Day 1

The day started early with the pre-operative clinic running smoothly and patients moving from station to station in a wonderfully efficient manner. This was thanks in no small part to the innumerable medical student volunteers who serve as translators, patient transporters and cultural liaisons through the relatively complex pre-operative evaluation. Patients were screened by our excellent team of nurses prior to entering the exam room. Upon entering the exam room patients were met and evaluated by members of the surgical team as well as Anesthesia and Physical Therapy. Our fantastic Anesthesia Team, led by Dr. Mercedes Concepcion (a native of the Dominican Republic) had already reviewed patients medical histories but were further able to provide counsel on medical optimization of patients prior to surgery. Dr. Concepcion's team performed a thorough cardiopulmonary exam as well as reviewing the pre-operative 12 lead EKG. Fortunately no patient required cancellation today for medical comorbidities which is a testament to the efficacy of pre-operative interventions spear-headed by the Dominican Opwalk Team in the months leading up the mission.

We managed to finish all the interviews and surveys today and it went really well. Some themes have emerged as we hear the stories of how the patients' physical activity and lives are changed by their surgeries. Many are able to spend more time with family and to visit neighbors. They are taking their grandchildren to the park, and several have described how wonderful it is to be able to lift, care for, and play with their grandchildren again. Some of the younger patients have resumed work or returned to work with renewed vigor. Another major theme has been the desire to" pay it forward". Many of the women who received knee replacements described their ability to visit home-bound neighbors and take care of sick community members, just as their neighbors cared for them when they were bed- or wheelchair-ridden with osteoarthritis.

As we arrived on the ward on Friday, our patients were mobilized by our Physical Therapy Staff, walking down the hallway and doing their exercises as our staff and our Dominican colleagues cheered them on ....Our ORs went into full gear with our surgeons and anesthesiologists and OR staff planning to perform 20 joint replacements throughout the day.

We also concluded our second post-operative follow up clinic seeing our patients from 2009, 2010 and 2011. The stories they share with us is the reason we do this mission. It is stories about walking 11 km from one town to the other and doing house work and caring for others in need; or the story of farmers getting back to their work on the land and using tractors and providing for their families again... We may be operating on one patient, but our work impacts the lives of many others..........

Today we completed our final full day of operations. Tomorrow we have four operations to take place in each one of our four Operating Rooms.

However, at this point in time we would be remiss if we did not recognize one of the most important groups in Operation Walk Boston. The nursing staff. In many ways they are the unsung heroes of our mission and do not get the recognition that they deserve. However, this is not the type of group to seek the Lime Light. Adjectives such as diligent, hard working, and irrespresible are more accurate in describing this group of peope. Consider the following. When operating at maximum capacity we will often have 50 to 60 surgeon hours completed per day. In order to adequately care for these patients our nursing staff will easily log 200 to 250 hours of nursing care. All in all this amounts to an incredible amount of work.

Today we completed our final four operations, all went succesfully. As demonstrated by the X Ray seen here the level of disease and deformity we are able to treat is extremely severe. We are fortunate to have such skilled surgeons to correct these deformities. However, once the operation is completed the real work begins, starting with the nurses in the PACU and continuing to the ward. While on the ward patients are receiving vigorous Physical Therapy from a great team of therapists from as close as New England Baptist and Brigham and Womens and as far away as Kansas City and New Hampshire. Patients start receiving treatments at 7 am and it continues until 8 or 9 each night. Ensuring that the patients are able to adequately mobilize and return to their normal activities as soon as possible is perhaps the most vital part of the mission. To their credit our patients meet this challenge head on with enthusiasm and grit. Our therapy team routinely remarks on what a pleasure it is to work with such motivated patients.

Our Mission is complete but it has just begun for Dr. Alcantra and his team of doctors, nurses and therapists in the Dominican Republic. In all we performed operations on 43 patients, performing 61 total joint arthroplasties in patients from 18 year to 82 years of age. We cannot give enough thanks to our Dominican medical colleagues. 55 post graduates and medical students helped us with everything from bringing Physical Therapy supplies to and from the cargo room to translating for us on rounds every day. They were a warm light to our mission. We will miss them dearly and wish them all well on their journeys forward.