Universal health insurance in the Dominican Republic does not cover expensive elective procedures like total joint replacements, and many people in the country cannot afford the cost of these procedures on their own. Over the past seven years, Operation Walk Boston has provided total joint replacements to nearly 300 residents of the Dominican Republic with advanced hip or knee arthritis and limited financial needs. During this time, the Boston chapter of Operation Walk, founded by Brigham and Women’s Hospital (BWH) Chief of Orthopaedic Surgery Thomas S. Thornhill, MD, has evolved to include outcomes research which has enhanced all aspects of the program.
In 2009, Operation Walk Boston and Hospital General de la Plaza de la Salud (HGPS) in Santo Domingo initiated a first of-its-kind research program, led by Jeffrey N. Katz, MD, MSc, Director of the BWH Orthopaedic and Arthritis Center for Outcomes Research. As part of this initiative, standardized preoperative questionnaires are collected each year from patients scheduled for total joint replacement. All patients undergo unilateral or bilateral hip or knee replacement and remain in the hospital between two and four days. They also attend outpatient physical therapy for two weeks after surgery and are prescribed physical therapy regimens to complete in their homes.
These patients are then invited to return the following year for a postoperative evaluation. To date, more than 95 percent of patients have completed the baseline survey, which includes pain and functional status scales of the Western Ontario and MacMaster Universities Arthritis Index (WOMAC) and the physical function scale of the Short Form Health Survey.
Pre- and post-operative data entered into a relational database at the Orthopaedic & Arthritis Center for Outcomes Research has yielded significant findings, including:
“Our program has demonstrated that clinical research as part of global medical relief organization missions can afford insights into the quality and outcomes of sophisticated procedures in resource-poor countries,” said Dr. Katz.
Operation Walk Boston’s annual missions are supported by a large group of volunteers from BWH and other Boston-area hospitals, including surgeons, anesthesiologists, medical physicians, nurses, physician assistants, physical therapists, and additional operating room personnel. The Boston team is led by Dr. Thornhill and Operation Walk Boston Chief Operating Officer Roya Ghazinouri, DPT, MS, of BWH. Traveling to Santo Domingo, the Boston team works alongside HGPS’ surgeons, medical students, nurses, anesthesiologists, and other medical staff, exchanging information and demonstrating clinical skills in many areas, including surgery, nursing, rehabilitation, and research. “Our missions have gone far beyond performing joint replacements,” said Dr. Thornhill. “We have formed a strong partnership with our colleagues in the Dominican Republic to help address their growing burden of joint disease through collaboration in medical education, surgical and rehabilitative training, and research, leading to improvements in care delivery and patient outcomes.”
Educational presentations by Operation Walk Boston volunteers also are provided to local medical students in the Dominican Republic on the management of arthritis and other musculoskeletal disorders. Examples include rheumatoid arthritis and the benefits of disease-modifying antirheumatic drugs (DMARDs), which are just beginning to appear in developing nations. The volume of total joint replacements at HGPS throughout the year also has increased five-fold since the start of Operation Walk Boston.
Conversely, Operation Walk Boston members have learned from their work in the Dominican Republic. They have observed, for example, that Dominicans have decreased need for pain medications and are more resilient in general than joint replacement patients in the United States. The Operation Walk Boston team also benefits from operating in a diverse team environment that is much different from an academic medical center.
“Operation Walk Boston really offers bidirectional benefits,” said Dr. Thornhill. “We have learned and gained from our experience as much as HGPS members have from their work with us.”
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