Health Volunteers Overseas

Health Volunteers Overseas

La Brigada de las Manos: Bringing Pediatric Hand Surgery Training to Nicaragua
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Dr. Michelle James and Dr. Jairo Rios with a young patient.
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Health Volunteers Overseas

HVO volunteer and hand surgeon Dr. Michelle James made seventeen trips to Nicaragua in only ten years, heading a team that included occupational therapists, hand therapists, other physicians, and residents. On each trip, Dr. James worked with Dr. Jairo Rios, who was interested in training to be the country’s first pediatric hand surgeon.

Dr. Rios began medical school at only fifteen years old and always wanted to be a surgeon. He decided to pursue a residency in orthopaedics and trauma, which he completed in 2008. In 2009, he met Dr. James and her team and began training with them to become Nicaragua’s only pediatric hand surgeon. Dr. Rios and Dr. James’ team, nicknamed La Brigada de las Manos, organized a clinic on each of their trips where they saw approximately 100 patients and operated on twenty to thirty patients with various congenital differences.

Dr. Rios now has fourteen years of experience working in pediatric orthopaedics and thirteen years of experience with congenital hand surgery. He says, “I am very happy now to be able to help so many children thanks to the collaboration and training of all my volunteer friends from HVO.”
In 2017, he, Dr. James, and two other colleagues published a paper entitled “Pediatric Hand Surgery Training in Nicaragua: A Sustainable Model of Surgical Education in a Resource-Poor Environment.” In the paper, they describe their experiences implementing their pediatric hand surgery training program. They discuss their collaborative efforts, the differences in training between Nicaragua and the U.S., and look at their results and ways further efforts might be improved. A second paper, “Assessment of Health Needs in Children with Congenital Upper Limb Differences in Nicaragua: Community Case Study,” which they also published in 2017 with two other colleagues, presents their findings on the needs of pediatric patients with congenital upper limb differences at La Mascota Hospital in the hopes that this research will inform possible new programs and pathways to better care.

Dr. Rios is still the only congenital hand surgeon in all of Nicaragua. He therefore has a very busy schedule and a long wait list. Due to continued political unrest in Nicaragua, HVO recently made the difficult decision to close all projects in the country for the safety of our volunteers. Dr. James made her last trip just three weeks before the start of the unrest. Dr. Rios, while understanding, is disappointed. “I wish with all my heart that help from all my friends from HVO would return and to be able to work together again for Nicaraguan children,” says Dr. Rios. “It would be a huge help to have more HVO volunteer collaboration to train more colleagues in pediatric hand surgery as all other hand surgeons in the country only operate on adults.”

While the project is currently closed, the relationships that came of it continue to thrive. Dr. James and colleague Dr. Marybeth Ezaki, a hand surgeon who accompanied La Brigada de las Manos on nine trips, are sponsoring Dr. Rios, to attend the World Congenital Hand Symposium in Minneapolis next year. HVO is hopeful that at some point in the future there will be an opportunity to re-establish programming in Nicaragua so that more pediatric hand surgeons can be trained to help Dr. Rios provide care to the young and vulnerable in Nicaragua.

Why HVO?

Text: Why HVO?
Text: Jon Kolkin, MD – HVO volunteer since 1998
Jon: Health Volunteers Overseas provided me with a lot of information about immigration concerns, how to get your visa, do and don’t within the country. So there was a lot of rich information that Health Volunteers Overseas provided. And they were also very good about getting on the phone with me even 20 years ago and I know now it’s even more of a well-oiled machine, so to speak.

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