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The Butterfly Foundation is a nonprofit organization focused on teaching spinal deformity surgery in developing countries. The primary site has been the Dominican Republic, with similar projects annually in Chile, Jamaica, Malawi and Vietnam. The first trip to the Dominican Republic was in March 2003. The pattern for following trips includes and established deformity surgeon working alongside a local surgeon as well as didactic lectures and saw-bone workshops. Missions are done on a quarterly basis (over 20 to date) and last one week. Teams consist of academic spinal deformity surgeons, anesthesiologists, nurses, OR techs, perfusionists and neurophysiologists. Local "fellows" have been selected at each site for focused training. More than 350 patients with severe spinal deformities have been treated.

The Butterfly Foundation was founded by Geraldine Collado and Dr. Andrew Moulton (Medical Director). Carmen Barthalomew serves as the Administrative Director and may be contacted at Carmen@maizeblue.com.

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Cali is a beautiful city nestled in the Andes Mountains, just north of the equator. Our hospital, Fundacion Valle del Lili, is the most modern hospital in Colombia, and on par with the finest hospitals in the United States. The SRS Global Outreach Trip to Cali began in October 2001 - pioneered by Drs. Steve Mardjetko and Mike O’Brien. The current team, led by Drs. Anthony Rinella and Matt Geck, return every May and November.

The Colombian trip is sponsored by SpineHope in the United States, and Fundacion Casa de Colombia in Colombia. Local surgeons Juan Uribe and Mario Gonazlez participated in every trip since its beginning. Their dedication makes this mission possible.

During our 1-week mission, the team evaluates 50-60 children with complex spinal deformities, and performs 10-15 procedures. The team stays in the hospital free of charge. No vaccinations or visas are necessary.

For more information please contact Anthony Rinella, MD or visit the SpineHope web site.

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Mission Reports November 2-16, 2007 (PDF) April 28-May 13, 2007 (DOC) April 20-24, 2008 (DOC) June 8-22, 2008 (DOC) November 17-29, 2008 (DOC) November 16-December 5, 2009 (PDF) May 16-30, 2010 (PDF) November 7-December 2, 2011 (PDF)

FOCOS trips originated in 1997 and we are entering our 13th year with two trips a year to Ghana and two or three trips a year to Barbados. FOCOS mentoring surgeons are Oheneba Boachie-Adjei, M.D., Michael Mendelow, M.D., Munish Gupta, M.D. FOCOS operates in two countries, Barbados and Ghana. In Ghana, we are working in collaboration with the Ghana Medical School and the Ghana College of Physicians and Surgeons. Sponsoring hospitals are the Korle Bu Teaching Hospital in Accra, Ghana and Queen Elizabeth Hospital in Barbados.

FOCOS-Barbados Program is very active. We completed about 35 cases and trained a young Barbados surgeon at the Hospital for Special Surgery for three-months. Dr. Randy Carrington is now leading the spine team and doing simple cases with occasional intervention by the FOCOS group in the USA.

We opened the FOCOS Clinic in May 2004 and doctors in Ghana have seen over 1,000 spine cases. We have seen and treated CP, Marfans Syndrome, idiopathic scoliosis (adult and adolescent) hyperkyphosis from congenital deformities, post traumatic, infantile scoliosis, neuromuscular scoliosis, Morquio's Syndrome, Myelomenigocele , TB kyphosis and traumatic deformities. To date over 150 patients have been treated surgically in both Barbados and Ghana. We have presented our data to the SRS meetings in the past and will continue to collect data. We have a very well established active FOCOS database.

We have a very active website which is www.orthofocos.org. If you are interested in joining a trip or making a donation to our program please email me at boachie@orthofocos.org or orearw@hss.edu.

FOCOS is willing to bring much needed care to patients in underdeveloped nations as well as educational activities and programs to surgeons who are seeking such knowledge.

Please see the links below for more information about FOCOS and an application.

• Frequently Asked Questions (PDF)
• Info Sheet (PDF)
• Application Form (PDF)
• Travel Checklist (PDF)
  
  
   

FOCOS Orthopedic Hospital

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Indonesia is equatorial and extends over three and half time zones and includes eight principle islands and is home to the fourth largest population, 250 million. The country has a democratic government. The geography includes many volcanic mountains, a warm climate, and varied agriculture of forests and tea plantations. The Dutch East India Shipping Company referred to these islands as the Spice Islands.

Java is the most populated island and Jakarta is the capital city which operates at many levels from highly educated wealthy with first class hospitals to a large struggling population who receive medical care via government hospitals. The University of Indonesia has a large Department of Orthopedics and manages with eighty residents who intentionally hail from outside of Java. The residents have generally done two years of general practice in their home area.

My first medical exchange occurred in 1995 when I met with Dr. Subroto, who was the Senior Mentor for spine surgery and a powerful political and academic surgeon. Dr. Subroto passed away in 2011 at which time Dr. Ifran assumed his position. Dr. Ifran and Dr. Sanjaya did advanced training in Albany, New York, USA and in Seattle, Washington, USA.

In this past year we have envisioned a more formal format of exchange. Although my visits with fellows and residents have been shorter, Dr. Ifran and I have constructed an exchange which would include housing, and support for three weeks in exchange for teaching and surgery in Jakarta. We then suggest a week on Bali where a house is available by Dr. Sanjaya. One would then return to Jakarta to see patients before returning home. The international transportation would be the responsibility of the surgeon.

This exchange, which might be named “The Subroto Exchange,” includes different orthopedic disciplines including foot and ankle, sports, oncology, trauma, joint replacement and spine.

Suggested schedule for spine trips: April and November.

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Complex Spinal Deformity Correction in Port-of-Spain, Trinidad
A Global Outreach Program from SRS and FOCOS

Vincent Arlet, MD
UVA Health System, Department of Orthopaedic Surgery, Division of Spine Surgery

David Toby, MD
Princess Elizabeth Centre for Physically Handicapped Children, Trinidad, West Indies

Background
Dr. David Toby provides expert orthopaedic care to patients in Trinidad and Tobago, with a population of 1.3 million. He operates an average of 50 spinal deformities every year at the Princess Elizabeth Center. I have been fortunate to know Dr Toby and help him doing surgery on complex cases requiring 2 spine surgeons.

Historical Perspective
In 2006 I approached Dr Boachie to know if he would help me setup a new chapter in Trinidad. Dr Boachie whose FOCOS outreach programs already included Ghana and Barbados was enthusiastic and helped me to organize such a new chapter in Trinidad.

Since that time the program has continuously expanded and has now 4 rotations a year.

Methods
Surgical theatre equipment upgrades were provided by funds from the Trinidad Health Department and private donors. These funds were used to add a Jackson table.

Spinal cord monitoring was provided by Impulse monitoring. Total intravenous anesthesia (TIVA) techniques were started under the leadership of Prof Pajewski from the University of Virginia.

Surgical Implants were generously donated by Synthes ( AOUSS deformity system) Additional equipment included intermittent pneumatic compression devices for thromboembolic prophylaxis, a cell saver machine, a Midas-Rex burr, a bone mill system, and modern surgical tool upgrades . . .

Old OR table	New Jackson Table	Dr. David Toby and his team in Trinidad.

Patients
Over the course of 3/4 Clinical Rotations a year, 35 complex spinal deformity cases have been operated. An example is shown below:

Pre-op	Intraop: Concave rib osteotomies	Post op

Results
The average pre-op Cobb angle has been 95 degrees corrected down to 50 degrees in average.

We had 6 complications: One superficial wound infection. One case of postoperative respiratory depression from narcotics that was reversed with Naloxone. One CSF leak that required a lumbar drain. Three loss of evoked potentials during the surgery all reversible with adequate steps. No patient had any post op neurologic deficit

Dr Toby and I would like to thank the SRS GOP, FOCOS, the staff from the Princess Elizabeth Hospital and the people from Trinidad and Tobago to help build up such an outreach program that helped us treat these complex spinal deformities.

• Mission Report - November 2010

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