COA Bulletin #122 - Winter 2018

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Your COA / Votre association


Lessons Learned While Treating Hip Dysplasia with Operation Walk London in Ecuador Supriya Singh, M.D. PGY5, Western University London, ON


ne of our first great milestones in life is learning how to walk. Walking is meaningful - not only does it represent an ability to move from point A to point B, but it represents freedom and a sense of independence. For some, these can be impeded by developmental dysplasia of the hip (DDH). In North America, due to newborn screening, hips at risk of dysplasia and dislocated hips are detected and treated early. With common treatment such as the Pavlik Harness or open reduction and spica casting, children’s hips are maintained in joint and this leads to a relatively normal progression of developmental milestones. Unfortunately in Ecuador, there is a higher incidence of DDH, and untreated DDH is not an uncommon occurrence. As such, there are many young adults who are severely disabled due to arthritis from a dislocated hip. These patients suffer from loss of independence and often share heart-breaking stories of life-long pain and suffering. The unfortunate reality is that this is largely preventable with adequate neonatal screening programs. An important understanding of paediatric hip examination is important worldwide to detect DDH and prevent hip dislocations and arthritis. Operation Walk Canada is a wonderful organization which treats patients in Ecuador in need of total joint arthroplasties. I was fortunate to participate in the 2018 Operation Walk mission to Cuenca, Ecuador, with Drs. James Howard and Douglas Naudie from Western University in London, Ontario. The mission was an incredible learning opportunity for me, as the severity of untreated DDH was devastating. We got straight to work after a long day and half of travel, and tackled a busy outpatient clinic on our first day in Cuenca. There were no simple cases. Each patient presented with high riding hip dislocations with severe arthritis. Left and right, patients were limping around as well as they Dr. Supriya Singh flanked by Dr. Douglas could, with leg length Naudie (left) and Dr. Michael Decker (right), outside the Cuenca hospital.

COA Bulletin ACO - Winter / Hiver 2018

Hip X-rays of a patient with DDH preop and postop THA.

discrepancies of up to six centimetres. I was overwhelmed at first by the number of patients and the complexity of the cases, but with an The COA Global Surgery (COAGS) outstanding multidisciplinary effort, 24 Committee is pleased to share patients were treated Canadian global health initiatives. If with total hip arthroplasties in one week. you are interested in COAGS featuring From the clinic to the your organization in the Bulletin, or if stifling hot operating you are a resident and you would like theatres, I marveled at the hard work, creato share an essay about your global tivity, and ingenuity surgery experience, please contact put forward by each member of our team. for details. We were all making do under less than ideal conditions, with our patients’ best interests at heart. Whether a PACU nurse, an OR scrub nurse, a resident, a fellow, a staff surgeon, a sterile processing department technician or translator, everyone played a vital role, and I discovered the true meaning of teamwork. Rounding on the patients after surgery was probably the most rewarding component of the trip. Patients’ smiles, words of thanks, and incredible resilience was the greatest reward of all. This overseas trip, near the end of my fourth year of residency, was in many ways rejuvenating. It reminded me how incredible orthopaedic surgery can be, how surgery can change a life, and how much good we can do in the world. It reminded me of the importance of team work. Most importantly, it reminded me of how lucky we are. I am truly grateful for this experience and recommend global health travel to all residents during their training, as a means of developing a greater appreciation and understanding of the scope of our profession around the world.