesting place: it's rustic, but well-maintained and strongly staffed, and extremely clean. The hospital hosts mission trips all year, and the personnel are excellent in their care for post-op patients. This has been a welcome change for our medical docs, nurses and therapists, because the locals are already quite adept.

Our Operation Walk staff remains the brightest spot in this experience. In the OR, on the wards, and in the storage areas, they continue to work tirelessly to provide care for our patients. And it becomes more impressive when one considers: each member of our staff is using personal vacation time to undertake this endeavor. Without their dedication and commitment, there simply could be no Operation Walk. Our surgeon's caps are off to them.

Interestingly: The combination of an adept hospital staff and an OpWalk staff that is using vacation time lends itself to a unique concept for us here: there is actually some free time to explore Antigua Guatemala and see some of the local sights. Over the course of the week, we have had the opportunity to get out into the city, interact with some of the locals, and enjoy the charming streets of Antigua Guatemala. It's a unique city: there is no place quite like it in the States. It combines the old-world feel of Europe's oldest cities with a sort of Caribbean low-key lack of urgency. The result is a friendly, approachable city that is a pleasure to explore. I would genuinely like to come back with more time to spend.

Tomorrow we wrap up our surgical days here, and then comes the process of breaking down the traveling circus that is Operation Walk and making our way home. This has been another incredible experience for us, and it's thrilling to think that we leave behind better lives for other people. That makes OpWalk a win-win: our patients see the benefits of first-world orthopedic care, and we come away with the humbling gift of having the chance to work toward the service of others. And I honestly can't say who is getting the better deal - because from this side, it's pretty great. The gratitude shown by our patients is truly matched by the gratitude we have for being able to care for them.

October 5th, 2016

There is risk in all things.

Each of us, at any given moment, is embracing some degree of risk. Usually, it is modest. Driving a car, riding a bicycle, crossing a busy street… these things are not completely risk-free.

And with risk comes reward. The willingness to accept risk stems from an understanding that our lives may be bettered or our circumstances improved by enduring that risk.

Sometimes, we choose to put ourselves at a greater degree of risk, in order to reap a potentially greater reward. One might choose to leave a stable job in order to pursue a higher paying position, or make a financial investment in hopes of achieving greater gains.

Choosing to undergo surgery reflects this risk/reward ratio perfectly. And nowhere is this relationship more transparent than in the surgical setting of a country like Guatemala.

The patients who undergo surgery with Operation Walk Syracuse are at significant risk, for a few obvious reasons. First, all surgery has a degree of risk (the term "minor surgery" is an oxymoron). Additionally, their surgical pathology is extreme, and the surgeries that they require are sometimes quite complex. So the decision to undergo that degree of surgery can be painstaking.

In many cases, though, the limb or joint on which they are choosing to have surgery is profoundly dysfunctional. And that in itself is a significant risk. In such a case, the decision to live without surgery presents a higher degree of risk than having the surgery. And with no surgery, there is no potential for the reward of an improved life.

For each potential surgical patient, even here in Guatemala, the sweet spot in that risk/reward ratio is a moving target. And each potential surgical candidate must think long and hard about the risks of surgery versus the risks of not having surgery.

One of our first surgical patients of the week was a 72-year-old man with advanced arthritis in both knees. Seeking to minimize his potential surgical risk, on our first day we replaced just his right knee. That leg was immediately improved, but his arthritic left knee still left him dysfunctional. So yesterday, our fourth and final surgical day, at his request, we took him back to the operating room and replaced his left knee, too.

The decision to have not just one, but two major orthopedic surgeries in the span of four days is a pretty big decision. It is a significant risk. But this morning, on rounds, he was smiling and appreciative, and obviously delighted to now have the opportunity to improve his quality of life. He was willing to endure the significant risk in order to reap a larger reward.

Each of us stares down this risk/reward ratio every day. For the patients of Operation Walk Syracuse, the risks may be significant, but the rewards are much more significant. And for us, it is an honor to help these patients balance risk with potential rewards.

The stalwart staff of Operation Walk Syracuse is spending today repacking boxes and equipment, and helping our post-op patients prepare for their new lives after our departure. For those patients, the risks have been endured. Now they can set their sights on the potential of great rewards.

And, once again, our hats are off to the OpWalk nursing, therapy, surgical and support staff who work so hard to make those rewards possible. Thank you, thank you, thank you.

October 6th, 2016

Connections.

The work of Operation Walk in Antigua Guatemala is complete, and the team is congregating to board the buses back to Guatemala City. As Hurricane Matthew pounds the East Coast of Florida, we hope to slip above it and make our connection in Atlanta.

But whether or not we make that connection, we have made connections this week that will endure.

First, it's impossible to come away from this week of patient care without making connections with those patients.
Clearly, they understand and appreciate the care they have received, and it has the potential to be life-altering for them. But what they may not realize is how life-altering these connections are for us. Because in no context does it become more clear that by giving, we receive.

In short, Operation Walk has been good for Guatemala, and it has been equally good for us.

And as we board the buses to depart Antigua Guatemala, it takes only a moment of eavesdropping to understand the remarkable and strong connections we have made with each other. There is laughter. There is good-natured ribbing and joking. And there is simply no hesitation to pile into these Guatemalan-sized bus seats right next to a team member who, 8 days ago, was an "acquaintance." But now, after working and laughing side by side for the week, we are friends - close friends - and the closeness of these tiny seats is a non-issue.

And those connections will endure when we get home and see each other in the familiar hallways of the hospital, and will spill over into the patient care we provide in that environment. Make no mistake - Operation Walk improves the care provided to our patients at home.

These OpWalk people... Each has his or her story, a story that has led them to Operation Walk. I have seen them early in the morning, and late at night. I have seen them under duress, working hard at hard jobs in the service of people they do not know, and will never see again. I have sat with them at breakfast, then at lunch, and then again at dinner. And I have come to appreciate the qualities in those people which make them the capable, dedicated professionals that they are. They are, each in their own way, leaders. And I am honored and humbled to work side by side with them... in Guatemala, and in Syracuse.

Traveling - being away from the comforts and routines of home - has a way of heightening our awareness and emotional responses to things. Our experiences become more vibrant, more stimulating. As such, it's difficult to stay objective when considering these new connections we have made. But a few final statements must be made.

First, to the leaders of Operation Walk Syracuse, I know I speak for all of our OpWalk team members when I say: Thank you. The opportunity to participate in this experience defies description, and we are more appreciative than we can say. We are changed for life.

Second, to the people of Antigua Guatemala, and especially to the hospital staff: Thank you. Your hospitality is unparalleled, and we could not have made this effort happen with you.

And last, and most important, to the generous donors and to the staff of Operation Walk Syracuse: Wow. Just... wow. The lives you have touched, and the difference you have made for your patients... these are the essential hallmarks of Operation Walk. You ARE Operation Walk, and without you, it simply doesn't exist.

The quaint cobblestones of Antigua Guatemala have been replaced with the bustling energy of Guatemala City. Next stop: Atlanta, and then home to the Big Orange. Thank you to the followers and supporters of OpWalk. Your support makes this possible, and you have changed the lives of our patients.