IEP Extremity Team in Bhutan

The International Extremity Project completed a recent humanitarian mission to Bhutan. The orthopedic and foot-and-ankle team joined fellow IEP volunteers, including the new dental team, to assess, treat, and improve health outcomes for underserved populations. On this mission, the lower extremity team focused on restoring function, relieving pain, and preserving dignity within a healthcare system guided by a philosophy unlike any other.

Bhutan has redefined progress through the concept of Gross National Happiness. Rather than measuring success solely through economic output, the Bhutanese government evaluates national well-being through sustainable development, cultural preservation, environmental conservation, and good governance. This philosophy fosters a life rooted in Buddhist values, community cohesion, and balance with nature. 

Healthcare is provided free of charge to all citizens, reflecting a national commitment to collective well-being. However, limited financial resources and geographic challenges restrict access to advanced orthopedic and subspecialty surgical care, particularly for complex lower-extremity deformities. 

At the invitation of Her Majesty Gyalyum Kesang Choeden Wangchuck, IEP was asked to assist in strengthening clinical care and surgical capacity in Bhutan. While IEP is recognized internationally for its work in treating complex foot and ankle pathology, our missions also emphasize education and sustainability. 

The Bhutan Medical Team

Led by Dr. Bruce Lehnert, the lower extremity team included Dr. Meir Nyska, Dr. Ezequiel Palmanovich, and Dr. Melissa Lipari. Their collective experience allowed them to address a wide range of congenital, post-traumatic, and neglected deformities. Dr. Jannani Krishnan, a resident in foot and ankle surgery, played a vital role in patient assessment, operative care, and postoperative management, reflecting IEP’s commitment to education and the development of future humanitarian surgeons.

During the mission, the team operated on 30 patients with complex lower extremity conditions, many of which had gone untreated for years. These cases represented more than surgical challenges; they reflected barriers to mobility that limited patients’ ability to work, care for their families, and participate fully in community life. 

In parallel with surgical care, the team delivered eight formal educational lectures, focusing on deformity correction, trauma management, postoperative care, and long-term functional outcomes. Local orthopedic surgeons received training in advanced techniques. IEP also donated essential surgical equipment to ensure that care can continue long after our team’s departure.

Comprehensive care extended beyond the operating room. 

• Jenni Lehnert, RN, IEP's head of nursing, coordinated perioperative care, patient education, sterilization protocols, and postoperative follow-up. Her leadership ensured continuity, safety, and compassionate care throughout the mission. 
• Mai Phan provided her nursing support and trademark compassion for the patients, their families, and the IEP team.  
• Nancy Chee, a certified hand therapist, expanded the scope of treatment by providing conservative and rehabilitative care, focusing on functional recovery, mobility training, and long-term support for patients who were not surgical candidates or who required ongoing therapy.

In parallel with the lower extremity mission, the IEP dental team addressed critical periodontal needs, reinforcing IEP’s holistic approach to patient care. The integration of dental and orthopedic services underscores the interconnectedness of mobility, nutrition, pain control, and overall health. Working side by side, the teams demonstrated that sustainable healthcare requires coordinated, multidisciplinary efforts that treat the whole patient rather than isolated conditions.

Value Beyond Surgical Care

The work of the lower-extremity team in Bhutan reaffirmed a central IEP principle: Meaningful impact is achieved not only through surgery but also through education, collaboration, and respect for local systems. Each restored limb represents renewed independence, dignity, and opportunity. 

In a country guided by Gross National Happiness, restoring the ability to walk is inseparable from restoring quality of life itself.