experience of my traveling fellowship 1996–1997

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Traveling Fellowship Report Experience of My Traveling Fellowship 1996-1997 Ariadna Cifuentes, M.D. T he receipt of this fine fellowship was truly an honor for me. As a Latin American, from the country of Guatemala, the anticipation with which I received this opportunity was great, and I appreciate the confidence in which it was given. I would like to congratulate the AANA Board of Directors and the Board of Trustees of the journal Arthroscopy for their vision of developing a fellowship in an effort to dis- seminate much-needed advanced medical and techno- logical knowledge to physicians, and ultimately im- proving the quality of patient care in developing countries. While studying under the fellowship in San Fran- cisco, I assisted in multiple arthroscopic surgical pro- cedures, providing both preoperative and postoperative care, as well as the follow-up and evaluation of patient progress following the procedures. Additionally, I as- sisted in the provision of conservative care to patients who did not require, or were not candidates for surgical interventions. All direct patient care was done under the auspices and direction of Dr. Francois Antounian. Additionally, while in San Francisco I was able to attend a minimum of three continuing educational pro- gram offerings weekly, which was a great improve- ment over the monthly courses I am able to attend in Guatemala. During my time in San Francisco I developed a method of evaluating the efficacy of using allografts in anterior cruciate ligament reconstructive surgery, reviewing the literature, and using a compilation of available international scoring techniques, to interview and examine 75 patients who had received this proce- dure 24 to 84 months before the study. I prepared a From the Centro Universitario de Occidente, Universidad de San Carlos de Guatemala, Quetzaltenango, Guatemala. Address correspondence and reprint requests to Ariadna Ci- fuentes, M.D., Section GUA-334, 8424 N W 56th St, Miami, FL 33166, U.S.A. © 1997 by the Arthroscopy Association of North America 0749-8063/97/1306-172053.00/0 formal paper on this research that was presented at the Orthopaedic Grand Rounds of the San Francisco General, California Pacific Medical Center, and Mount Zion Hospitals, as well as at the Northern California Bone and Tissue Bank. Although Dr. Francois Antounian was my primary preceptor, I was able to consult with Drs. James Glick, Mount Sinai Hospital; Scott Dye, president of the San Francisco Knee Society; and Leslie Anderson, partner at Orthopaedic Surgery Associates; for additional in- sight into the scoring and evaluation of the program participants. I viewed first-hand the procedures and quality con- trol of the Northern California Bone and Tissue Bank implements in the processing of cadaver bone and tis- sue grafts that are used in various reconstructive sur- geries and witness the vast technological advances in quality control that have occurred in this field. As you are aware, there are cases in which a patient cannot use his or her own ligaments and must rely on cadaver grafts to achieve optimum results, as well as cases in which the use of allografts is preferred for a particular Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 13, No 6 (December), 1997: pp 737-738 737

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Page 1: Experience of my traveling fellowship 1996–1997

Traveling Fellowship Report

Experience of My Traveling Fellowship 1996-1997

A r i a d n a C i f u e n t e s , M . D .

T he receipt of this fine fellowship was truly an honor for me. As a Latin American, from the

country of Guatemala, the anticipation with which I received this opportunity was great, and I appreciate the confidence in which it was given. I would like to congratulate the AANA Board of Directors and the Board of Trustees of the journal A r t h r o s c o p y for their vision of developing a fellowship in an effort to dis- seminate much-needed advanced medical and techno- logical knowledge to physicians, and ultimately im- proving the quality of patient care in developing countries.

While studying under the fellowship in San Fran- cisco, I assisted in multiple arthroscopic surgical pro- cedures, providing both preoperative and postoperative care, as well as the follow-up and evaluation of patient progress following the procedures. Additionally, I as- sisted in the provision of conservative care to patients who did not require, or were not candidates for surgical interventions. All direct patient care was done under the auspices and direction of Dr. Francois Antounian.

Additionally, while in San Francisco I was able to attend a minimum of three continuing educational pro- gram offerings weekly, which was a great improve- ment over the monthly courses I am able to attend in Guatemala.

During my time in San Francisco I developed a method of evaluating the efficacy of using allografts in anterior cruciate ligament reconstructive surgery, reviewing the literature, and using a compilation of available international scoring techniques, to interview and examine 75 patients who had received this proce- dure 24 to 84 months before the study. I prepared a

From the Centro Universitario de Occidente, Universidad de San Carlos de Guatemala, Quetzaltenango, Guatemala.

Address correspondence and reprint requests to Ariadna Ci- fuentes, M.D., Section GUA-334, 8424 NW 56th St, Miami, FL 33166, U.S.A.

© 1997 by the Arthroscopy Association of North America 0749-8063/97/1306-172053.00/0

formal paper on this research that was presented at the Orthopaedic Grand Rounds of the San Francisco General, California Pacific Medical Center, and Mount Zion Hospitals, as well as at the Northern California Bone and Tissue Bank.

Although Dr. Francois Antounian was my primary preceptor, I was able to consult with Drs. James Glick, Mount Sinai Hospital; Scott Dye, president of the San Francisco Knee Society; and Leslie Anderson, partner at Orthopaedic Surgery Associates; for additional in- sight into the scoring and evaluation of the program participants.

I viewed first-hand the procedures and quality con- trol of the Northern California Bone and Tissue Bank implements in the processing of cadaver bone and tis- sue grafts that are used in various reconstructive sur- geries and witness the vast technological advances in quality control that have occurred in this field. As you are aware, there are cases in which a patient cannot use his or her own ligaments and must rely on cadaver grafts to achieve optimum results, as well as cases in which the use of allografts is preferred for a particular

Arthroscopy: The Journal o f Arthroscopic and Related Surgery, Vol 13, No 6 (December), 1997: pp 737-738 737

Page 2: Experience of my traveling fellowship 1996–1997

738 A. CIFUENTES

patient. In Guatemala, we do not, as of yet, have access to cadaver grafts, so I will be using autografts for this surgery, but the understanding of current technology is of utmost importance.

As you are aware, countries outside of the United States, Canada, and Europe generally do not have the state-of-the-art technology and resources that are used in industrialized countries so freely. For example, in Guatemala, orthopaedists may see only on the average 10 to 15 magnetic resonance image (MRI) examina- tions of knees each year, whereas in the United States, an orthopaedist may see upward of 15 a day. This is due in part to the lack of availability of MRI machines and the great cost of the examination for the patient. Yet, experience in the reading of MRIs and other tests proves invaluable in the quality of patient care given.

Nonetheless, much can be done for patients in devel- oping countries without the benefit of high-cost tests, because as any physician knows, the most important component in the diagnosing of a medical problem is the quality of the physical examination that is per- formed. Still, the opportunity to witness surgical and technological advances first hand, is necessary in order to recognize and strive for optimum care.

This fellowship requires the recipient to analyze and discern which techniques are truly scientifically based and worthy of emulation. There are many "advances" which may not truly be deemed advances in the end, but today shine with a false golden brilliance. The physician, of any nationality, must be able to decipher what interventions will have the potential to benefit the patient and apply this knowledge in the context and setting in which he or she works, with whatever modifications are necessary.

While studying in the United States, I experienced the compassion and concern for world-wide dissemina- tion of medical, surgical, and technological knowledge of many physicians. My supervising physician, Dr. Francois Antounian from the Orthopaedic Surgery As- sociates of California Pacific Campus Medical Center in San Francisco, was an excellent mentor for me dur- ing my year in the United States. He carefully helped me direct my plan of study, allowing a great range of experiences and educational opportunities to produce

a well-rounded program in my chosen area of advanced arthroscopic surgical techniques.

I had the additional blessing of receiving arthro- scopic equipment for use in Guatemala. This will af- ford poorer patients the possibility of modern arthro- scopic surgical techniques that cause fewer complications than the traditional open-knee proce- dures.

I return to my country with the great hope of im- parting the information that I have been privileged to receive with my fellow physicians and surgeons. Realistically, I know that the greatest audience I will influence with this new knowledge will be that of the medical students with whom I am entrusted at the Centro Universitario de Occidente, Universidad de San Carlos de Guatemala, branch located in Quetzalte- nango, Guatemala. As well, I will be able to incorpo- rate these new skills in the treatment of both private and public patients whom I see in my practice. As the president of the Women's Medical Association in Quetzaltenango, Guatemala, I will also be able to help coordinate continuing educational offerings for the general medical community in the newer techniques in orthopaedics and arthroscopy.

I am aware of, and thankful for, God's blessings in the receipt of emotional support given by many friends and other concerned people, including Ms. Anne Stew- art, the managing editor of Arthroscopy: The Journal of Arthroscopic and Related Surgery. From our first contact through Fax, our personal meeting at the Acad- emy of Orthopaedic Surgeons, and consultation by telephone, she has demonstrated a consistent attitude of concern for my well-being and success.

I would like to wish future recipients of this fellow- ship much success in their endeavors. I hope they will be able to enjoy this experience as much as I have this year, and gain further medical and surgical expertise in order to share with their colleagues, and thus improve patient care in their respective countries. This, in fact, is the essence of the Hippocratic Oath, a promise to provide the best medical care available and share expe- rience and knowledge with others in our medical com- munities. Hopefully, this imparting of knowledge to the medical communities of the world will improve medical care, offer hope, and alleviate suffering.