Tampa nonprofit can again perform hip, knee surgeries in Cuba

Tampa nonprofit can again perform hip, knee surgeries in Cuba
Updated: October 4, 2015 at 06:16 AM

TAMPA — The United States' five-decade-long policy of isolating Cuba was
meant to economically cripple its Communist government.

Instead, some in the medical profession say, it played a role in
crippling the bodies of some with debilitating hip and knee problems who
could have sought surgery considered common in the U.S.

For 20 years, Los Angeles-based nonprofit Operation Walk has sent
medical teams to developing countries to provide total hip and knee
replacement surgeries for free. Politics has made it impossible to help
Cubans since 2004.

Now, with relations improving between the former Cold War enemies,
Operation Walk will return to the island nation with a team of 70 U.S.
medical professionals Nov. 11 to 18 in hopes of performing as many as 50
surgeries.

Led by surgeon Kenneth Gustke, a founding member of the Florida
Orthopedic Institute, the Tampa group will also include his physician's
assistant, Susan Heinrichs, as well as nurse Shirley Supalena and
technician Oona Hastings from Tampa General Hospital — both part of his
regular surgical team.

"Some of these patients will not have arthritis like we see in the
U.S.," said Gustke, who has volunteered with Operation Walk since the
early 2000s. "Due to lack of treatment for so many years, some have
grossly deformed limbs and can barely get around even with a walker."

"The amount of gratitude you get from people who would otherwise have
zero access to this help is amazing."

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Operation Walk takes over an entire hospital ward in nations it visits —
in this case, the Centro de Investigaciones Médico Quirúrgicas in
Havana, also known as the CIMEQ Hospital.

All members of the U.S. team are volunteers — the surgeons, nurses,
physical therapists, anesthesiologists and every other medical
professional needed to treat the patients from check-in to check-out.

And they bring the prosthetic hips and knees as well as medical items
such as scrubs, drapes and IVs, all either directly donated by a U.S.
medical center or company or purchased through contributions to
Operation Walk.

Larger equipment such as anesthesia machines and surgery tables are
provided by the developing nation's hospital. Using these is the biggest
challenge, Gustke said.

"We bring as much as we can and do the best with what they give us," he
said. "Some of the equipment in Cuba will be 50 years or older. But it
all works, so we'll get it done."

Cuba was the first nation a new Operation Walk visited, in 1995. The
organization returned another six times over the next nine years

Gustke was part of Operation Walk's mission to Cuba in 2004 and looked
forward to future trips there.

But the following year, the State Department denied the nonprofit's
request to visit the island nation, said Operation Walk's medical
director Jeri Ward.

"Every year we'd ask again and be turned down," Ward said.

Then in January, President Barack Obama announced that Americans could
travel to Cuba as long as the trip fits under one of 12 categories that
include medical and health-related projects.

"We are happy we are going back," Ward said. "We are not a political
organization. We are not a business. We are just people who want to help
other people."

The Journal of Bone and Joint Surgery recently reported that more than 7
million Americans are benefiting from total hip and knee replacement
surgeries.

"It is probably the most successful surgical procedure we have in all of
medicine for a patient, in terms of pain relief and ability to get back
independence," said surgeon Gustke, who estimates he has performed at
least 10,000 such procedures in his 34-year career.

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Because they lack proper equipment, doctors at the CIMEQ Hospital cannot
adequately predict in advance of Operation Walk's arrival which patients
are candidates for the surgeries or what size prosthesis is needed,
Heinrichs said. So the nonprofit brings a bell curve of prostheses and
performs as many surgeries as possible.

"It is unfortunate that there will also be so many we cannot help," said
Heinrichs, the physician's assistant.

To ensure that others go home with some relief, physical therapists will
attempt to alleviate pain for some, and walkers will be given out while
supplies last.

"Even for that they are so grateful," Heinrichs said. "They just want
their independence back in any way."

Still, Cuba boasts of its accomplishments in the field of orthopedics.

This week, the city of Camaguey is hosting nearly 400 orthopedic
specialists from around the world — including the U.S. — at their 26th
meeting of the National Congress of the Cuban Society of Orthopedics and
Traumatology.

Cuban health professionals will be presenting their nation's latest
advances and most significant results in the treatment of bone pathologies.

And Cuba promotes its Frank Pais Orthopedic Hospital in Havana as
top-of-the-line.

"While the standard of orthopedic surgery is excellent, the Cubans are
often lacking in the most up-to-date surgical equipment," said John
Kirk, a professor of Latin American studies at Canada's Dalhousie
University and author of "Healthcare without Borders: Understanding
Cuban Medical Internationalism."

This dichotomy, Kirk said, stems from the embargo against Cuba, which
still keeps U.S. companies from selling certain medicines and equipment
to the Communist government, and a moribund economy that prevents Cuba
from making purchases.

Cuba has trained 40,000 health care professionals who are working
temporarily in 77 countries — most recently, helping treat Ebola
patients in West Africa.

The nation has vaccines for lung cancer and diabetic foot ulcers,
neither of which the U.S. has been able to develop.

Yet, something as simple as bandages and over-the-counter medicines are
in short supply.

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Katherine Hirschfeld, author and a professor of anthropology at the
University of Oklahoma, said during her visits to the island in the
1990s, she saw hospitals with no running water, pain relievers, sterile
gloves or even toilet paper.

"The reports I've read suggest that conditions today are not that
different from the ones I encountered while I was there," Hirschfeld said.

The Frank Pais Orthopedic Hospital is indeed an excellent center, she
said, but it is mostly for the elite. Most Cubans do not have access to it.

"Instead, they have to make do with substandard hospitals that may or
may not have enough medical resources to provide quality care,"
Hirschfeld said.

Helping these such patients, said Ward, the Operation Walk medical
director, is why her organization is needed.

Since it was founded by Lawrence Dorr of Los Angeles in 1995, Operation
Walk has led over 150 missions to 14 nations including El Salvador,
Guatemala, Nicaragua, Peru, Mexico, Vietnam and Tanzania and has
operated on over 7,500 patients, 250 of whom were in Cuba.

The patients pay nothing. Hospital charges for a hip replacement surgery
would total around $117,500 and $119,000 for a knee, according to
Operation Walk's website.

The services of the staff, not including physicians, would cost $115,320
for the work put in on a mission. And each physician's time equals
$300,000. The Cuba team will have eight of them.

Gustke said the team also pays its own and uses vacation days. But it is
all worth it.

He cited an Operation Walk mission to El Salvador a few years back as an
example of why.

One patient had knees, hips and spine fused together. With the help of a
walker, he hopped to get around because he could not take steps. Nor
could he sit.

"He was as stiff as a board," Gustke said.

Following knee and hip replacement surgery, the patient stared and
stared at his feet.

"It was the first time he'd seen them in 15 years," Gustke said. "We can
get people like that back to normal life. It feels good to help."

pguzzo@tampatrib.com

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