5 Tips to Begin Your Global Orthopaedic Outreach While in Residency 

1. Identify mentors and expand your network 
Begin within your own institution. Seek out attendings, fellows, and other residents who have participated in global orthopaedic outreach and ask them about their experiences. Most if not all will happily share their global health journey and connect you with others who have done likewise. In the event no one at your institution has participated in global orthopaedic outreach, don’t fret as you can be the first! POSNA’s Pediatric Orthopaedic Global Outreach (POGO) page is a great resource for finding faculty mentors. Likewise, conferences like POSNA’s IPOS® and Annual Meeting provide valuable opportunities to connect with others with global health experience. 

2. Join an established global orthopaedics site 
It is difficult to create a trip from scratch. It takes years to build rapport with locals, identify needs, assess what resources are available locally versus what must be brought in, etc. Instead, join an established global orthopaedics site where there is pre-existing infrastructure for identifying patients. Once you have formed relationships, continue to build on them by returning to the same site. Not only will you have more to contribute as your familiarity with the site and surgical competence develops, but it is enriching (and sometimes humbling) to see and learn from your personal follow-ups. 

3. Ensure there is longitudinal, local follow-up to address patients’ complications and chronic conditions 
To avoid medical voluntourism, it is vital for there to be robust follow up in place to monitor patients postoperatively if complications arise. Partner with one or more local surgeons to manage short-term complications until you or someone from your organization returns on the next trip. Furthermore, traveling to an austere environment and performing complex surgeries with high complication rates is not recommended. Focus on addressing basic needs (i.e. fracture care, congenital deformity, etc.) and prioritize optimizing patient function. Finally, remain mindful of what resources are available to your patients and organization when preoperative planning. The last thing you want is to leave a patient worse off than before because they lack the specific DME to protect your construct. 

4. Gain knowledge of local environment/cultural norms  
One of the biggest pitfalls encountered during global orthopaedic outreach is overlooking cultural norms and addressing patients in a paternalistic manner. Instead, research the location to which you are going using websites of organizations such as the US State Department or the local government. Try to learn some of the local language, especially if you plan to return to that site. Consider how cultural norms may affect the care you provide to patients. While on the trip, befriend local residents and support staff and learn from them. Likewise share your experiences and knowledge with them. If you feel comfortable doing so, stay in touch with the friends you make. It is easy to build lasting relationships in this day and age with the prevalence of social media. 

5. Share your experiences and learned knowledge with others. 
With your patient’s consent, take clinical photos and save x-rays on your trip. Compile a presentation of the cases with which you were involved. If you have the opportunity to give a grand rounds or a lecture to your residency program, do it. Otherwise, simply making the presentation is valuable as it allows you to reflect on your surgical indications and technique in different context from your norm. Finally, be a resource to others interested in global health. Perhaps one day, you will have the opportunity to help your future trainees start their own journeys in global orthopaedic outreach. 

Graham and Emily both traveled on separate occasions to Buga, Colombia with the Silver Service Children’s Foundation in partnership with Casa de Colombia. Do not hesitate to contact them about their experiences.