2019 SLAOTI/POSNA TF - Exploring Orthopaedics in Curitiba, Days 1 and 2

Greetings from South America!  While we will share our first experiences as traveling fellows in short order, we wanted to introduce ourselves to you, the POSNA membership.  The three of us are honored to have been selected for the 2019 POSNA-SLAOTI traveling fellowship, and will have the opportunity to travel to Curitiba, Brazil, Buenos Aires & Cordoba, Argentina and Santiago, Chile.  Coleen Sabatini, MD MPH is an Associate Professor at the University of California San Francisco with an interest in global health, club foot and trauma.  Apurva Shah, MD MBA is an Assistant Professor at The Children's Hospital of Philadelphia with a focus on congenital hand and upper limb anomalies, brachial plexus birth injuries and upper limb trauma.  V. Salil Upasani, MD is an Associate Professor at Rady Children’s Hospital with expertise in hip preservation, spinal deformity and trauma.  After leaving our respective homes, we rendezvoused in Sao Paolo after international flights from Los Angeles and Miami and then continued on to our first Traveling Fellow site - Curitiba, Brazil. 
 
Day 1 – Curitiba, Brazil (10.25.19)
 
After arriving in Curitiba at around 1pm after a quick 1 hour flight from Sao Paolo.  After picking up our luggage we were greeted by Dr. Victor Hugo Mariano Ramos.  He gave us a quick tour of Curitiba and dropped us off at the beautiful Four Points Sheraton Hotel.  We checked in and got a few hours to settle in after our long travel.  Around 8pm, Dr. Jamil Soni (President-Elect of SLAOTI) picked us up at the hotel to treat us to our first dinner in Brazil.  We went to a delicious Italian restaurant named Barolo.  Interestingly this southern part of Brazil has more influence from Italian and German cultures than the rest of Brazil, and rivals the Portuguese influence.  At dinner, we met Dr. Weverley Valenza, Dr. Joao Caetano Munhoz Abdo and were joined again by Dr. Ramos.  There are two main orthopedic groups in Curitiba.  One group that works at the Hospital Pequeno Principe (The Little Prince Hospital) and the other that works primarily at Hospital do Trabalhador (Worker’s Hospital).  Both groups have amazing faculty that provide expert care to the children of Curitiba.  We enjoyed some amazing Malbec wine (Zuccardi) from Mendoza, Argentina and a family style dinner.  The best part was definitely the delicious payaya mousse with crème de casis and the banana with melted carmel and vanilla ice cream desserts.  By the end of dinner, we were ready to get back to the hotel and pass out.

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Day 2 – Curitiba, Brazil (10.26.19)
 
Bom Dia!  After sleeping for a few brief hours, we were picked up this morning by Dr. Luiz Antonio Munhoz de Cunha, the Chief of Orthopaedic Surgery at Hospital Pequeno Principe, the largest children’s hospital in Brazil. After an educational drive through the neighborhood, he took us to Hospital Pequeno Principe where we had a quick tour of the hospital which is a wonderful place for children that happened to be celebrating its 100th birthday today.

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We then went to the conference room where we were greeted by a very welcoming group of orthopaedic surgeons, fellows and residents from Hospital do Trabalhador and Hospital Pequeno Principe.  After some brief introductions, we then started our morning of talks and case discussions.  Between the three of us, we delivered 6 talks with Dr. Shah discussed both brachial plexus birth palsy and improving surgeon performance and efficiency in the operative room. Dr. Upasani covered Selective thoracic fusion for AIS and 3D assessment of acetabular morphology. Dr. Sabatini discussed management of chronic osteomyelitis in children as well as opportunities and challenges of working in resource limited environments.   Staff from both hospitals then presented cases for us to discuss collectively and through these cases, we addressed a breadth of topics including both acute and missed Monteggia fracture management, hip instability and dysplasia in Down Syndrome, comminuted distal femur fractures in children, juvenile scoliosis and Ewing’s sarcoma of the pubic ramus.  

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After a morning of dialogue and information exchange, our Saturday conference wrapped up in the early afternoon.  We then headed with the faculty out to a wonderful lunch at Jardins Grill – a Churrascaria in Curitiba close to the hospital.  Salil and Apurva partook in meat from numerous anatomic locations of the cow, as well as chicken hearts and multiple types of pork and lamb delicacy, while Coleen enjoyed the numerous salad and vegetable options available.   Caipirinhas were top of the list as we needed to enjoy the national drink of Brazil before too much more time passed.   The meal was excellent and the company of our gracious hosts was even better!  We were able to learn about Brazil, the life of orthopaedic surgeons in Curitiba, discussed various orthopaedic conditions and preferred management strategies, and even ventured into some discussions about politics in our respective countries.
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After lunch we rested at the hotel for a short time and then were treated to a tour of Curitiba by Dr. Ramos.  We first drove to the Museu Oscar Niemeyer – referred to more commonly as the “Eye Museum” because of its shape - designed by a famous architect named Oscar Neimeyer.   Mr. Niemeyer was a Rio-born architect who lived from 1907-2012 and was one of the key figures in the development of modern architecture. Besides admiring the beautiful architecture, we walked around the park surrounding the museum and had some cappuccinos. 
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We then visited the Igreja Ucraniana the “Ukrainian monument” which was a beautiful old church surrounded by a forest of Araucaria trees which is the state tree of Paraná. Curitiba is the capital of the state of Paraná. Dr. Ramos then dropped us back the hotel to get ready for our evening festivities.

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After another brief rest at the hotel, we again were picked up by Dr. Ramos (who is definitely part of our TF family now as he has been at every event and taken us all around the city, educating us on the beauty and history of Curitiba along the way) and we went, of all places, to a German restaurant where we met up with two of their current pediatric orthopaedic fellows.  We had a chance to learn more about the orthopaedic training process here in Brazil and to learn more about their lives and work schedules, both as faculty (Dr. Ramos) and as fellows/trainees. 
 
It was an amazing activity- and learning-packed day!  We were dropped again at our hotel, wished each other a much-needed excellent night’s sleep and parted ways looking forward to what is to come tomorrow.
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