Operation Walk (SOP) sample draft binder Jan 2026

Standard Operating Procedures Operation Walk Manitoba Inc.

Operation Walk Manitoba (OWM)

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Who We Are Operation Walk Manitoba is a registered charity based in Winnipeg, Canada. We are a volunteer team of surgeons, nurses, physiotherapists, and healthcare professionals who provide free joint replacement surgeries in developing countries where access to orthopedic care is limited.

Founded in Los Angeles in 1996, Operation Walk has since grown to include 13 teams across North America. Our Winnipeg-based team launched in 2011, completing its first mission to Managua, Nicaragua, in 2012.

In 2019, we became Operation Walk Manitoba Inc. and in 2022 we were registered as a charity with the CRA and we continue to return annually as an independent team.

Our volunteers come from across Manitoba and beyond—including Brandon, Saskatoon, Kelowna,, Montreal and Toronto.

Leaving a Legacy

We work in close partnership with Roberto Calderon Hospital in Managua, a public teaching hospital offering limited joint replacement surgeries for impoverished patients. Our team collaborates with local surgeons, nurses, and students to build skills, enhance care, and leave a lasting impact long after each mission ends.

Operation Walk Manitoba (OWM)

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Table Of Contents Program Overview & Guiding Principles

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Mission, Vision, and Values

Ethical Standards & Patient-Centered Care

Relationship to Concordia Foundation & Partners

Scope of Operations (Clinical, Fundraising, Volunteer)

Governance & Leadership . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Governance Structure (Board, Committees, Advisors)

Decision-Making Authority & Escalation

Risk Management & Accountability

Annual Planning & Reporting Cycle (Audit, Budgets, Reporting to CRA)

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Clinical Program Operations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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Patient Identification & Referral Process

Patient Screening & Eligibility

Surgical Planning & Clinical Protocols

Pre-Operative Patient Preparation

Surgical Mission Execution

Post-Operative Care & Follow-Up

Data Collection, Outcomes & Reporting

Roles and Responsibilities

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Medical Director

Physio Team Lead

OR

Ward

Volunteer Management

Volunteer Recruitment & Onboarding

Roles & Scope of Practice (Clinical & Non-Clinical)

Training & Orientation

Scheduling & Deployment

Code of Conduct & Expectations

Volunteer Recognition & Retention

Partnerships & Stakeholder Relations

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Hospital & Clinical Partners

International & Local Community Partners

Medical Device & Supplier Relationships

Donor & Sponsor Stewardship

Operation Walk Manitoba (OWM)

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Fundraising & Financial Management

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Communications & Public Relations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Brand & Messaging Guidelines

Internal Communications (Team & Volunteers)

External Communications (Donors, Media, Public)

Social Media & Digital Presence

Privacy, Consent & Storytelling Logistics & Mission Planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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Compliance, Safety & Risk . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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Evaluation & Continuous Improvement.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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ppendices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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Fundraising Strategy & Annual Targets

Signature Events (e.g., Fiesta, Campaigns)

Donations, Sponsorships & Gift Acceptance policies

Financial Controls & Approvals

Budgeting & Expense Management

Reporting to Board & Donors

Mission Timeline & Planning Checklist (cycle and milestones)

Travel, Accommodation & Scheduling

Equipment, Supplies & Shipping

On-Site Coordination & Daily Operations

Storage in Winnipeg

Contingency Planning & Incident Response Patient Safety & Clinical Risk

Volunteer Safety & Insurance

Legal & Regulatory Compliance

Privacy, Data Protection & Records Program Evaluation & Metrics

Patient Outcomes & Impact

Volunteer & Partner Feedback

Lessons Learned & SOP Updates A

1. Sample forms

2. Sample letters of request

3. Important information

· Banking and Credit Card Information

· Accounting and Audit

· Legal Team

· Bylaws

· Website · Donorbase

· Board and Governance Documents

· Corporate Documents

· Insurance (D & O) and Travel Insurance

Operation Walk Manitoba (OWM)

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Medical Director Responsibilities Op Walk Board Composition & Responsibilities Determine members and terms with board (usually at AGM)

Look for new members and succession planning

Criminal Record Checks Sterling Backcheck, the company that is conducting the checks Executive composition and meetings (bi-monthly)

Board Meetings - 4-6/ year and AGM annually Set agendas

Maintain minutes (Exec secretary) Select representatives to attend Op Walk Central annual meeting

Maintain an up-to-date Standard Operation Procedures binder

Governance Items – need to help oversee with assistance from: Secretary Sue Barkman (Concordia Foundation Executive Director)

Legal Counsel Orvel Currie, DD WEST LLP

Board Finance appointee – Mike Stephens

Other board members - Laura Reimer

Corporate Responsibilities CRA charitable status maintenance

Liability insurance

Board members

Trip participants Finances

Annual budget

Annual audits

Filing of Tax Returns for the Corporation Fundraising

Annual Gala – determine Chair and committee (first meeting of year)

Promote Other events

Surgeons’ office handouts/videos etc

NB - Engage all team members in fund raising efforts and encourage all to attend the Gala MOU with Concordia Foundation

Documenting and maintaining corporate responsibilities

Mail outs

Maintain Donor Data base

Website maintenance

Social media

Record keeping (meeting minutes etc)

Maintain relationship with Pro bono support (Sue Barkman

All corporate, insurance and financial documents are maintained on Basecamp website

Operation Walk Manitoba (OWM)

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Determine Site & Date of Mission Coordinate site and date of mission with Board members and Op Walk Central if necessary.

There is currently no plan to change the site from Nicaragua.

Should be confirmed at 1st board meeting after last mission

Contact hospital to confirm dates

Write letter to hospital administration (CMO and Head of Surgery) requesting a formal letter of invitation from Nicaragua (appendix 1) to proceed with mission, outline goals (number of joints etc) and dates preferred. (have these translated into Spanish).

This letter is required for the application of support from the Surgical suppliers (need this letter early – minimum of 6 months before mission to submit to vendors)

Provide hospital with detailed itinerary of mission - including

Clinic – days, number of rooms, resources required

OR days - require 4 rooms

Patient volume – 60-70 joints

Post op protocols to be discussed with resident staff

Social events with staff – dinner or lunch for hospital staff

e

Check that all onsite surgical needs are in plac

z

Sterili ers must have minimum of 2 functioning units

l

Check that 4 are ORs are operationa

Determine if there are any deficiencies Consider a pre-trip in spring to inspect site if there are any concerns

z

Test sterili ers and MDR capabilities

Check OR resources - tables, positioners, anesthetic machines etc.

Select the Team Team compositions – to be determined by March/April to allow team members to apply for vacation

Work with team leaders to select members

Operating room nurses

Ward nurses

Anesthesia and recovery room staff

Surgeons and Assistants

Volunteers (all need to be submitted to and approved by the board)

Interpreters

MDR

Residents – Orthopedic program director should be contacted to select Ortho resident.

Anesthesia lead to select anesthesia resident.

A Team meeting with all team members should be scheduled once team has been selected - ( appendix 2 - items to cover

Operation Walk Manitoba (OWM)

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Documents

Team member documents must be collected and sent to health authority in Nicaragua before the mission All NEW team members are required to submit the following documents.

Degree /Diploma (medical degree for physicians) *

Specialist certificate if applicable *

License to practice for the current year* (nurse check) *

CV summary (1 page version)

Copy of passport with expiratory date a minimum of 6 months after date of the mission

Signed Operation Walk waiver

Returning team members who were on the previous years mission are required to submit only

License to practice for current year*

Passport

Keep an up to date spreadsheet with all team members, role, email, cell, travel group – this will change many times during the year. (Appendix 3) * These documents must be notarized with signature, date, stamp and palpable watermark.

All these documents need to be certified before submitting to Nicaraguan authorities (includes a seal). The best option for doing this is at the team meeting when we have access to a Notary Public (Brian Meronek and Greg Huzel (Chandra’s husband)

Physician licenses in Manitoba are renewed late in summer and need to be expedited to be available to send to Nicaragua before the mission. Contact the College of Physicians and Surgeons with physician/CA/PA list requesting priority for the renewed licenses.

Physicians encouraged to notify CMPA of participation ( Appendix 4)

Team member name tags (will need to be updated for each mission) and patient lanyards

Keep copies of all documents: FedEx to Government

1. Letter explaining mission

2. Volunteer list and roles

3. Team documents

4. Letter of invitation from hospital (all members to carry copy on flight down!)

5. Letter of authorization from SILAIS

6. Letter of intent ( Carte de Intencion)

7. Certificate of Donation

8. Cargo list

All letters / documents must have Op walk letterhead and seal.

Operation Walk Manitoba (OWM)

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Team Member Contributions

The cost of the missions has increased significantly over the past few years and for 2024 was around $350 000. There is a requirement that all team members contribute to the cost of the mission.

Current contributions: Physicians . . . . . . . . . . . . . . . . . . . . . . . . $4000

Board Members . . . . . . . . . . . . . . . . . . . . $3000

Volunteers . . . . . . . . . . . . . . . . . . . . . . . . $2000

Residents /CA . . . . . . . . . . . . . . . . . . . . . $2000

Nurses . . . . . . . . . . . . . . . . . . . . . . . . . . . $1200

Physiotherapists . . . . . . . . . . . . . . . . . . . $1000

MDR / Interpreters . . . . . . . . . . . . . . . . . . $300

This needs to be reviewed annually by board and amended as necessary.

Monitor contributions through the year and remind team members regularly.

Team members who have problems with the contribution may contact Sue Barkman who can help with personal fundraising options.

Patient Selection Process The patients are submitted by the local orthopedic team (head of orthopedics (Joel Narvaez) around 6 months prior to the mission. This is done through WhatsApp sent to Claudio who passes them on to Medical Director.

A list of patients with some demographic data and pictures of x-ray are submitted. The medical director reviews the list and decides which patients are suitable for the mission and submits this back to Nicaragua to set up appointment for these patients on the clinic day.

It’s important to keep in mind that the surgical supplies are limited, and this precludes the selection of patients with very complex surgical problems unless a special plan has been developed for that particular case.

On the clinic day there are unfortunately many changes to the list that was originally submitted, with many no shows and many more additional patients. We have learned that it’s best to ask for an updated list from Nicaragua the week prior to the trip to minimize the changes.

The goal is to select between 60- 70 joints to do over the course of the 3 days in the OR. Usually there are around 10 hips, and the rest knees (many bilateral).

Patients in Nicaragua have a propensity to have poor bone quality and joints are generally of the smaller sizes. We have often run out of smaller implants on previous missions and have adjusted the implant requests from companies accordingly.

Operation Walk Manitoba (OWM)

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Set up clinic day (typically 6 rooms). 4 rooms for patient assessment - requires surgeon, anesthesiologist, nurse, physiotherapist, translator. One room for internal medicine consults and one room for bracing.

It is best to have a provisional OR template done prior to clinic day so that as much as possible the teams doing the surgery will be seeing those patients in clinic. This also allows patients for day 1 to be seen first and they can then be admitted earlier in the day for surgery the next day.

Have photographer in clinic to capture patient pictures with patient number showing and any interesting clinical problems (video if necessary)

Prepare cases for discussion for team meeting at end of clinic

Finalize OR template with physiotherapy, nursing and anesthesia as soon as clinic done.

Keep a record of all patients - NB for fundraising

Mark operative limb in clinic

Put patient number (on lanyard) on patient as leaves clinic room to allow us to track the patient through their hospitalization.

Travel & Hotel ( Finance lead / Team leader Coordinates) Work with travel agency to determine flight options and book flights – this needs to start early in the year as flight options and routs are limited.

Early team (usually departs 2 days earlier) : required to unpack equipment and setup, start patient screening.

Main team: arrive on day prior to clinic

Group bookings give best flight rates and payment options – encourage as many team members as possible to travel with the group.

Team members who book own flights will be reimbursed for the cost of an economy ticket. (We discourage this option as it makes it difficult to help with flight schedule changes which are frequent)

Traveling on weekdays (Mon / Tues) is cheapest option

It’s best to have departure and arrival on the same day with no overnight stays. However, be mindful of risks of using 2 non-connecting airlines (eg Air Canada and Avianca)

Hotel booking usually done through travel agent. All team members (except physicians and board members who make larger contribution) are required to share a room with another member.

Set up document with room sharing choices and assign those that don’t have a specific choice (Sutherland did this for past 2 missions)

Current hotel preferred: Hyatt Place Managua. The management there has been very supportive and have given us very good rates. · Travel agent currently used - Continental Travel (204) 989-8575 Daryl Silver and Kathy Simeonidis

A list of all team members must be submitted to the Nicaragua Health authority – with job description, arrival and departure dates and flight numbers. This is usually sent down with the list of equipment that also to be sent approximately 1 month prior to trip.

Book team events (can usually be done by early team)

Welcome function

Team dinners

Hospital staff recognition dinner

Resort

Operation Walk Manitoba (OWM)

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Surgical Supplies Implants Request to industry for support (implants and instrument sets)– Jan/Feb deadline (minimum of 6 months before mission)

Currently using 3 companies for implants - Smith and Nephew, Zimmer/ Biomet and J&J Depuy.

They require a letter from the hospital in Nicaragua requesting support for the mission.

They require a detailed list of all implants needed (appendix 5)

Must be done online through the companies’ charitable donations portals (Sue Barkman has details) Other Surgical Supplies: OR lead has list which includes - see attached Conmed – Saw blades, cautery, cautery pads

BD – Prepsticks and surgical scrub brushes

Stryker – Consumables for cementing total hip. Stryker does not usually donate products like cement, but they do a monetary donations towards Op Walk.

Medline – sterile surgical gloves (they said no last time we requested a donation, but was able to get someone from Ontario to donate to us)

Solventum – avaguard, chemical indicators, dressings

Ethicon J&J – Sutures and Prineo dressing

Zimmer Biomet – irrigators Determine what supplies need to be purchased and submit to board (OR lead has this list)

All surgical supplies need to have a dollar value and expiratory date (we cannot use expired supplies) General Instrumentation Sets (Joint Extras)

these are co-owned by Orthopaedic Innovation Centre (OIC) and Operation Walk Manitoba

Need to check each set annually and make upgrades as necessary as many are old.

Power Equipment There should be 10 operational sets with chargers

They need to be checked annually to ensure chargers and batteries are in working order

The Li batteries can NOT be checked on any airline. We generally send 9 sets and batteries with the cargo and take one set as carry on (which is allowed).

Ensure that have all appropriate attachments (blades etc.)

Operation Walk Manitoba (OWM)

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Other Supplies Drugs – work with anesthesia lead and ward nursing lead to determine what is required

Some drugs (opiates) cannot be carried as supplies into Nicaragua. We have got round this by having one team member carrying a small supply of hydromorphone as personal medication. Fortunately, we don’t need a lot of op opiate drugs for these patients

Physiotherapy supplies - coordinate with Physio lead

Knee braces – coordinate with Trevor Greaves

Ward equipment (coordinate with ward nursing lead)

Documentation (coordinate with admin member – all documents, pre /post Op orders, white board, stationary etc)

Computer, printer and projector

Packing equipment and labels

Snacks for team member

Storage & Shipping

We currently have 3 storerooms at Access Storage on Marrion

Coordinate equipment shipping with team leader assigned to do this.

Establish a packing date – team members to help – usually a minimum of 2 months prior to mission

Team coordinator maintains lists of all supplies with value and expiratory dates and what is returning to Canada after mission (see team coordinator report) All equipment must be documented with a dollar value and expiratory dates (Claudio) and what is returning to Canada *

Mission Documents *

Need to be reviewed annually and updates as necessary Patient clinical data form

Preoperative orders

Post –op orders

Consent forms

Photographer

Maintain a patient database with photographs - for patient sponsors.

Operation Walk Manitoba (OWM)

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Other Tasks Team transportation arrangements in Nicaragua(Claudio arranges)

Lunches – we have preferred to organize own lunches or have hotel provide them.

Arrange Itinerary for volunteers and VIP guests

Gift for hospital staff (budget $100-200) – gift is usually exchanged at the end of the mission.

Communication in Nicaragua - key personnel need to be able to communicate (cell phones– esim works best) Presentations & Speeches Gala dinner presentation if applicable

Team member meeting (May/June) - overview of trip

Welcome to team on arrival in Nicaragua – review plans

Team wind up dinner with hospital staff - and exchange gifts (we have not done this on last 2 missions) Finances Work with finance lead to ensure all members make contributions (amounts should be discussed at board meetings each year to set amounts)

NB Contributions will cover the cost of economy flights and shared hotel room. Those who wish to fly business or via an alternate route are responsible for the additional costs. The physician group has agreed to pay a higher fee to have a single hotel room. If other team members wish to have a single room, they will be responsible for the additional cost.

Maintain a ledger of all team members, role, fight, roommate and contribution*

Arrange with finance lead to have cash available for purchases on the mission.

Other Trip Planning Tasks Letters to team members – details of trip, what to take and safety / illness information*

Letter for customs/immigration for members carrying equipment *

After Trip Trip summary document needs to be generated and sent to the hospital and all sponsors

Debrief with board

Get feedback from team members – usually done by email to team after trip

Unpacking date - need team members to help

Start planning for next mission by early January of the following year

Operation Walk Manitoba (OWM)

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Letter of Invitation Needs to be submitted to industry supporters

Operation Walk Manitoba (OWM)

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Volunteer Recruitment & Lead Use: Volunteer Binder and Recruitment Protocols

This guide is used to:

Orient prospective and confirmed volunteers –

Provide a consistent reference in the Volunteer Binder –

Support safe recruitment, onboarding, and deployment

Define a process for volunteers who want to join the mission and what their role would be.

Define Financial Commitment to volunteer This Guide explains how Operation Walk Manitoba operates, what volunteers can expect, and how each role contributes to safe, ethical, and effective patient care. It complements (but does not replace) detailed SOPs and clinical protocols.

For further information, visit our website at: www.operationwalkmb.ca

Our Mission & Values - At a Glance Restore mobility and quality of life through joint replacement surgery

Put patient safety, dignity, and respect first

Work collaboratively across clinical, volunteer, and community partners

Act ethically, transparently, and responsibly with donated resources

How the Program Works (High Level) Patients are identified and screened through local clinical partners

Volunteer teams are recruited and prepared (clinical & non-clinical)

Missions are planned (travel, supplies, schedules, risk planning)

Surgery and care are delivered on-site

Post-operative follow-up and reporting are completed

Learning and improvement are documented

What Is Expected of All Volunteers All volunteers are expected to:

Follow approved OWM SOPs and clinical protocols

Work within their defined scope of practice

Respect patient confidentiality and privacy - Follow local laws, hospital policies, and cultural norms

Raise concerns early (safety, ethics, logistics)

Act as ambassadors of OWM at all times

Operation Walk Manitoba (OWM)

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Volunteer Journey (Recruitment to Deployment) Recruitment & Pre-Mission Initial inquiry and role discussion *ADD A CONTACT & LEAD

Confirmation of scope of practice

Reference and credential verification (as applicable)

Completion of onboarding package

Review of standard operating procedure (SOP)

Pre-mission briefing attendance

Complete onboarding and role confirmation

Review relevant SOPs and training materials

Submit required documentation (licenses, insurance, travel info)

Attend pre-mission briefings During the Mission Report to assigned team lead daily

Follow schedules and escalation pathways

Document activities as required

Flag risks, issues, or near-misses immediately After the Mission Participate in debriefs

Submit required reports or feedback

Support follow-up communication if requested

Safety, Ethics & Escalation If something feels unsafe, unclear, or inappropriate:

1. Speak with your immediate team lead

2. Escalate to the Mission Lead if unresolved

3. Document concerns when requested Patient safety always comes first.

Key Roles – At a Glance

Medical Director

Mission Lead: Overall responsibility for mission execution

Clinical Lead: Clinical decisions and patient care standards

Volunteer Coordinator: Volunteer recruitment, scheduling, suppor t

Logistics Lead: Travel, supplies, daily operations

Fundraising / Comms Leads: Donor, sponsor, and public-facing work

Operation Walk Manitoba (OWM)

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Role-Specific Standard Operating Procedures (SOP) Summaries Volunteer Coordinator – SOP Summary

Purpose: Ensure volunteers are recruited, prepared, supported, and retained.

Key Responsibilities: Recruit and onboard volunteers - Confirm credentials and documentation Match volunteers to appropriate roles - Coordinate schedules and coverage - Serve as primary volunteer point of contact - Support recognition and retention efforts

Decision Authority: Volunteer placement and scheduling (within approved roles)

Escalation To: Mission Lead (operational issues) - Program Chair (policy or conduct concerns)

Mission Lead – SOP Summary

Purpose: Ensure safe, effective, and coordinated mission delivery.

Key Responsibilities: Overall mission planning and execution - Daily on-site leadership and coordination - Risk management and issue escalation - Alignment between clinical, logistics, and volunteer teams - Post-mission debrief and reporting

Decision Authority: Day-to-day operational decisions - Escalation of critical risks

Accountable To: Program Chair / Board

Clinical Lead – SOP Summary

Purpose: Maintain clinical integrity and patient safety.

Key Responsibilities: Patient screening and eligibility oversight - Surgical planning and protocols Clinical team leadership - Post-operative care standards - Clinical data and outcomes reporting

Decision Authority: - All clinical decisions

Logistics Lead – SOP Summary

Purpose: Ensure smooth, safe mission logistics.

Key Responsibilities: Travel and accommodation coordination - Equipment and supply management - On-site scheduling and facilities coordination - Contingency and incident planning

Operation Walk Manitoba (OWM)

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Volunteer Commitment & Acknowledgement All volunteers are asked to acknowledge that they: · Have reviewed the Volunteer SOP Quick Guide –

· Understand their role and scope of practice –

· Agree to follow OWM policies, clinical protocols, and codes of conduct –

· Will escalate safety or ethical concerns immediately

(Signature / Date – retained in Volunteer Binder) You are part of a trusted, mission-driven team.

Clear roles, respectful communication, and adherence to SOPs allow us to deliver life-changing care safely and responsibly.

Operation Walk Manitoba (OWM)

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Physio Team Lead Roles & Responsibilities Pre Mission Role Team selection – Ideally completed in January of each year

If additional physiotherapists are required:

I have not needed to advertise or look for PTs since 2018. As of now there is no formal application process. Interested parties have e-mailed Operation Walk and this has been forwarded to myself.

Since 2018 we have had one Spanish speaking physiotherapist on the team, in 2024 and 2025 we were lucky enough to have two.

There are never enough translators, having Spanish speaking therapists isn’t a must, but it certainly increases the efficiency of the team.

Wait listed for 2026:

Robyn Tully

Gareth Thiessen gareththiessen@hotmail.com

Joel Genyk – jgenyk@gmail.com

Consideration

When choosing therapists make sure they are aware that work days are long (12-14 hrs) and it is very hot on the ward.

If they are of thinking of having a family/childbearing age that they know that the Zika virus is in

Nicaragua.

I have generally taken a team approach on selection as it is important to see if this individual will be a good fit. They need to be able to take direction, work quickly and take initiative.

It is okay to go with the same team – you do not need to constantly rotate therapists. It is a very quick paced environment and experience goes a long way.

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Equipment Selection Equipment collection is the largest pre mission job that the PTs have. This begins immediately following return from the trip as it takes significant time to gather. We have looked to the whole team to assist us – this is including non PT members that are advertising in their place of work.

Deb Suderman (debrasuderman@mymtsnet) is an invaluable resource for this as she has gone on many missions and has contacts in nursing homes and places of business around the city.

Jill Twordik (jtwordik@pmh-mb.ca) has contacts in Brandon with nursing homes as well Recommended Equipment for Trip • 40-50 - 4 wheeled walkers (combined minimum of 60 walkers)

Majority of patients are short.

• 10-20 - 2 ww* - more short than tall if possible

• Canes (as many as you can get)

• 5 wheelchairs (collapsible- 18” width or larger)

• 20 crutches (or more)

• 1 platform walker/ gutter walker

• 4 urinals

• 3-5 commodes

• 3 RTS

• 3 toilet bars

• walker baskets if available

• 5 transfer belts

these are often hard to come by I usually ask the

physios to bring one with them for their own use.**

Additional Supplies Purchase and pack in red Operation Walk containers

• 3 Costco size containers of Lysol wipes (they come in a 6 pack, but you will

need 3-4 containers to wipe down equipment when you arrive in Nicaragua)

• 2 folding stools (300 lbs weight capacity - I have picked them up at Canadian Tire. With the new beds you don’t need these)

• Package of Zip Ties – to give to patients so they can Zip Tie on their basket

when they get home

• Equipment Stickers - CANADA stickers from Dollarama to identify that equipment has been given to them from Operation Walk Manitoba

• Keep receipts and submit for any purchases made

Collect and Pack up in Red Operation Walk Containers:

• 3-5 empty coffee cans

• 5 towels to wrap around the cans

• colored highlighters

• equipment stickers

• masking tape to label walkers

In Storage: (this equipment comes back with us every year)

• Pliers/exacto knife,

• Black filing box

• Collapsible blue wheelchair Operation Walk Manitoba (OWM)

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Pack Up (Done in August) Prepare all team members that they need to be present for pack up. Once supplies are at the locker (shrink wrap), this can be done ahead of when the regular team goes to do the “big pack.”

Be sure to keep a list of all equipment / supplies you are shipping in each numbered box.

Claudio will require this list from you. You will be provided with a number that will need to be written on each wrapped box.

2025 – Deb picked up 5 watermelon (or potato boxes) from one of the grocery stores and brought to the locker. Costco is often a good place to go for these.

Put the boxes together on day of packing and reinforce with packing tape.

Place the box on a PALLET – pallet jack will be at the storage facility (bring muscle)

Boxes were filled and then layered (like building a tower), crutches were shoved around the corners of the box to help them maintain their shape. Start with 4wws in the bottom and then stack and fill from there. The equipment must remain within the border (think of the boarder extending up from the box) and then wrap it snuggly with the packing wrap, including on top of the tower.

Zip ties can be used to keep things together as needed

Often helps to shrink wrap a few two wheeled walkers together for ease of packing as well (in groups of 2-4)

Use the watermelon boxes to put the wheelchairs in as well – remove the footrests for ease of packing.

Red Box Labeled Physio Supplies:

I usually put our towels, black filing box, coffee cans, pens, pliers, exercise sheets*, transfer belts, paper copy templates, coloured sharpies, highlighters and zip ties in there.

In the black filing box you will need:

• 50 copies of knee exercise sheets*

• 30 copies of hip exercise sheets*

• 20 copies of how to manage stairs

• 60 copies of Discharge instructions

• 30 copies of patient wall sheets (these are legal size)

• 10 copies of to-do lists

* I have always brought all the paper copies with me in my suitcase, but you could

send the sheets above in the shipping container as well

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Mission Time Communication with your team is crucial. What’s App is used for all communication and a therapy team chat is created by yourself for this.

Things to communicate:

Hotel room numbers for all team members

Pick up times from hotel and hospital

Team also uses What's App to relay info on resort etc.

Screening Clinics In Nicaragua ( 1 Day Before Mission) 1-2 therapists may be asked to assist in the preop clinic. Lead PT tends to be involved in preop and it is their job to lay eyes on all patient’s so they can assess their abilities prior to surgery. You will have a chance to check the intake forms which will also include the following,

Identify those that are largely wheelchair bound

Those with flexion contractures

Those using canes and or walkers pre surgery

Social concerns – mattress on floor, stairs, outdoor bathroom, no toilet

PMHx – diabetic cases should go first in day

Lead will begin to create a personal list of patients that can be identified prior to surgery as requiring more equipment. Eg. Bilateral with no toilet seat or a bathroom outside that requires them to do stairs, may need a commode so you can flag this.

Be ready to help in whatever capacity is needed.

Slating After all patients are done in clinic, the slate will be created and reviewed with OR team and

surgeons. It is important for the lead PT to speak up if they feel there are specific patients that should be done day 1 or first in day etc. These are those that are identified to meet to criteria of the above bolded concerns.

Others that should go first:

Bilats early in day (mainly day 1 and 2)

Flexion contractures – day 1 (more painful and difficult to mobilize)

Diabetics early in day

More complex medical history early in day and week

Last OR Day:

Young healthy unilateral knees/hips can be done on the last OR day

Older patients should go in the morning because believe it or not half a day

makes a difference!

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Surgery Day One - PT TEAM JOBS BEGIN Equipment Check • Have 2-3 PTs delegated to getting equipment wiped down and checked for safety and sorted.

• Take Equipment needed to the staff room on the ward

2- wheelchairs, 3-2 wheeled walkers, 2-4 wheeled walker, Red “Physio supplies” container

Keep in mind we share this space. Don’t take too much equipment down.

• Go through ward with all therapists and familiarize them with where things are.

• Install RTS/ Bars in patient bathrooms and commode in communal bathroom.

• Make up “wall sheets” with patient names and place up on wall, explain tracking system.

Encourage fluids and breaks – it is hot on the ward and your team needs to stay hydrated!!

Pre-Operation Teaching – 2-3 PTs In the past two years we have attempted to preop as many patients as possible while they are waiting on the ward. These have been done after patients are admitted to hospital and awaiting their surgery.

We have found this is very effective so that patient’s families can help them prepare and patients have time to look at the exercise sheets.

We have done this is groups and one on one depending on which patients are in which rooms.

Eg. Day 1 we attempt to preop those waiting and will have missed only those cases that went first that day.

We will then preop the patients coming in for day 2 as they arrive later in the day on day 1.

With the help of a translator you will review the exercises and have patient perform them with you.

You will discuss the importance of exercises, and some tips for at home eg. Raising chairs or bed height.

- You will discuss what to expect from surgery and course of rehab needed

- Discuss the importance of walking and movement to prevent blood clots.

- Discuss elevation and ice.

- Discuss appropriate use of gait aid

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Post Surgical PT Role: Full Team of PTs Patient’s returning to Ward post surgery (around 10:30)

First check done in 20-30 min

Check vitals on chart under mattress.

Check sensation

If yes, they can start on bed exercises with you. If no, have family keep trying to work on foot and ankle pumping until freezing comes out.

Complete bed exercises

Once they have quads control – work in teams of 2 to sit at bedside.

If able to sit and perform quads extension (there will be a quads lag), stand patient with transfer belt and two wheeled walker

If patient can stand and weight shift, attempt steps with a third person there for wheelchair follow.

It is not uncommon to walk patients 2- 3 times a day, nurses will help as well.

Once walking well, teach standing exercises

Decide type of gait aid needed for discharge

Review how to do stairs as needed

Review discharge instructions – this can often be done in groups to save time.

Continue to mobilize patient to increase confidence – assess for discharge. The last two years we have discharged 10 patients the day of their surgery.

Be sure PTs are filling out chart notes on wall. This allows them to say equipment that will be needed and to know what is left to review. Most of the time the same physios will continue to see patients from assessment through discharge, but work together to get this done in timely fashion. Once discharged that patient’s name on wall chart will be highlighted and then this will be communicated to nursing by the team lead. (we work in highlighters)

Work smarter not harder….team teach, see more than one patient at a time, eg. Four patients in the same room back from recovery etc., use the nurses as your assist, they want to help!

A vast majority of patients will be independent same day or by day 1 post op. Family members will stay with patient and can help to assist to bathroom, hold IV, wheelchair follow. Most patients need to use communal bathroom, you will find family members helping them with same.

Nicaraguan people are very modest and clean, don’t be surprised if they won’t sit on the toilet seat to pee.

Patients and families want to please you. They often don’t ask for help.

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Discharging Patients – Same Day or in Morning Goals for discharge: Independent transfers or has assist at home if needed

Independent ambulation with a gait aide step through gait

Education on exercises, walking, gait aide progression, and when which hand to

use a cane, use of ice, elevation, sleeping position dos and don’ts,

Education done with family members

Flag and size a walking aide for each patient to go home with and place in our storage room

on the ward. Write the patient’s name and room number on tape on the gait aid and label with a sticker. Read the room….each patient is receiving a gait aid but some will be nicer than others. You may choose to hang on to equipment in the storage area until the people are being wheeled out on discharge. In the last two years this has been less of an issue for us.

Discharge teaching includes: Importance of pain control

Exercise and walking progression, multiple short walks are better than one long walk

Gait aide progression from walker to cane, cane to no gait aide.

Chair with arm rests for home, correct height of bed

Sleeping positions/ pillow positions

Use of ice and elevation

Signs and symptoms of infection/ blood clots

Car seat set up If you expect discharge first thing in the morning, provide the family with the discharge instructions page to look over.

Before you leave for the night: Put all equipment back in the staff storage room on ward

Leave the wheeled commode at the nursing station (if SBA or 1A)

Educate patients and family about the commode as most patients will not be encouraged to mobilize to the communal bathroom

Leave a 2ww in each room to assist with transfer to commode

May need to leave urinals and or bedpans for those that are less mobile

You may leave without mobilizing the last surgical cases of the day. THIS IS OKAY. Review bed exercises and have them use urinal / bed pan, the rest can be done in the morning.

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Surgery Day 2 & Day 3 Meet in the morning to review patients and decide which therapists will see which patients.

Discharge patients left over from the day before first.

If still having difficulties ambulating / pain – they will need multiple visits with hopes of being discharged later in the day.

Make sure everyone for day 2 has had preop teaching and look to start preop teaching for those coming in to have surgery on day 3.

As the new OR’s come up - start back to the steps from – first check.

It’s important to keep communicating with your team. It may make sense for some to concentrate on discharges while the others begin first checks and possible preop teaching!

Final Day This is a half morning and it moves quickly. Your goal is to discharge all patients by 10. Ask for all interpreters to be present that morning

Pack Up What to Bring Back in the storage container:

Blue ‘packable” wheelchair

Transfer belts

Pliers/exacto knife

Leave all other walking aides, exercise sheets, linen at the hospital. Claudio will coordinate pick up of these items with hospital staff and they will determine where the additional items can best be used.

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1155 Concordia Avenue, Suite 320 Winnipeg, MB R3K 3S8

Phone: 204.813.4354 Email: info@operationwalkmb.ca