Naomi Shields
Naomi Shields
Orthopaedic Surgery · Wichita, KS

Orthopaedic Foot and Ankle

February 18th
San Jose, Costa Rica

Project Description

On my trip to Costa Rica I will train staff and residents at Caja Costarricense de Seguro Social in Foot and Ankle Orthopaedics. The hospital does not currently have a foot and ankle program.

I will treat both adults and children with foot and ankle problems and train the staff to be able to provide ongoing care. Medical mission trips should continue to help the population long term. Beyond the education I will provide onsite, I plan to keep in contact by email and phone to continue training after I leave.

I am currently between practices and using the time for several mission trips.

Trip Photos & Recap

I went to Costa Rica with Dr. Ruth Thomas (University of Little Rock) with whom I have done multiple mission trips. Dr. Fernando Contreras is the HVO coordinator and we had communicated with him prior to arrival. He sent a list of potential surgeries provided by Dr. Perez and Dr. Mora. We arrived Sunday, February 18, 2018 in San Jose, Costa Rica. Dr. Eduardo Perez and his daughter, Andrea, (who spoke good English) met us Monday morning and took us to a wonderful breakfast and we discussed the week. We then went to Hospital San Juan De Dios which is a government run hospital that was established in the 1800’s. It is sprawling, crowded and clean. As we walked through the maze of halls, it was obvious that Dr. Perez is well liked by the staff and patients! Dr. Perez had organized a clinic of foot and ankle patients. Dr. Perez has not done a foot and ankle fellowship but is very interested in foot and ankle and provides that service at the hospital. Dr. Carlos Ugalde is a 5th year Orthopaedic Surgery resident who is interested in Foot and Ankle and spoke great English. We were joined by Dr. Mora who has done a Foot and Ankle fellowship in Australia and is working at CENARE (Center National Rehabilitation) which is a smaller facility that does not do trauma. Patient history and imaging studies were presented and discussed. Then the patient (and spouse) came in for examination and stayed for the discussion. Some of the cases were very complex. I felt this session was one of the highlights of the trip as we had time to really discuss the examination, the imaging and the treatment options. As you know, getting a group of doctors to agree can be like herding cats! In the end, I feel a better treatment plan was purposed than what each individual physician would have done. I liked that the patient/spouse was included in the discussion and their concerns addressed. We spent more than one hour with one patient with a severe deformity. Patients were than selected for surgery during the week.

We spent 3 days at San Juan De Dios and 2 days at CENARE. CENARE is a newer small hospital specializing in rehabilitation. Dr. Mora has been there for 2 years and focused on Foot and Ankle. We saw clinic there as well with Drs. Mora, Perez, Ugalde and another resident. I really wanted to operate on a 10 year old girl with very flat feet. However, Dr. Mora explained that he could not “move her up” to the next day as he had to take the patients in the order in which they had been indicated for surgery. At CENARE, they are currently operating on elective orthopaedic cases seen in April 2016! For the foot and ankle service, the wait is 6 months as it is a new service.
Both hospitals had well equipped operating rooms and first world standards. We started quickly without anesthesia or nursing delays. The patient was asked which extremity was being operated on by the surgeon who then marked the leg with his initials. C-arm was available when needed.

Dr. Thomas and I felt this was a good trip and a good site with great local support. I have recommended to the AOFAS (American Orthopaedic Foot and Ankle Society) that these hospitals be considered for our outreach program. We already have at least 4 people who would like to go. Drs. Mora and Perez would be supportive of an annual or biannual foot and ankle week and felt they would have not problems finding patients and OR time. The educational aspect of this trip was great with all the intense discussion. We attended Friday morning lecture at CENARE given by Dr. Mora and while I do not speak Spanish, I could follow along. Dr. Mora is working to build a team approach for foot and ankle care at CENARE and is teaching the hospitalists, internal medicine, nursing and rehabilitation specialists on foot and ankle diagnosis, treatment, what should be referred to him and when. He has regular meetings with the hospitalists where they discuss various topics covering patient needs. He is a natural leader. I have encouraged him to apply for the AAOS international traveling fellowship award.