September 2014
9/16/2014 | BY Dr. John Grayhack
Interview with Dr. Richard Schwend
DR. GRAYHACK: Was there a point at which you made a conscious decision to become more involved in such projects?
DR. SCHWEND: It really started at the end of medical school. I had always enjoyed travelling and applied for a fellowship which allowed me to travel with my wife to Liberia for four months at the end of medical school. This proved to be a true “dose of reality” regarding the conditions and medical care for certain populations from under-resourced regions of the world.
DR. GRAYHACK: And how did this evolve?
DR. SCHWEND: At the conclusion of medical school I had a public health service obligation. I completed a pediatric residency and was assigned to the Zuni Indian Reservation in western New Mexico for two years. There I was the medical director of the hospital and clinic and was able to work with numerous dedicated public health professionals. I had always thought I might go into orthopaedics, and in this primary care setting I had to do a lot of the orthopaedic care and trauma, which stimulated me further. In addition, I understood the difference one could make in a setting such as this. We were the first US government hospital to put in a no smoking policy. There was a good deal of backlash, but it stuck. I really enjoyed the whole experience of being a doctor to a population and stayed on an extra year.
DR. GRAYHACK: Once you began orthopaedics, were there any opportunities through mentors who influenced this?
DR. SCHWEND: Quite definitely. Dr. John Hall was a tremendous mentor. He had travelled extensively earlier in his career to India and Africa, and told us his many stories of doing Harrington instrumentation for children in those settings. Dr. Peter Waters asked me as a fellow to accompany him to Romania after the fall of communism. Dr. Waters was so generous to pay my way, and we worked with an orphanage doing reconstructive hand surgery. I returned several times later when Dr. Waters could not go. Later, when I worked in practice with Dr. Bob Gillespie, he really encouraged me to travel, visit senior surgeons and continue this type of work. Once you get started, it’s very hard to say no, especially when you have such great mentors guiding and encouraging you.
DR. GRAYHACK: How did you develop the clinic in Ecuador?
DR. SCHWEND: In 2001 I was deployed to the Air Force as a reserve officer after 9/11. During this time I was asked to go to the Navy Hospital in Ecuador for a humanitarian mission to provide surgical care for Ecuadorian children who could not get orthopaedic surgery. Sister Annie Credido, a Catholic nun, was the local host of the trip. She has been devoting her entire life to the care of Ecuador people who are suffering from Hansen Disease. She was passionate about these children who could not get orthopaedic care, so worked with us to set up a program with the Roberto Gilbert Children’s Hospital in Guayaquil, Ecuador. It has continued to grow from there.
DR. GRAYHACK: What aspects of this sort of work surprised you?
DR. SCHWEND: Well first, the energy and enthusiasm of both the accompanying professionals and of the local medical care. For example, a physical therapist went with us on one trip to Romania, and then went back of her own accord, staying for one year to train the local physical therapists to improve our outcomes. In Ecuador, they had a strong need for orthotics and prosthetics. Our own orthotist and prosthetist from Kansas City accompanied us, greatly improving their outcomes by working with the local brace team, developing their skills and improving their materials.
DR. GRAYHACK: How did the medical side evolve?
DR. SCHWEND: You need to learn what works and what doesn’t. The staff in Ecuador wanted us to do spine surgery but didn’t have the support systems (blood banks, ICU, imaging, sterile processing.) We laid out a plan and they gradually improved in each of these areas over the next several years, to the point where we now can do spine surgeries and have appropriate support and outcomes. A key part of the program is that our sterile processing technician from the States has been with us on each trip to train their staff in proper sterile processing techniques. We have not had any infections since she has been involved. Two local orthopaedic surgeons have an interest and are developing the appropriate skills by working with us and visiting with our colleagues both in Central America and here.
DR. GRAYHACK: Tell us how POSNA was involved in Haiti during the period following the earthquake.
DR. SCHWEND: At that time I was on the COUR committee, with Dr. David Spiegel as Chair. A number of POSNA members responded immediately to the disaster in Haiti and were involved in many ways. Dr. Kaye Wilkins invited me to go with him to evaluate opportunities to train a Haitian orthopaedic surgeon in pediatric orthopaedics. I was amazed at the depth and breadth of the efforts for such an extensive disaster. The group there had truly learned to adapt to the environment and over time became more organized and could deliver care in a better fashion. One good outcome was that Dr. Francel Alexis, a Haitian orthopaedic resident decided to receive further training in Pediatric Orthopaedics, was the recipient of a POSNA COUR scholarship, and is now caring for children with a variety of musculoskeletal conditions in Port a Prince.
DR. GRAYHACK: If a resident or fellow has particular interest in this, how would one develop this more?
DR. SCHWEND: The members of POSNA have been very generous with their time and effort. There are any number of opportunities to accompany them as trainees. Their own attendings very likely have made similar trips. The POSNA COUR Committee can help them sort this out. In addition, we recently developed a stipend through the orthopaedic section at the American Academy of Pediatrics www.aap.org/sections/ortho through which a resident or fellow can apply for funds in such a setting. I would strongly encourage them to consider this. The deadline for submission of an application is November 1, 2014.
DR. GRAYHACK: How has this affected your personal and family life?
DR. SCHWEND: My family has been remarkably supportive and actually feels it greatly benefits them. My wife has accompanied me a few times, and always encourages me to go so that I “don’t disappoint the people.” My daughter accompanied me only after I insisted she become fluent in Spanish to help me. While she’s not going into medicine, this has proven to be a true motivation in her life. There’s no question that the rewards greatly outweigh my effort.
DR. GRAYHACK: Thank you for your contributions and your time today.