Global Health

Many of our faculty and residents pursue opportunities around the world that will provide an exceptional learning experience, using their specialized skills to help people who typically do not have reliable access to advanced medical care. We have been able to participate in providing high-quality care to communities in Nicaragua, Africa, India, and Turkey to name a few, and the list keeps growing!

Read more about how we are bringing the Michigan Difference to communities around the world:

La Romana, Dominican Republic - January 2018

"I was able to spend 1 week in La Romana, Dominican Republic with a group out of Kansas City led by Dr. Scott Beall. Dr. Beall graduated from University of Michigan Orthopedics in 1974, and he has invited current U of M orthopedic residents to join his trip for the last 7 years. The group consisted of 3 practicing orthopedic surgeons, C-RNAs, RNs, scrub techs, and more. There were a total of 32 people who came on the trip with the shared goal of treating the underserved population in La Romana. The vast majority of our patients were Haitian immigrants who worked in the sugar cane fields. We saw and operated on numerous infected nonunions, malunions, chronic dislocations, and more. It was an incredibly rewarding trip that re-ignited my interest in global health. Cannot express my gratitude to Dr. Beall for the invitation to join him and for the Department for supporting me. I will use this trip as motivation to get involved or establish a similar trip when I am a practicing orthopedic surgeon." Dr. Brandon Hood, Orthopaedic Resident

Ahmedabad, India - November 2017

Read what Dr. Rakesh Patel has to say about his time spent in India:

"In November 2017 I went to India as part of a US and UK team of spine surgeons to perform complex procedures in the pediatric population. The care was paid for by the Health and Care Foundation, formerly known as the Polio Foundation. We arrived on a Saturday and saw patients that were prescreened by a local spine surgeon. We booked the week’s cases from that clinic and began operating that afternoon.

The setting was rudimentary at best with equipment that you would never see in the states. Gowns were limited, imaging was nonexistent, blood was not readily available and neither were hemostatic agents. After surgery they were transferred to a local hospital for 24 hours for acute care and then back to the Health and Care Foundation. Overall the trip was a success and tremendously rewarding, impacting the lives of individuals who otherwise would live a life of pain and deformity."

Managua, Nicaragua - April 2014

Dr. K. Linnea Welton completed an off-site elective at the public hospital (Hospital Escuela Antonio Lenin Fonseca - HEALF) in Managua, Nicaragua. This hospital provides free(or nearly free) healthcare to Nicaraguan citizens and provides medical services for a large catchment area. Here is what she had to say about her trip:

Treatment of subacute fractures and chronic osteomyelitis were common cases that are not normally encountered to the same severity as at my home program. The management process of fractures, arthritis, sports-related ligamentous injuries were often done differently because of the severely limited resources, ability for patient follow-up, and surgeon knowledge. So while many of the orthopaedic disease processes I saw were fundamentally similar to those back home, the methods by which they could be managed were unique. HEALF is a 90 bed hospital and in addition to caring for the indigent and low-income population, receives referrals of difficult or complex cases from hospitals around the country outside of Managua. Common cases at HEALF are complex articular fractures, open long-bone fractures, and machete injuries to the hand. The wards are inhabited mostly by open fracture cases in various stages of treatment. Clinics occur on a daily basis and are predominantly resident driven. The Orthopaedic Department also has a designated room in the ED that sees patients on a continuous basis and is staffed by both residents and an attending during the day (and by a resident all night).

I found out about Health Volunteers Overseas (HVO) through one of the other residents in my program. She had done a rotation in Malawi and after reading through the HVO mission statement and values online I applied to become a volunteer in Central/South America. Upon approval to volunteer, I then applied for an HVO Orthopaedic Travelling Fellowship and a travelling fellowship through the UMHS Department of Orthopaedic Surgery. I received funding through both of these sources.

The best part of this experience was absolutely the challenge of learning how to treat orthopaedic patients with limited resources. I realized how the thought process for fracture management is completely dependent upon what is available and the type of environment we anticipate the patient returning to postoperatively.

The worst part of the experience was dealing with my own personal shortcomings (likely a mixture of perceived and true). Reflecting now, I anticipated that more of the medical staff would have some grasp of the English language than was actually the case. I was glad for the background in Spanish that I had and for taking the time to refresh my language knowledge both before and during my time abroad. However, if I had been more fluent I think my volunteer-work would have been even more fruitful for everyone involved.

I definitely would recommend volunteering with Health Volunteers Overseas to another resident and felt that I made a useful contribution to the orthopaedic residency program at HEALF.

Not only am I more appreciative, but I am more cognizant of the immense resources that we have at our disposal at the University of Michigan. The experience increased my drive to become the best orthopaedic surgeon that I can, not only for my patients, but also for my ability to one day pass along knowledge in the field.

Istanbul, Turkey - May 2014

Dr. Ozkan, Hand Surgeon and Dr. Elizabeth King, Resident

Dr. King spent 4 weeks in Istanbul University Hospital in their Hand Surgery Department. The hospital is located in Istanbul Turkey. It is a government university hospital treating adult and pediatric patients.

"The Hand Surgery Department treats a variety of conditions affecting the hand, including congenital, traumatic, infectious, and degenerative conditions. The best part of her experience was the opportunity to see a variety of congenital hand and brachial plexus palsy cases that she would not have had exposure to. She also enjoyed getting to know the Turkish residents, experiencing a different culture, and learning about a health care system different from our own. The worst part of her experience was the language barrier. Most doctors spoke English but had difficulty communicating well with patients. She would recommend this experience to other residents because it provided valuable opportunities to see cases that are not frequently encountered in Michigan, and the Turkish doctors were very warm and welcoming. Istanbul is a fascinating city, but the cultural differences can be overwhelming." Dr. Elizabeth King, Orthopaedic Resident

Malawi, Africa - March 2013

"In my third year of training I spent a month as the Orthopaedic Surgery Resident Traveling Fellow through Health Volunteers Overseas in Malawi, Africa. My trip was additionally supported by our departments Baril Award. Africa is home to about 11% of the world’s population, owns 24% of the global burden of disease, and is incredibly short of supply of providers with just 3% of health care workers. Malawi is a landlocked country surrounded by Mozambique, Tanzania, and Zambia. It is a former British colony and is a poor country reliant on agriculture and whose struggles are not limited to the effects of HIV/AIDs with a large orphaned population, famine, and economic instability. Of the 266 practicing physicians in the country, nine are orthopaedic surgeons. This roughly requires one surgeon to provide care for 1.8 million people versus 11,000 in the US. My home base was Queen Elizabeth Central Hospital in Blantyre, where in addition to training 2 Malawian Orthopaedic surgeons a year, is houses the Orthopaedic Clinic Officer (OCO) training program. OCO’s are medical technicians who are trained in basic orthopaedic care including some standard surgical procedures. They bridge the gap and in most hospitals and can provide care here independently.

My job was to teach residents and clinical officers and did many offsite visits to other district hospitals in Chickwawa, Tholyo, Mulanje, Zomba, Mwanza, and Machinga allowing me to get really good at driving on the “other” side of the road and see the spectrum of life in the southern region of the country from the flatlands to the plateaus and the enormous and beautiful Lake Malawi. I was a visiting primary consult at the district hospitals where I was the only orthopaedic surgeon in the building and helped to advise, assist, and relay information to the larger central hospitals. I also assisted in daily activities at Queens including surgical, clinical, and rounding activities. As a guest, I visited local private and children’s specialty hospitals. Patients presented with basic and neglected orthopaedic problems including trauma, oncologic issues, congenital deformities, and infections. The perspective I gained by teaching and learning the adaptive techniques of their local practice was invaluable and has affected my approach to patients and problem solving and seriously makes one consider what is necessary and efficient back home in the US. In the future I am considering doing an international fellowship after completion of my Pediatric Orthopaedic Fellowship and hope to incorporate a long term relationship to assist in teaching in a developing country throughout my career." Dr. Sarah Nossov, Orthopaedic Resident

Maharashtra, India - April 2012

In December of 2012, Nikhil Oak, a third year resident, had the opportunity to pursue an away elective in Orthopaedic Surgery at the Sancheti hospital in Pune, Maharashtra, India.

Pune is a rapidly growing metropolitan city in the state of Maharashtra, approximately 2 hours by car from Mumbai, India. It has a population of about 5.5 million and is the 8th largest city in India. It has a very heterogeneous population from a socioeconomic standpoint ranging from residents well-off economically to residents living in slums. The hospital where Dr. Oak rotated was called the Sancheti Institute for Orthopaedics and Rehabilitation located in central Pune. It is a 200-bed dedicated orthopaedic hospital, one of the largest in Southeast Asia. Marathi is the official language and is most spoken, while English is also understood. The attending surgeons there spoke Marathi and English, so communication was not a problem.

As a rotator Dr. Oak was taken in as a “fellow” and part of the orthopaedic training program there. They would all meet in the conference room at 630am and would take 15 minutes to meditate. Then from 645-730 there would be a case conference where patients scheduled for elective procedures for the day would be presented in front of the department. The patients would show up for this and it would be an interactive physical and history. After that they would go over the admitted traumas and they would break for breakfast before starting in the OR at 9am. Dr. Oak was mainly involved in trauma, pediatrics and joint replacement cases. This experience will definitely impact Dr. Oak’s long term career path. Dr. Oak plans to take part in medical missions and regular trips abroad during his practice in the future. Dr. Oak is very grateful to have been given the support from the Alumni/department to pursue this experience.