In March 2024, Jordan Tropf, MD, traveled to Moshi, Tanzania to teach at Kilimanjaro Christian Medical Center (KCMC). He was the recipient of an HVO Traveling Orthopaedic Surgery Fellowship. The fellowship provides funding to defray the costs for senior orthopaedic residents to volunteer at an active HVO orthopaedic project for a period of 2-4 weeks. Dr. Tropf shares his reflection on his visit.
I was initially referred to HVO by Dr. Spiegel, an orthopaedic surgeon I had the chance to work with on my rotation at the Children’s Hospital of Philadelphia. I was quickly put in contact with HVO project director Dr. Glen Crawford, whom I connected with and planned my travel dates to align with his. Dr. Crawford is a role model in so many ways. His contributions to KCMC (and across the world) are incredible. He and his wife supplied KCMC with many of the surgical sets, OR equipment (lights and fluoroscopy), and other resources that have helped train hundreds and treat thousands. It’s truly impossible to quantify the true magnitude of their contributions.
Our primary role during this trip was teaching. In the operating room, we would frequently talk through cases and then operate with the residents. We would review their plan, consider anticipated challenges, and draft revised plans. When scrubbed into cases, we were able to teach and coach during surgery, as well as demonstrate a few tricks and techniques when appropriate. On the wards, we listened to the patient presentations and were able to teach on the spot.
We had reserved academic time daily with the residents and medical students where we covered high yield topics. I think that the most worthwhile sessions were those where we practiced surgical procedures and instrumentation using actual sets from the operating room on “sawbones.,” or anatomic medical training bones that we use for practice. They are anatomically accurate, true life sized, engineered “bones” that have textures and properties of real bones. This allowed residents to get hands-on experience. It forced them to think about the finer details of the case and recognize any deficiencies while in a low-pressure learning environment. Overall, this was a fantastic opportunity with enormous potential to learn and teach.
The residents were fantastic to work with. They were extremely knowledgeable, enthusiastic, and welcoming. They are supportive of each other and care deeply about their patients. They were an absolute pleasure to work with and I think we all learned a lot. I felt that we were able to genuinely contribute to the residents’ education.
Perhaps the greatest educational impact is in the OR, where we were able to share some technical tips and tricks to make cases easier or solve specific problems. The residents, especially the more junior residents, really liked to discuss cases before the OR. We would draw pictures, watch videos, and review literature to plan for cases. They weren’t afraid to ask questions and they were very open to suggestions. Our outside perspective often proved useful in the operating room, and residents would often seek us out to scrub cases with them.
But importantly, especially for me, the learning went both ways at KCMC. The residents taught me how to use the SIGN nail, which they use frequently but that we don’t use in the United States (it’s an intramedullary nail that can be placed without intraoperative fluoroscopy). In Tanzania, there are barriers to care, differences in treatments, resource scarcity, and protocols that are very different from in the United States. This experience greatly enhanced my perspective. I am certain that my experiences at KCMC will help me better care for, interact with, and teach my patients, juniors, colleagues, peers, and support staff.
There are several residents who have become staff at KCMC who interacted with HVO volunteers during their training or in the recent past. Residents and staff would frequently reference techniques or cases that they did with recent volunteers. There’s no doubt that HVO volunteers have made a lasting impact at KCMC. It is obvious that past volunteers have enabled residents to confidently tackle cases considering their resources and learn for future cases. I also noticed that attending physicians appreciate the help from volunteers in managing complex or challenging cases.
It seems that techniques and knowledge from past volunteers are compounding to result in significant changes. Residents frequently brought up techniques that they learned from previous volunteers during surgeries and taught those things to junior residents. I think that education is one of the most effective ways to bring about the adoption of new technical or clinical protocols.
Two specific things come to mind that made me feel like we were making a difference in health care and health education at KCMC.
1. We had almost full resident attendance for our afternoon academic sessions. These sessions were tailored to the residents and often featured hands on practice with surgical sets on sawbones. These sessions were not mandatory, but consistently had outstanding attendance by residents of all levels, suggesting that they found these sessions worthwhile. The residents were eager to learn and participate, which made it an extraordinary learning experience for everyone.
2. I had two junior residents, on separate occasions, seek me out and ask me to scrub in the operating room with them. One told me, “I liked learning from you the other day.” Hearing that made the whole trip worth it. The learning that took place the previous day, specifically, involved reviewing his plan for a distal radius fracture, including the approach and fixation, and then executing his plan in the OR. It was a very challenging case, but we used a few tricks and by the end of the case it looked perfect.
HVO is an outstanding organization that I hope to continue to contribute to throughout my career. Thanks again to everyone who made this opportunity possible!
On this visit, Dr. Tropf worked with Dr. Johnson Mbise, a local resident who took part in training. Dr. Mbise provided his own perspective on the visit and the HVO project:
I have had the opportunity to work with HVO for all four years of my residency, from 2020 to 2024.
There have been a lot of benefits. For example, volunteers have taught us with updated lessons/lectures and advanced surgical techniques. They also bring very useful equipment to make the working environment more user friendly.
Personally, I feel that this HVO program has had an impact on stimulating our department to improve evidence-based practices and by encouraging junior doctors to have awareness of different fellowships.
The biggest things I have learned from volunteers has been about the various basics in preparing a patient for surgery in different cases—which specific implants to use, the best approaches, decision making, and patient care as whole.
Volunteers have had a long-term impact through the knowledge and equipment they brought to the department, and we wish to see more HVO visits to teach us. We hope for a chance to visit our colleagues abroad to see how modern practice is conducted there.
After finishing my residency, I am looking forward to using the useful skills I have learned from my teachers here, and, most importantly, I look forward to the chance of a scholarship for a possible fellowship.