Long distance difference makers

Long Distance Difference Makers

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Scenic view from the Navajo nation.

Navajo Nation

In an area like metropolitan Washington, where so many services are readily available, it’s sometimes easy to overlook the scarcity of such resources as quality health care in other parts of the country, and of the world.

For decades, MedStar Orthopaedic Institute physicians have been among the thousands of medical professionals who seek to bridge these gaps through volunteer outreach efforts. They all strive to bring their knowledge to those for whom basic health care may be a luxury, and improve the quality of life for those patients, their families, and their communities.

Healing the hands of America’s first citizens

Michael Kessler 

To reach the U.S. Indian Health Service’s Chinle Comprehensive Health Care Facility in northeast Arizona, Michael W. Kessler, MD, MPH, FAOA, flies to Phoenix or Albuquerque, then drives up to five hours through countryside—both scenic and sparsely populated.

Dr. Kessler, chief of the Institute’s Division of Hand Surgery, is one of several orthopaedic surgeons who periodically visit Chinle’s hand clinic to treat members of the Navajo Nation.

“Another physician who volunteered at Navajo facilities suggested I look into it,” he says. “I’ve come out at least once a year since.”

Dr. Kessler’s four-day visits combine clinic examinations with surgical procedures for chronic conditions such as carpal tunnel, trigger finger, arthritis, and cysts. An on-site staff member at Chinle coordinates his work with those of other physicians—an overlapping chain of examinations, diagnoses, and, when needed, a treatment recommendation to be performed by the next surgeon who comes through. Occupational therapists in the area provide care between physicians’ visits.

Although the 60-bed hospital offers only basic facilities, Dr. Kessler says most of his patients prefer to seek care close to home. Navajo translators assist with patients who speak little or no English.

“Working here makes you use your diagnostic and testing skills differently,” Dr. Kessler says. “You have to rely more on the physical examination because CT scans and MRIs aren’t readily available.”

Awareness of patients’ own limited resources is also important. Dr. Kessler recalls suggesting ice for a patient’s sore hand. “'Where am I supposed to get ice,’ the patient asked. His house had no electricity.”

As chair of Indian Health Services for the American Society for Surgery of the Hand, Dr. Kessler hopes to encourage other physicians to share their skills at Chinle and other Native American health care facilities across the U.S.

“Reservation outreach doesn’t have quite the same cachet as international work,” he says, “but the needs are no less critical. And considering what Native American populations have experienced over the centuries, we owe it to them to bring quality care any way we can.”

Health Outreach Programs_Nigeria.jpeg

Nigeria, Africa

Creating a new foundation for specialty care


Born in Colorado and raised in Nigeria, orthopaedic surgeon Aham Onyike, MD, has experienced health care in both countries. The differences are stark. Lagos, Nigeria’s capital, is the largest city in Africa, yet access to specialty care is often limited. The deficiencies deepen in remote areas.

After completing his orthopaedic training in the United States he began to explore options to help in Nigeria. Dr. Onyike often performed the first-ever hip and knee replacement procedures in some Nigerian hospitals. As important as those trips were, however, the country’s demand for quality care was overwhelming—particularly, Dr. Onyike says, expanding orthopaedic surgical care services and longitudinal continuity of care.

He says, “We needed to build local expertise and find ways to support those physicians with modern equipment.”

Ahamefula OnyikeDr. Onyike worked with other Nigerian physicians to establish a clinical practice in Lagos in 2013 as a small office for routine care. It has since evolved into the Center for Advanced Specialty Surgery (CASS), a small orthopaedic specialty hospital with facilities for hip and knee replacements, surgery, sports medicine, and trauma care, as well as physical therapy and non-surgical services. CASS’s 15-person staff, which includes Nigerian-trained physicians, handles up to 200 patients a week.

“CASS has pushed the envelope in hip and knee surgeries, as well as corrective procedures for spinal and joint deformities,” Dr. Onyike says. “For sports medicine, we can do ‘bread-and-butter’ procedures” such as ACL, meniscus repairs, and some shoulder surgeries. In parallel with CASS is a foundation, Operation Stand-Walk-Run, established to continue charitable patient care, teaching and non-profit work.

CASS recently established a six-person parallel practice in Owerri, in Nigeria’s southeast region. Dr. Onyike and colleagues around the world regularly visit both locations to perform more complex surgeries and provide training.

Honored with a 2019 Humanitarian Award from Healthcare Corporation of America, and a 2021 Award from the Nigerian American Public Affairs Commision (NAPAC), Dr. Onyike says the missions of CASS and Operation Stand-Walk-Run are only beginning. Having teamed with a local physician to provide urology services at CASS, they are exploring strategies to expand the hospital’s reach by adding laparoscopic, colonoscopic, and endoscopic capabilities.

“At some point we anticipate expansion into a bigger space,” Dr. Onyike says.

“I want to see the programs be self-supporting and viable with or without me,” he says. “I don’t want to be a ‘glass-half-empty’ thinker, but it’s hard to ignore the tremendous need out there.”

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