Spinal (con)Fusion goes International!

Last month I travelled with my colleague and Physician Assistant Jack Bagley to Nepal where I was privileged to be a faculty member for the NZAUSA 2018 Conference on Spinal Deformity.  Several months prior I was introduced to Dr. Chet Sutterlin, a renowned orthopedic spine surgeon who runs a small non-profit called Spinal Health International (SHI).   Through SHI, Chet educates surgeons from developing countries on modern techniques in spinal surgery and NZAUSA 2018 was the most recent iteration of his educational efforts (NZAUSA stands for Nepal, New Zealand, Australia and USA where members of the faculty were from.)   As fellow climbers Chet and I were trading mountaineering stories when he mentioned his course in Nepal.  He’d barely gotten the invitation out of his mouth before I’d accepted! 

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Rather than just performing surgeries in-country via the traditional medical mission model, SHI is unique in its goal of educating the local surgeons so that they can become self-sufficient and build robust surgical programs at home.  It’s the old “teach a man how to fish…” idea.   I hesitate to use the word “educate”, though, because it implies some sort of knowledge gap between the Western surgeons and their Nepali counterparts.  In fact, I quickly learned that these surgeons are quite knowledgeable and skilled and that their only limitations stem from a lack of access to the technological resources we have in the U.S.    

I’ve never participated in an international medical education conference before and I approached my lectures as I would for a meeting back stateside.  Here I was, prepared to talk about advanced minimally-invasive (MIS) techniques such as Lateral ALIF (LALIF) or some of the innovative single-position lateral surgery we’re doing.  Man were these Nepali surgeons gonna be impressed!   As we moved through the Q&A sessions after the first few lectures, though, it was evident that these surgeons weren’t going to find my lectures applicable to their own practices at all!  This was a tremendous oversight on my part, as I didn’t really take the time to understand my audience.  Sure, these surgeons are well-trained, very knowledgable and appreciate the benefits of minimally-invasive single-position surgery in theory. The problem is that they can’t even get the basic retractors used to perform the techniques.  To think they’d be able to replicate these techniques, which are so technology-dependent (and thus very expensive), with the limited resources in Nepal was quite obtuse of me.  In the end I was able to tweak the messaging in my talks to focus more on the general themes rather than the technical nuances of these procedures and I think the talks were well received.  I could definitely tell that the Nepali surgeons are eager to learn more about MIS techniques so that they can start using these techniques in their own practices.  Maybe I’ll be invited back to Nepal for future courses!

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Dr. Thomas presents a lecture to Nepali surgeons on spinopelvic parameters at NZAUSA 2018.

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Jack Bagley, PA-C receives a traditional Nepali hat and scarf as a gift for participating as faculty in NZAUSA 2018. 

Ultimately I was left truly humbled by what the Nepali surgeons are able to accomplish with such limited resources and technology.  They’re routinely tackling complicated pathology such as Pott’s Disease (spinal manifestation of tuberculosis which is rampant in Nepal) and severe spinal deformity using very basic spinal instrumentation.  I was particularly humbled when I was asked to scrub in to a case of a severe thoracic spinal fracture.  I’m supposed to be the “expert” in the room but I looked like a fish out of water performing an open spinal procedure without even a fluoroscope to help place pedicle screws!  I was thoroughly impressed with my Nepali counterpart Dr. Bigyan Bhandari’s skill in navigating this complicated case with his assistant of questionable skill (yours truly) at his side.  Now that I’m back home doing cases in the US, with my advanced instrumentation, image guidance and neuromonitoring technology, I feel like I’m cheating!  Maybe it’s a good thing I’m a surgeon here and not in Nepal!

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Image on left shows severe T12/L1 fracture/dislocation in a young male who was left paralyzed after a motor vehicle collision.  Image on right shows Dr. Thomas and Dr. Bhandari performing an open reduction of the spinal fracture. The accident occurred in a remote part of western Nepal and it took the patient 2 days to get to Kathmandu. 

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The entrance to Grande International Hospital which celebrated its 5th anniversary this year.  This is a very modern private hospital with all of the facilities you’d see in a hospital in the U.S.  The image on the right is a view of Kathmandu taken from the helipad on the roof of Grande.  

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We did get out for some sightseeing!  Image on left is Jack Bagley looking down at Everest base camp on the helicopter flight out of the Khumbu Valley.  Image on right is me standing at Gorak Shep with Pumori in the background.  Mt. Everest would be to my left.  We’re at over 18k feet here and while it may not look like it I feel like I’m about to lose consciousness!

Thanks for reading!

J. Alex Thomas, M.D.

1 thought on “Spinal (con)Fusion goes International!

  1. I enjoyed your blog on your recent trip to Nepal.
    My family and I also have Chet to thank for a trip to Nepal in 2013 and our experience changed us all.
    Education and sharing our experiences are the key to solving many of the worlds inequalities …
    Thankyou for sharing

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