1. Hire a trip coordinator. Though the physician is usually the team leader, he or she should hire a trip coordinator to ensure the logistics run smoothly. The coordinator is responsible for traveling to the location beforehand and making sure the hospital is ready for the team. The coordinator should also secure a list of patients for the physician to treat, organize cargo and coordinate the shipment of equipment and supplies to the location.
2. Travel with a full team. When traveling abroad, the physician should bring internists, anesthesiologists, operating room technicians, physical therapists, nurses and additional staff to perform duties such as instrument cleaning. Physicians need the support from this additional staff and cannot depend on the hospitals abroad to provide staff for them.
3. Bring your own supplies. Physicians should bring their own equipment on the trip and arrange for implant shipments to the hospital because the hospital may not be at U.S. standards. “It doesn’t do any good to go to these countries and use their supplies,” says Dr. Dorr. “We take everything, including the implants which are donated from implant companies.”
Complications sometimes arise when physicians run out of supplies or need an unavailable tool. Sometimes there are several patients who need the same sized implants and if the physician runs out, he or she must adapt the inappropriately sized implants for the patients. “You can’t be demanding that you have everything right for the patient like you do at home,” Dr. Dorr says.
4. Create a follow-up system. Physicians need to set in place a system for following-up with the patients they treated during their trip. For teams associated with Operation Walk, Dr. Dorr says different teams traveling to the same country follow-up with the previous team’s patients. Physicians can also send a team nurse or therapist or travel back themselves to the country and conduct follow-up clinics. Finally, a local physician can conduct follow-up examinations with the patients and send reports and x-rays to the U.S. physician via e-mail.
5. Work with foreign governments. Be sure to communicate with the foreign governments about the trips, detailing the equipment which will be used and the services performed. Dr. Dorr says governments of underserved populations are often supportive of the teams. “In general, the governments are very cooperative because they are appreciative of physicians coming in and helping their people. Most of the time the governments want us there,” says Dr. Dorr.
During his travels, Dr. Dorr has taken part in press conferences regarding his visit and met presidential wives as representatives of the country. During a trip to Cuba, Cuban leader Fidel Castro gave a speech to the medical team.
6. Adapt to unexpected situations. When serving poor populations, physicians are often challenged with circumstances they would not encounter in the United States. “Everything is unpredictable. The power might go out,” says Dr. Dorr. When the power went out during one of his surgeries in the Philippians, he finished a knee replacement by flashlight. He has also performed surgery in situations where he could not use power saws. Instead, he performed joint replacements with cutting tools. “Everybody adapts pretty well,” says Dr. Dorr.
Learn more about Operation Walk.
Learn more about Dorr Arthritis Institute.
Read other coverage on orthopedic surgeons practicing abroad:
– Orthopedic Surgeons from Texas’ Foundation Surgical Hospital Lend Support Haiti Relief Efforts
– Orthopedic and Spine Industry Leader to Know: Dr. Alex Vaccaro, President of the American Spinal Injury Association
