It was 17 degrees with 40 inches of snow and brutal, stinging, mind-numbing cold in Mamaroneck on February 12. When we landed in Nicaragua six hours later, it was 94 degrees, hot, sticky and humid. Mosquitoes were circling. “Welcome to Central America,” Dr. Jeffrey Siegel and I thought to ourselves as we prepared for four days of intensive surgeries at the local teaching hospital in Leon, Nicaragua.
The two of us, podiatric foot and ankle surgeons, were on a return trip to Leon with twelve volunteers from the Mamaroneck Methodist Church. Dr. Siegel is from Philadelphia. (See: Mam’k Podiatrist Straightens Limbs in Nicaragua.) For many, this was our seventh year in Leon. (See: From Mamaroneck to Nicaragua: Good Will & Good Works.)
While some would be continuing work on the school, church and community center begun last year in the nearby village of Carlos Fonseca, Dr. Siegel and I would be based at Hospital Escuela Oscar Danilo Rosales Arguello (HEODRA).
Unbeknownst to us, the orthopedic residents and attendings at HEODRA had been saving their patients with the most severe limb deformities all year for us.
Mission Not Quite Impossible
Our mission was to provide medical advice and restorative reconstructive surgery to as many children and adults as possible in four days. This proved to be a daunting endeavor. During 6 hours of triage on our first day, we evaluated 54 patients and 15 diabetic limb salvage cases and scheduled 30 surgeries.
The most difficult part of this process for us was deciding who not to operate on. Dr. Siegel had to say no to two mothers whose babies had severe cerebral palsy. The children did not walk and both had club foot.
Every year, tears fill the parent’s eyes as we try to explain why their babies are not surgical candidates. The babies have so many problems, and all the parents want is for their babies to look normal. Saying no is the part of our job we don’t like.
This year, we said yes to two additional trauma cases, including a 17-year-old boy who got his leg caught in a corn de-husker. He had an open fracture from his mid leg to his big toe.
5 am sharp on our second day at the hospital: Scores of roosters, dogs and birds wake us up — again. As I roll over, I feel my arms for new mosquito bites. I’m bringing a net next year.
7 am: An hour of resident lectures is followed by 12 hours of surgery from 8 am to 8 pm for the next 4 days straight.
Two Poster Children
My “poster child” this year was Kevin, the boy who decided to move the blades of a corn harvester with his foot. Dr. Siegel and I were upstairs in the operating room when Kevin came into the emergency room. We brought him immediately into surgery for a 3 hour debridement and application of an external fixator to stabilize the foot and ankle. He had lost a considerable amount of bone and soft tissue, but we were able to save his leg.
Now, two weeks later, we have heard Kevin is stable and, so far, his prognosis appears to be good. Perhaps God does intervene? I believe if we were not there at that exact moment, Kevin’s leg would have been amputated.
Dr. Siegel’s “poster child” this year was Jelleser, who he described as “a beautiful, shy 9-year-old girl with a left clubfoot.” He applied three external fixation frames, including a 5-ring Ilizarov frame for a complete fusion of the ankle and midfoot joints.
Dr. Siegel recalled, “The evening after her operation, while we were making rounds, Jelleser said in perfect English, ‘Thank you very much for helping me to walk.’ She exemplifies the purpose of our mission and why we do this type of work. It was a week I will never forget.”
We treated a large variety of pathology including a massive bone tumor (above) and numerous rare congenital defects. All treatment was done without the benefit of intra-operative x-rays or fluoroscopy.
We Had Help
Our success is the direct result of the generosity of our sponsors. I want to thank: Vilex Inc., who donated a complete set of power equipment and surgical hardware for this mission; Arthrex Orthopedics for their bio-absorbable anchors; and Ortho-Fix for the external fixators. Thanks also to Kay Jeweler’s for their donation of Colby plush stuffed animals. Dr. Siegel was sponsored by Musculoskeletal Transport Foundation; Stryker; Orthofix; SBI; SOTA; Stephen Masseri, MD; Hand and Orthopedics Physical Therapy; Summerton Physical Therapy; NovaCare and both of his hospitals, Aria Health Care and Lower Bucks Hospital.
My life changes every year. As I reflect on this year’s trip, I am deeply humbled and grateful for the opportunity to be of service.