On a steamy Sunday morning last April, Dr. Gerry Engh walked into a un-air-conditioned hospital room packed “wall-to-wall” with people. Many leaned on canes and handmade crutches or sat in wheelchairs. He recalls one man, Bernardo, whose legs were both bent in 50-degree angles, as if he were astride a horse. “Wow,” Engh thought, “That guy really needs our help.”
This April, Operation Walk Virginia will entail 40 medical professionals, 15 pallets of supplies and at least $150,000, most of it from individual donations. The staff and equipment will travel to Roberto Calderon Hospital in Managua, the capitol of Nicaragua, which is the second-poorest country in the western hemisphere. Before the full staff arrives at the end of April, an advance team will collect the supplies that have been cached under the protection of armed guards — everything from medicines like Tylenol and Percocet to bandages, prostheses, walkers, crutches, stockings, surgical power tools and 50-pound tourniquet machines — and make sure all is ready for the April 28 arrival of the rest of the staff: floor, O.R. and recovery nurses, scrub techs, anesthesiologists, physical therapists, sterile processing personnel and six joint replacement surgeons.
Then, on another Sunday morning, the team-members will meet their patients. For the 60 or so Nicaraguans who will be treated in the following week, Operation Walk Virginia is the only chance they may ever have to be free of the pain of advanced arthritis. They will have new knees and hips to replace bones that have been rubbing against one another for years.
JULIE WARNER, the clinical coordinator for Inova Mount Vernon’s Joint Replacement Center, has already traveled to Nicaragua twice and will go again in April. She describes how every storefront in Managua is protected by guards armed with submachine guns. Restaurants sit behind locked gates. The hospital windows lack screens. In the operating rooms, IV bags are often hung from nails in the wall. There is no sewage treatment in the capitol city, so used toilet paper goes in the trash. Toilet paper, is on the list of items to be shipped from America along with the medical supplies and surgical tools.
“It’s a gift for me to have been able to be a part of this,” Warner says. “This year it’s going to be more like coming home. I remember a lot of the people. They’re so happy to see you.”
There are six “Operation Walk” organizations in the United States and Canada that provide free joint replacement surgery in developing countries all over the world. Virginia’s is the newest. Last year, the team from Inova Mount Vernon Hospital traveled with a group from L.A. This year they will be going on their own for the first time. They hope to see about 60 patients, averaging 20 a day in a merry-go-round of 12 hour-sessions in three operating rooms. They will focus on knee replacements because knee prostheses are so expensive ($5,000 for the prosthesis and $20,000 for the surgery) that they are unavailable to all but the wealthiest Nicaraguans, who would fly to the United States anyway.
Although surgery is unavailable to most Nicaraguans, the need is there. “They lead a much harder life than pretty much anyone over here does,” Warner said. “Their physical conditions can and do deteriorate far more than ours do.” In the next few weeks, the surgical team will review almost 200 x-rays sent from Nicaragua. “Some of the x-rays are frightening,” Warner said.
UNLIKE IN AMERICAN HOSPITALS, where doctors explain the procedure and its risks, patients in Nicaragua have little idea what to expect. “Here come a lot of Americans that largely don’t speak Spanish and they’re entrusting us to fix them,” Engh said. Friends and family crowd the doors of the operating rooms, “waiting anxiously outside not even knowing exactly what we’re doing in there.”
Engh, who is a leader of the trip, described operating all day in “antiquated, tiny little operating rooms with marginal air-conditioning at best.” He said that in one day last year he had to replace his scrubs three times because he soaked them with sweat. Warner said she must force the nurses to drink water. Once last year she looked down at her shoes and thought she had spilled something on them. Then she realized she was hallucinating.
They came to help others, but doctor and nurse agreed that the experience changed the healers as well. “Once you go down there and you do it and you get this feeling, you obviously want to go there and do it again and again and again,” Engh said.
On Friday, when the doctors and staff gather to pose for photos and say goodbye, the patients insist on expressing their gratitude by the most profound method at their disposal: walking. Warner described having to force an 89-year-old-woman back into her room. Bernardo, the man whose legs had been curved like the pincers of a nut-cracker, propelled himself down a hallway until he nearly collapsed. He had to be carried the rest of the way in a plastic chair. The effort Warner says, was “the least he thought he could do to try to repay us: show as that we succeeded.”
BUT ENGH SAID the week of treating patients is the least challenging part of the endeavor. “There’s no problems staffing these trips. That’s the easy part. The hard part of this trip is paying for it.”
“We’re still fundraising. There’s still a need,” said Beverley Alexander, who uses her position at the Inova Foundation, the hospital chain’s charitable arm, to help raise money for Operation Walk Virginia. Inova Joint Replacement patients are the project’s most important donors. Alexander said they donate so generously because “they understand the life changing nature of the surgery.”
Community groups like the Mount Vernon Rotary Club and Messiah Lutheran Church are also helping financially. And Engh said he is hoping to get financing from even deeper pockets. “Our government has realized that the most important thing we can do to fight terrorism is good will. The good deeds that we can do in troubled areas around the world probably do more in our fight against terrorism than anything else.”
Warner returned to Nicaragua several weeks ago to inspect the hospital and meet with government officials. On a free afternoon, she and a colleague hired a car to visit Tipi Tapa, Bernardo’s home village, which lies in the hills outside Managua down a road whose surface she compared to a riverbed. After asking many passersby how to find Bernardo, Warner eventually spotted him in his front yard. He happily introduced the nurses to his wife and told them he was not only walking without assistance, he was trying to take her dancing.
“It’s such an opportunity,” Warner said. “You go into this profession to do good. It was beyond my expectations of ever having the opportunity to do that much good. And I consider myself lucky, very lucky, to be a part of it.”
“It’s the fulfillment of why you’re a doctor,” said Engh, “no remuneration and no reward other than the reward of seeing someone relieved from pain.”