Thursday, January 2, 2020

Surgical notes #2—2001: Devoted doctors making a difference

Watching orthopedic surgery, Vilnius, Lithuania, 2001 (Photo by Robert A. Davis)

      I'm home and on the mend after my hip replacement Monday. But I'm giving myself a few days to get settled before I have to scrape together a coherent thought. In the meantime, I'm running some surgical stories from the past. I appreciate your indulgence.

     VILNIUS, Lithuania—The walls of the main operating room at the National University Children's Hospital here are covered with pale green bathroom tile—the same tile, it turns out, found in prisoners' showers in the old KGB prison not far away.
     The tile is old and cracked in places. Inside the walls, the heating pipes can't be regulated, so the operating room is warm, uncomfortably so. Sweating doctors flee from time to time to the coolness of the bleak corridors.
     A hot operating room isn't the only telltale sign you're not in an American hospital. Medical waste is tossed out with the trash. There is little disposable equipment. Food for patients is scooped out of chipped enamel pots trundled on a cart down the hall. The air in the operating room isn't filtered. Instead, the exhaust pipe from the anesthesia machine is merely jammed in a nearby air intake, and whatever is in the patient's lungs is pumped directly into the hospital's ventilation system.
     On the operating table is a 13-year-old Lithuanian girl. Her eyes are taped shut, and she has two red clips in her hair.
     She has a vertical talus—a congenital deformity of her left foot that would have been corrected when she was an infant if she had been born in the United States. But, living in Lithuania, the problem was never fixed, leaving her foot drawn back, toes tightly clenched, nearly touching her shin.
     She can't walk and can't wear a shoe on that foot. After the operation, she should be able to do both.
     The surgeon's hands move with balletic grace, manipulating bones this way and that. He inserts long pins to hold the bones in place and fuses useless joints into useful positions.
     Two hours into the operation, the question arises of how to close the incision because, with the patient's toes properly aligned, there isn't enough skin. The doctor attempts a new procedure—cutting skin from the lower leg, freeing it from the tissue beneath and letting it stretch more easily. The technique is so new it was only just described in the January Journal of Pediatric Orthopedic Surgery, in an article by a noted Chicago surgeon, Dr. John P. Lubicky, chief of staff at Shriners Hospitals for Children.
     Trying it might be reckless for the average doctor in Lithuania. But, in this case, the man holding the scalpel is Dr. John Lubicky.
     "He's the best surgeon I've ever worked with," says Dr. Greg Brebach, an orthopedic surgeon at Rush-Presbyterian-St. Luke's Medical Center.
      Brebach is one of a dozen doctors, residents and nurses Lubicky has brought to Lithuania on this, his 10th, visit as part of an extraordinary humanitarian effort that aims to do no less than help a nation's medical system leap 50 years into the future—or, more aptly, leap 50 years into the present.
     Lubicky made the first trip by himself, in 1993.
     "The Russians were still there, and they left their medical system," says Lubicky. "The hospital was dirty and smelly. Everything was broken and in bad shape. Every case was a failure, practically. There were lots of conditions we don't see here—poor neonatal care, lots of bone and joint infections in newborn and young children, and probably some effect from Chernobyl in terms of congenital defects."
     Norene Jamieson, the nurse manager of surgery at Shriners, is on her ninth trip with Lubicky. She remembers the first trip well. Jamieson brought lots of equipment, but not the special brushes and antibacterial soap used in the United States. She figured they would wash in whatever the Lithuanian manner was, not realizing just how backward the system was.
     "You had to scrub with lye soap for four minutes, then dip your arms in formic acid for three minutes," she says. "They sterilized the formic acid each morning by setting it on fire. My arms were all welted and blistered."
     Jamieson never left the antibacterial soap behind again. She organizes the yearly trips, in addition to her own trips to Colombia with a team of plastic surgeons. It is a major logistical challenge.
     "I solicit people all year long for donations for trips we sponsor," she says.
     This year, the team brought 39 cases of medical equipment, worth $300,000, and left it all behind for the Lithuanians to keep. Included was an $80,000 set of state-of-the-art Moss-Miami tools for spinal surgery.
     "A drop for American medicine," marveled Dr. Jurgita Januskyte, a Lithuanian surgeon. "But, for us, it's expensive."
     The American doctors and nurses flew in the previous Saturday, dropped their bags at the hotel, then went to the hospital. Before the week was out, they would examine 176 children and perform 19 surgeries. That might not seem like a lot, until you realize that the procedure to correct a scoliotic spine—one of the operations they performed—can take 12 hours.
      This is the last surgery of the week. The next day will be spent giving seminars on things such as how those new Moss-Miami tools should be used. Fifty doctors come from all parts of Lithuania to hear Lubicky speak.
     "We never thought our role was to come over here and do a lot of cases," says Lubicky. "Our role was to make them self-sufficient, and I believe that has happened, to a certain extent. They know what to do."
     Some of the Lithuanian doctors use their annual vacation to observe the Americans. They give credit to Lubicky—who last year was decorated by Lithuanian President Valdas Adamkus for his work here—for playing a key role.
     "Dr. Lubicky has changed children's orthopedic surgery in Lithuania," says Dr. Kastutus Saneukas, head of children's orthopedics at the hospital. "We get new techniques, new experience, news, the latest books, journals, education. He changes minds every time he comes."
     The medical personnel on Lubicky's team also speak of the experience in glowing, reverent terms, particularly the residents. "This is what we went to medical school for," says Brebach, who is on his first trip.
     "It gives them an idea how orthopedics are practiced in another country," says Jamieson. "It also opens their eyes to the needs of people in other countries. Maybe when they're finished with their residency and out on their own, they will devote time to helping in other countries. There's a tremendous need."

      —Originally published in the Sun-Times, March 20, 2001


  1. Glad you're back home. Hope you'll feel better than new.

  2. Excellent choice to rerun this piece, a contrast to the medical care available to us. That we have pros willing to share it around the world does our country proud while the pols who would deny basic health care to American citizens is a national shame recognized by civilized countries around the globe.

    1. I wonder if the enviable standard of care in the US stems from the capitalist risk/reward system.

    2. No doubt the our system's production of so many high achievers includes health care, but parcelling it out as a reward to only other high achievers is the flaw.

  3. What great humanitarians. This is exactly why I never wanted to get sick or hospitalized in another country! My son was hospitalized in Mexico back in the late 90s and doctors would not release him until he paid cash. Not having enough cash on hand, his wife called me to wire the money directly to the hospital. I asked what room they were in and she said room 2. I learned the hospital had but 3 rooms! My son and daughter-in-law were anxious to come home — my son needed to be transferred to a hospital here in the states. It couldn’t happen soon enough for him. He said there were no disposable needles and he didn’t think the needles being used were properly sterilized! Oy vey!

  4. I hope you are feeling better and stronger by the day, Neil, and off the pain meds sooner than later. When it eventually comes to PT, embrace it. I can say, from personal experience, it really does help speed recovery.

  5. Count your blessings, they say. It's often eye-opening to see how much better we have it here in the US of A than elsewhere. Lithuania, Ireland, Poland, Mexico, even Russia, even Iran, they all have their charms, but can't compare to what we have here, despite all our troubles.

    And it's heartwarming to hear of people dedicated to healing of one sort or another sharing their time and expertise without seeking compensation or applause. We of little skill and resources can do but little, but oft times we don't offer even that.



  6. No need to take care. You don't owe us anything.

  7. Hope all is well....I’m about to go through it, and am very apprehensive. Looking forward to your accounts. Tom S.


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