Friday, August 17, 2018

IEP Medical Mission in Namibia: Day 4 in Surgery

We started off the second week of surgery with a very aggressive schedule. We planned 13 cases and completed 10. One was canceled because the patient had a fever and another moved to Wednesday. Sadly, they had to cancel a procedure for a seven-year-old boy because we couldn’t get parental consent. His family is in the Okongo region, which is very far north near the Angolan border. His uncles had brought him to screening, but the hospital needs actual parental consent. It’s sometimes hard to explain to the families. Culturally, uncles are like fathers and aunts are like mothers. Legally, it’s just not the same.

Just to keep things hopping, we screened several more patients in between cases while the operating rooms were being turned over for the next surgeries. We also reviewed the x-rays and CT scans of patients we screened last week to make final decisions on whether they should receive surgery.

The team completed nine surgeries on Tuesday, our busiest day yet:
  1. 8-year-old girl – tendon transfer and plantar fasciotomy 
  2. 10-year-old girl – bilateral clubfoot repair
  3. 12-year-old boy – Achilles tendon lengthening, tendon recession, and plantar fascial release
  4. 29-year-old woman – triple arthrodesis 
  5. 32-year-old woman – ankle fracture repair
  6. 44-year-old woman – ankle fracture repair 
  7. 50-year-old woman – ankle fracture repair
  8. 54-year-old woman – bilateral metatarsal cuneiform exostosis
  9. 63-year-old man – ankle fracture repair
We’ve seen a lot of ankle fractures referred from the local orthopedic departments. The doctors here say they see a lot of trauma, largely from car accidents. Our team really specializes in deformities like clubfoot that are often not treated as quickly as trauma cases.

It was a long day, but very satisfying. We spent nearly 12 hours at the hospital, which meant the van was particularly quiet on the way home. One of the things I appreciate most about this group is that it really is a team. We eat breakfast together, work together, and usually eat dinner together. There's plenty of work, but plenty of good humor as well. While we're here, we're definitely family -- which makes being half a world away from my own family much easier.


IEP Medical Mission in Namibia: Day 3 in Surgery



Our first week of surgery finished with a full schedule in both operating rooms. Because Dr. Kao and Dr. Oloff were only able to join us for one week, it was also the last day for arthroscopy cases. But it wasn't the last use of the arthroscopy equipment. We're donating it to the Namibian Ministry of Health so that the local surgeons have the latest equipment to treat more patients.

The team completed seven surgeries on our third day in the operating theaters:
  1. 11-year-old girl – bilateral Achilles tendon lengthening
  2. 21-year-old woman – repair of meniscus tear in knee
  3. 22-year-old man – repair of Achilles tendon rupture
  4. 23-year-old man – tendon repair in hand
  5. 28-year-old woman – removal of bone fragments from foot
  6. 33-year-old man – shoulder stabilization to prevent repeated dislocations
  7. 47-year-old woman – scar revision from previous surgery
Meanwhile, part of the team traveled north to Angola with Dr. Haifuku, the Namibian Minister of Health. Dr. Nyska, Henry Duvalsaint, and Flecher Fleudujon joined Dr. Haifuku to share information about our project, evaluate more patients, and tour the medical facilities at multiple hospitals.

Dr. Nyska was very impressed with the facilities and equipment in the Angolan hospitals, much of which is very new. He shared information with the orthopedic doctors from Angola, who planned to visit our team in Windhoek the following week.

Although Namibia and Angola share a border, there are significant differences between the two countries. Namibia has a population of about 2.5 million, while Angola has more than 28 million. One of the biggest challenges for healthcare delivery in Namibia is the population density. The population is spread broadly across the country with 55% of people living in rural areas. Many of our patients traveled several hours by bus from the north to see our team for screening.

Dr. Haifuku has been very supportive of our mission and spent time with members of the team to talk about what we can all do to improve healthcare through efforts like public and private partnerships.

Friday, August 10, 2018

IEP Medical Mission in Namibia: Day 2 in Surgery

We saved Day 1’s expected chaos for Day 2. The changes we made to the surgical schedule on Tuesday afternoon didn’t quite make it all the way through the system, so we had a few surprises this morning. The theme of flexibility came up again as we shifted patients between operating rooms and doctors to account for the schedule changes.

The person who had the most trouble with the schedule changes was a 5-year-old boy. Because patients cannot eat for several hours before surgery, we like to put the youngest children earliest in the day. The shift in the schedule put him a bit later and he needed some extra mom time – and two teddy bears – to get through the wait. The bears definitely helped comfort him, but with the language barrier, I was unable to reassure him with any kind words. It’s one of the times when I feel most helpless.   

Wednesday, August 8, 2018

IEP Medical Mission in Namibia: First Day of Surgery

We always expect a bit of chaos on the first day of surgery as everyone gets their bearings in a new place with new people.

Dr. Helena, our main liaison, has worked incredibly hard to make sure everyone at the hospital was prepared for our arrival. This time, everyone dove right into the work and our first day of surgery went very smoothly.

The Windhoek Central Hospital facilities are much more modern than those we used at Katatura in 2016. The nursing staff was well-prepared and has been an important part of our team.

We completed seven cases on Tuesday, six children and one adult:

Tuesday, August 7, 2018

IEP in Namibia, Day 1: Patient Screening

Our first day was very busy. We started the morning taking most of our equipment to Central Hospital, where we’ll be doing all the surgeries. There we met the matrons (head nurses) of the operating theater and the equipment sterilization departments. We bring most of our own instruments, so we worked with the department to organize everything for sterilization in preparation for Tuesday’s surgeries.

By 11a we were on to Katatura Hospital, where we worked in 2016, to do the patient screening. There were quite a few patients ready to be seen, so we quickly got moving. The team usually focuses on foot and ankle deformities but based on the specialties of people on this mission team we were also seeing patients with knee, shoulder, and arm injuries.

I’m their first stop. I check in the patients and create an information sheet (chart). I gather their basic personal information – name, birth date, contact information. Then I gather details about why they’ve come to see the team for evaluation. There are many languages spoken in Namibia, so I often run into communication challenges. But it’s rarely a major issue because the other patients are quick to help translate.

Sunday, August 5, 2018

Adventures in Travel with IEP

Lehnerts and luggage left behind...
We’re here in Windhoek – all 16 of us! But it was a bit of an adventure to get here.

Traveling internationally is almost always an adventure. Add to the equation a large group with a lot of medical equipment along for the ride and it’s a lot to manage. Even so, the biggest challenge is usually making sure we get everything at the baggage carousel when we reach our destination.

Namibia gets a little more challenging because we also have an overnight stop-over in Frankfurt, Germany before our flight to Namibia the next day. That means getting all of our gear through customs and into taxis to the hotel – and back again the next day. Twelve of us arrived in Frankfurt on Thursday, where we met up with another two team members before our flight on Friday.

Everything went smoothly at check-in – 14 people, 14 suitcases, and 14 boxes of equipment. We went through passport control and security with no problems. And then, we discovered an interesting challenge at the gate. It turns out that Namibia had enacted a new law shortly after our last trip. Unfortunately, we weren’t aware of it. Out travel guidance didn’t flag it and the airline didn’t have any information about it during ticketing or even the check-in process.

Thursday, July 26, 2018

Who Me? On a Medical Mission to Namibia?

I started working with International Extremity Project more than ten years ago by creating the website and writing blog posts from information the team sent me from the trips. And then six years ago, Dr. Bruce Lehnert asked if I would join the group for a trip to Vietnam. 

It was definitely one of those "who me?" moments. It was like when you're in a room and someone waves in your direction and you look around wondering if they're really waving at you. Except I was in front of a keyboard and screen, so the question really was for me.

Needless to say, I said yes. I agreed to fly around the world with people I didn't really know to do something that I'd never even come close to doing before. It was amazing. 

And now I'm headed on my fifth journey with International Extremity Project. Somehow it's still hard to imagine that I have this opportunity. Am I really packing for my second mission trip to Namibia? Are those really totes of medical equipment in my living room?

I've gone from writing blog posts to managing the patient information, working on the surgery schedules, and sometimes even helping in the operating room. (Fear not: My OR role is usually paperwork, comforting patients, or getting sterile supplies for the medical team.) It makes the answer to "what did you do on your vacation?" far more interesting than it once was.

Tuesday, July 17, 2018

Looking forward to Namibia


From John Kao

Well, it's only two weeks away. There certainly is a nervous excitement within me as I finish off my vaccinations and begin packing for the big trip.

All the arthroscopy stuff is packed away and ready to ship. Our excursions are set. Now, all that's left are the Packing party and the trip itself.

I'm not sure what to expect being the first arthroscopist to make this trip. Whatever happens, it will be enlightening to see deformities and injuries in this part of the world. I look forward to the challenge and helping in any way possible.

Yes, an adventure lies ahead of us all. And as for me, I say, bring it on!

Sunday, July 15, 2018

Getting Ready for Our Medical Mission in Namibia

Post from Jenni Lehnert


Medical supplies and equipment are prepared.
Team meetings and trip planning are behind us. 

Next up is the packing party, where we organize our supplies and equipment. After inventory, we address and pack everything into totes. That's when the big excitement comes and the reality of the upcoming mission reveals itself.

I am personally excited to work once again with United Africa Group, the Namibian Ministry of Health, and all the staff at the hospital. The ongoing working friendship to help the people of Namibia is a true calling of mine. 

Please follow our mission through our daily posts here, on Facebook, and on Twitter

Thanks to all who have helped.

Saturday, July 14, 2018

16 Days Until Namibia

Post from Henry Duvalsaint

Once again, IEP is in the last weeks of preparation for our next mission visit to Namibia. Our experience in Namibia two years ago had left a great impression on our staff ability along with the local Namibian hospital community. 

In addition, United Africa Group has been extremely supportive and has provided some of the logistical support for our upcoming mission. I am looking forward to a successful trip and I thank both the IEP team and the United Africa Group for their continued efforts and dedication in helping underprivileged children and adults.

Tuesday, July 10, 2018

20 Days Until Namibia!

Logan in Vietnam. January 2018




From Logan Lehnert

IEP has been a fun and broadening experience. I have learned a lot about operating rooms, orthopedic deformities and how they change people's lives.

What a great opportunity to see past our own society and culture. I have gotten to see different cultures and the advantages I have in the United States. I look forward to helping this August in Namibia.



Thursday, July 5, 2018

Less than a Month to Namibia

From Bruce Lehnert

Namibia map
In less than one month we will be in Namibia. This will be our third medical mission to the country that lies between Angola, Botswana, and South Africa. Independent since 1990, Namibia has the spirit of a young and determined country. 

We are going to help the kids with deformities that are preventing them from participating in their country's shedding of the past. This is real feel-good stuff. 

Thanks to all that have made this happen through donations of time, medical supplies, and money. 

Oh, I forgot to mention that we are in our 21st year of helping kids in need!

Sunday, May 20, 2018

Celebrating 20 Years of Medical Missions

From Bruce Lehnert

It is hard to believe 20 years of medical missions have come to pass. When I started this journey in 1998, the dream was to have exactly this outcome. It has been a very rewarding journey that ties my life to so many of our patients.  When I see them return for follow up their smiles live in me forever!  

Twenty years in we have published our techniques in peer-reviewed journals and have nailed down the bottom-up approach to making a medical mission work smoothly and effectively.

Flecher Fleudujon's 20th anniversary IEP short film captures it all.  Please watch.


A big thanks to all past and present IEP members! And a gracious hug to all IEP supporters.

Monday, March 5, 2018

Countdown to Namibia: John T. Kao, MD

The IEP team is getting ready for our next mission to Namibia in August. Today's post is from Dr. John Kao, who will be joining IEP for his first mission.
As I begin my 25th year in sports orthopedic surgery -- caring for the weekend warrior as well as the professional athlete -- I have thoroughly enjoyed my career in medicine. I have gained great pleasure in helping others get back to athletic competition or their chosen activities. Most importantly, I appreciate the trust that my patients have had in me and my abilities over the many years.  

Still, as my last child sets off to college and my wife and I ready to become empty nesters, I started growing concerned about the routine nature of my practice. So, when Dr. Bruce Lehnert approached me regarding an opportunity to participate with the International Extremity Project, I accepted. Looking forward to this summer, I feel a renewed excitement and energy as I learn more about this great organization and its cause.  

Now, as I prepare to embark on my first medical mission, I look forward to helping others in the fundamental manner that I originally led me to choose a career in medicine over 35 years ago.  I truly appreciate any support that you may have to offer, and I look forward to sharing my great experiences with all of you when I get back!

Saturday, February 24, 2018

Up Next, Namibia!

Barely home a month and we're getting ready for our next trip! A smaller group of us will be heading back to Windhoek, Namibia in August for our second full mission. While there, the team will perform surgeries as well as lecture at the University of Namibia to help train the new generation of surgeons to treat lower-extremity deformities.

I'm always honored to have Drs. Lehnert and Spanko invite me to participate -- and grateful that I have the opportunity to travel with the team and help make a difference in the communities we visit. I've already applied for my visa and submitted my vacation notice for work.


Stay tuned as we prepare for our journey!

Thursday, February 1, 2018

Medical Mission: Thanks to Our Supporters

The International Extremity Project (IEP) team arrived in Can Tho, Vietnam, after over 25 hours of air and bus travel. With 22 boxes of medical supplies and equipment, plus our team of 25 people, it took two buses to get everything and everyone to our final destination!

The IEP team began screening patients for surgery the next morning and started surgeries the day after screening. After multiple surgical days, the team treated 47 surgical patients, most with multiple procedures.

Monday, January 29, 2018

Medical Mission: Communicating with Patients

Jesse Hsiao, RN shares his thoughts after his first mission with the IEP team. 

It’s difficult to name a most memorable moment since many were new learning opportunities, unforgettable, and inspirational. I particularly enjoyed going on rounds with the residents and translators.

Side note: Our teamwork and communication were impeccable. For those of you who watch basketball, it was like the fluidity of all five players clicking — think the current Golden State Warriors and San Antonio Spurs offense at their best. 

During this time, I did post-operative teaching with patients and their families. What I love about this is that I was able to talk to patients and their families. After surgery, there’s still some anxiety, especially with the duration and process of recovery. In particular, all of them were concerned about managing pain, when they could walk again, and when they could return to their routine or in some cases have a dramatically new life.

Tuesday, January 9, 2018

Medical Mission, Day 5: Final Surgeries

Our final day at the hospital was another busy day in the operating rooms with 14 patients. Outside of the OR, we had to pack up our all supplies for the journey home and visit patients who had surgeries in the days prior.

There's always one particularly memorable case in each mission. Two years ago it was a little girl with tibial agenesis, this year it was a young man with bilateral macrodactyly.



Friday, January 5, 2018

Medical Mission, Day 4: Full Day of Surgery


Because we were in Vietnam for less time than some of our previous missions, it was important that we were very efficient in the operating rooms. Wednesday was our biggest day -- 15 patients.

Our morning was made a bit more challenging with scheduling changes between the two teams. We knew what patients we'd see, but the Vietnamese doctors needed to make changes to the order in which we'd see them. I spent the first part of my morning matching up our patient records with the hospital records to make sure everyone had the information they needed in the operating rooms.

Communication across departments is a challenge in any organization or business. Here we get to add in the challenge of being a team with another country trying to align with the local doctors, anesthesiology teams, and nursing staff. But it always works out.

Wednesday, January 3, 2018

Medical Mission, Day 3: Surgery Time!

Once we've identified the patients we can help and the procedures the team will do, it's time to get started on the work of changing lives. Maybe it sounds dramatic, but just giving someone the ability to walk more normally or even wear shoes for the first time is a significant life change for most.

Wing Ip and Bruce Lehnert review
x-rays before a procedure.

The Art & Science of Scheduling

Because we're here for a relatively short time, we're utilizing three operating rooms so we can do as many procedures as possible. We alternate between soft tissue and bony cases to allow time for sterilization of the powered instruments between bony procedures. At the same time, we try to do most of the youngest patients earlier in the day to minimize their discomfort from hunger and anxiety. It's quite a balancing act that Wing Ip manages, then works with Dr. Em, the head of orthopedics at Can Tho General Hospital, to confirm and arrange the local team for anesthesiology, nursing, and operating room support.

Teamwork in Patient Care

Surgery days take coordination of the full medical team as well as most of the support team. Our translators are invaluable in communicating with the medical staff and the patients, especially in delivering post-surgical care information and medication.

2018 Vietnam Mission Team

A medical mission like ours takes a complement of people to fill the various roles. It's important not only that everyone has specific skills, but that people work well within the team and with the local medical staff. We intentionally keep the group small to minimize costs so that the funds we raise go to patient care. We're together all day, nearly every day for two weeks and -- most importantly -- we're responsible for the medical care of dozens of people.

The work begins long before we ever pack our gear to travel. Henry arranges air and ground travel for the team as well as our hotel accommodations. Meanwhile, Jenni takes the lead in identifying the supplies we'll need, collecting supplies, and identifying the people in each role. (It takes months!) While we're in Vietnam, our days are busy with everyone playing a part -- whether their primary role or doing other tasks as needed to support the medical team. My main role may be managing patient information, but you'll find me hopping down the hall to gather supplies or even supporting the team in the operating room. 

Medical Team

Tuesday, January 2, 2018

Medical Mission, Days 1-2: Patient Screening

Dr. Bruce Lehnert and resident Aziz Razooli
evaluate a boy for possible surgery.
The day after we arrive in Vietnam, we immediately start work by evaluating patients for the first two days.The hospital pre-screens many of the patients so that our team is evaluating the most likely surgical candidates.

The patient evaluations follow a three-step process:
  1. We start by doing a short interview with each patient to identify what they'd like our team to evaluate, some basic history on the condition and previous treatment, and basic demographic details.