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Mission to Nicaragua

Concordia Hospital surgical team to help as many as 60 people regain ability to walk during week-long trip

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Winnipeg Health Region
Wave, July / August 2012

Fifty health-care providers from the Winnipeg Health Region are heading to Nicaragua this fall as part of a volunteer mission to provide free hip and knee replacements to as many as 60 patients.

The week-long mission is being organized by Concordia Hospital nurses Karen Watchorn and Alison Bartel under the umbrella of Operation Walk, a Los Angelesbased organization founded in 1995 to provide joint surgeries in the developing world.

The Winnipeg team - only the second group from Canada to participate in such a mission - includes surgeons, anaesthetists, operating room and ward nurses, physiotherapists, and staff who will look after cleaning, processing and keeping track of supplies. Most of the team works at Concordia, but it will also include staff members from Health Sciences Centre, Seven Oaks and Grace Hospitals, according to Bartel and Watchorn.

The team will staff four operating rooms as well as pre- and post-operative wards and recovery rooms in a hospital in the capital city of Managua. In addition to their expertise, they will bring with them a long list of supplies and instruments, much of it gathered from Winnipeg-based International HOPE Canada. During their week in Nicaragua, they will screen patients before the operating days, carry out 50 to 60 surgeries, and check on patients after surgery.

Watchorn and Bartel first connected with Operation Walk when they, along with two other Concordia nurses and two surgeons, took part in a mission to Guatemala in 2009 as part of a team from London, Ont. When the Winnipeggers expressed interest in going on another mission, the Los Angeles organization upped the ante by inviting them to provide an entire team.

Watchorn and Bartel say they expect the experience to be both exhilarating and exhausting.

"We did 68 joints in three and a half days," says operating room nurse Bartel of the Guatemala trip. "It was a long, tiring, fun day. You're not focused on 'When do get my coffee break? When can I go for lunch?'"

Getting so many surgeries done in such a short time is "a logistical nightmare," says Watchorn. Part of the challenge is the smaller work space they will have to deal with. "In Guatemala, the ORs (operating rooms) were one quarter the size of what we have here," she says.

For the staff who work with patients outside the operating room, there will be an added challenge: there's air conditioning in the OR in Nicaragua, but not in the wards.

Some of the challenges will require careful planning to overcome. Whereas here instruments are cleaned by machine, during the Nicaragua trip they will all need to be cleaned by hand before sterilizing. As a result, just scheduling the operations in such a way that there will be time to have sterile instruments ready for them is a major task. In preparation for the trip, the team is amassing supplies and equipment and storing it at International HOPE's warehouse. Specialized instruments are being taken on loan from the vendors, but many other items including sutures, needles, syringes, walkers, crutches and commodes are being gathered from International HOPE's inventory.

The team members expect the project to have a major impact on the lives of patients, many of whom have been living with a great deal of pain or with very little mobility for a long time.

Watchorn and Bartel travelled to Nicaragua in April to prepare for the trip and returned with a suitcase full of X-rays so that the team can begin assessing which patients to treat in the fall.

The benefits of the trip don't just flow one-way. It's extremely motivating for the Manitobans to work so closely together and have such an impact. "It's a big teambuilding opportunity for us, because the bulk of the team is from the Concordia Hospital," says Bartel.

While the team members are donating their time, Operation Walk aims to raise $100,000 to pay for shipping supplies as well as to cover as much of the transportation and accommodation costs as they can. Donations can be made through the Concordia Foundation or through the Operation Walk Winnipeg website. The knee and hip implants themselves are being donated, says Watchorn, which makes the trip much more financially feasible.

The caseload is expected to be different from what the group typically deals with at Concordia, where about one-third of the surgeries are on hips and the other twothirds are on knees. In Nicaragua, they expect the majority of their surgeries to be on knees.

Part of the preparation includes planning for the health of the team. One of the anaesthetists is acting as the staff doctor for the team and making plans for any necessary shots or food-borne ailments.

Travelling into a developing country with an important job to do, the team members already have one rule designed to ensure that health problems don't prevent them from working.

"We have a rule," says Bartel, with a laugh. "No eating street meat until after our operating room days."

Bob Armstrong is a Winnipeg writer.

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