In a small operating room at El Buen Samaritano Hospital, a team of surgeons, nurses and surgical personnel work to fix a distal femur fracture. The break is four months old. It wasn’t initially treated with surgery, and it’s left one of the patient’s legs several centimeters short.
The surgical team from University of Michigan Health is working in La Romana, Dominican Republic, a city on the country’s southeastern coast. The repair is one of around 25 procedures the group will perform in a week – packing in as many as possible for patients who would otherwise not receive care for their injuries.
“Many patients who break a bone here have pay to out-of-pocket for surgical care,” said Mark Hake, M.D., an orthopaedic trauma surgeon who also leads the U-M Health Department of Orthopaedic Surgery’s residency program.
“When they can’t afford appropriate care, they often have significant disabilities as a result. Some procedures are fairly straightforward and others very complex due to the fact that the patient was initially cared for in a way that is different from what we would see here in Michigan.”
The work is part of a medical mission program started 20 years ago by alumni of the orthopaedic surgery department. Hake initially traveled with the team in 2014 as a senior resident. Now, as a faculty member, he organizes the trips with Tom Hearty, M.D., D.P.T., a local foot and ankle surgeon and adjunct teaching faculty member at U-M.
The two, along with a team of orthopaedic residents, anesthesia providers, nurses and surgical technicians, travel to the Dominican Republic each year to provide care at an under-resourced local hospital. The trip was cancelled due to COVID-19 in 2020, but the Ann Arbor contingent returned for a week in November 2021 and is planning two trips in 2022.
Left: An image of El Buen Samaritano Hospital. Right: A look at La Romana on a map of the Dominican Republic.
Creativity despite limited resources
The traveling physicians tackle many orthopedic problems in La Romana. They repair fractures, take care of infections and manage foot and ankle pathology. But Hake and his colleagues are actively trying to expand the program, seeing opportunities to provide more extensive and higher quality care.
“At Michigan, every sub-specialty is available to help with our complex patients and run tests,” he said. “Everything we use here in the Dominican, we have to find, purchase and bring in suitcases when we travel. We have to be creative about treatment plans and think about how to provide care with limited resources. While those processes allow us to come up with innovative solutions, we hope to gain more resources, create a more established presence and come down here more times a year.”
The Michigan surgical team operates out of El Buen Samaritano, a non-profit hospital that provides care for local residents and Haitian immigrants, many of whom work in the sugarcane fields. The hospital only has four operating rooms, which are in use for nearly the entire week during the mission trip. The surgeons operate on patients ranging from eight years old to the elderly.
Despite the difficulty in coordinating cases, the gratitude expressed by patients and their families after the surgeries reaffirms why the program needs to continue and grow, said Stefan Garcia, M.D., an orthopaedic surgery resident at U-M Health who took part in the November mission trip.
Staff prepares for procedures in La Romana
“One story that sticks out to me was a young man with a club foot who was evaluated on the previous mission trip in 2019, but the group ran out of time before we were able to treat him,” Garcia said.
“After two years due to COVID-19 postponing our trips, the patient came to our clinic, and we were able to reconstruct his foot. Not only are we able to help all these patients, but these trips allow us to re-center and re-focus on why we became doctors. I hope the program continues to expand and find funding to support three to four trips per year.”
Future plans
U-M Health’s next mission to La Romana is scheduled for April 23, 2022. Hake and Hearty have put together a team of people that work at both Michigan Medicine and at neighboring hospital St. Joseph Mercy Ann Arbor. This collaboration allows the team members to be away for the week without impacting necessary resources at either institution.
In addition to adding more trips from Ann Arbor, Hake and his team hope to coordinate with other hospital systems to grow the number of surgeons taking part in the program. They are already working with Scott Luallin, M.D., who practices at University Health Lakewood Medical Center in Missouri and helped pioneer the mission trip, and Jason Halvorson, M.D., who works at Atrium Health Wake Forest Baptist.
The next step in the mission’s evolution, Hake says, is to work more closely with the staff at El Buen Samaritano to educate local trainees on the procedures they perform and discuss commonalities and differences among practices.
A photo of the staff from U-M Health and St. Joseph Mercy Ann Arbor during the mission trip to the Dominican Republic.
Helping even more patients
Each trip to the Dominican Republic costs around $25,000, with the trip volunteers paying out-of-pocket for their own travel and housing during the week. The team also funds many costs for the patients, including X-rays and labs prior to surgeries, medications and more.
Hake and Hearty have created a nonprofit organization, called Great Lakes Orthopedic Relief International, to consolidate support for the mission. Through talking with alumni, donors and industry partners, Hake envisions a sustainable, long-term program that helps hundreds of patients receive essential care each year.
“We don’t take care of huge numbers of people right now, but for those we do see, they often have problems that prevent them from normal daily activities and also from working and providing for their families.” he said. “The support of Michigan Medicine, St Joseph Mercy Ann Arbor and generous donors has allowed us to help get these people back to a normal life. This opportunity is one of the reasons I love what I do, and my hope it to continue to partner with others to be able to do more in the future.”
