A 16-year-old girl with severe scoliosis traveled to the National Hospital of Sri Lanka for a chance at a new life. An international volunteer medical team had arrived to perform complex spine surgeries alongside a few of the local surgeons, while dozens more would participate virtually by live video. Two members of that visiting team were from Virginia Mason: Rajiv Sethi, MD, director, Neuroscience Institute, and Vijay Yanamadala, MD, complex spine fellow.
Many years of performing volunteer surgery to treat scoliosis, a spine deformity that affects 3 percent of the world’s population, have sent Dr. Sethi to Asia, the Middle East, Africa and South America. With the support of a team and donated spinal implants, spinal diseases brought on by tumors, infection and congenital deformities can be treated, restoring function and relieving crippling pain. For the young girl in Sri Lanka, a spinal curvature of 90 degrees would be made nearly straight again.
“Without our intervention this girl would progress to a 130 or 140 degree curve, have difficulty breathing, horrible pain and likely an early death,” says Dr. Sethi. “Now everything will improve, and it will be hard for anyone to tell she had scoliosis.”
Dr. Yanamadala had just begun his fellowship at Virginia Mason when he heard about the mission. Then came an invitation from Dr. Sethi: Would he like to join the team in Sri Lanka?
“It seemed like a great opportunity to see what surgery is like in that part of the world,” says Dr. Yanamadala. “I expected to do surgery and help some people, but I found it changed my entire perspective as a surgeon. I was struck by how we could accomplish everything we wanted with a fraction of the resources we have in the U.S.”
Dr. Yanamadala says a typical lumbar fusion surgery here might utilize four or more trays of equipment, whereas only one tray supplied everything the team needed in Sri Lanka. A conserving strategy must be applied, however, for the use of spinal implants. Each donated implant is just one piece of a “scaffolding” applied to strengthen and reshape the spine — a typical surgery could require 20 or more – at a cost of about $2,000 apiece. With the mission’s limited supply of implants, Dr. Sethi modified his approach, spacing them out to use fewer implants while maintaining a good surgical result.
Besides equipment, what the volunteer surgeons bring is more hands to carry out the complex surgeries, and the expertise to empower a small but dedicated group of surgeons. Dr. Sethi notes a senior surgeon in Sri Lanka may only take on three scoliosis cases a year, procedures that can last 12 hours or more, simply because there’s no one available to assist. “Doing surgery in these places is a personal challenge I don’t find anywhere else,” says Dr. Sethi. “I’ve operated in stifling heat, with bugs flying around, lights that go out and very limited equipment. It’s easy to complain about things at home until you see what they have to deal with. You come back with a much more positive outlook.”
On the last day of the mission, Dr. Yanamadala remembers checking on one of the team’s patients who had traveled many days to reach the hospital. A senior surgeon from Sri Lanka was there, and mentioned he would drive the patient home himself, since the ambulance service ran only once every three weeks.
“My time in Sri Lanka emphasized the humanitarian side of medicine, and the reasons I became a physician in the first place,” says Dr. Yanamadala. “Seeing all they accomplish with few resources makes you rethink what’s truly valuable for patients.”
A version of this article was originally published on Virginia Mason’s internal news site.