Improving orthopedic care in Colombia, one step at a time

A team of orthopedic nurses pose in a hospital in Colombia.
Danielle (far left), Michelle (in Boston Children’s shirt) and I pose with the local nurses

Colombia is a beautiful country. On my first impression from the airplane, I was struck by how lush and green everything looks. People are warm and friendly, and quickly make you feel at home. For the past three years, I have had the opportunity to work at University Hospital in Neiva, Colombia with Healing the Children and the Boston Children’s Hospital Orthopedics Department as part of a surgical outreach program. My nursing work is also sponsored by Boston Children’s Global Nursing Fellowship.

Overwhelming needs

I think the greatest pleasure of working in Colombia is the families we meet. Their gratitude, faith and patience are amazing. But there is also an underlying seriousness and urgency. University Hospital is well run and well equipped, but can’t handle the needs of an entire state. Colombia signed a peace treaty in 2016 ending the longest-running civil war in Latin America. In addition to costing more than 200,000 lives, the war prevented the development of a health care infrastructure that could meet the needs of its population. So the most overwhelming thing we saw on that first day was an immeasurable amount of suffering from what were often very treatable conditions.

Meeting Heidi

And we saw brave kids like Heidi, who had already spent too much of their childhood without treatment. She was an 11-year-old with thick wavy hair, a wide grin and beautiful brown eyes. She looked like she should have been kicking a soccer ball around with her friends, but she could barely walk. Both of her feet were badly clubbed, so she walked on the outside of each foot, looking like she was about to fall with every step. And yet somehow she got around. It hurt to watch her, but she was smiling and laughing with her father. I wondered what growing up had been like for her, what school was like, if she still found a way to play with her friends.

A doctor teaches medical students how to do hip exams on babies in Colombia
Dr. Kristin Alves teaches medical students how to do hip exams on babies, while I translate

The next time I saw Heidi was in surgery. I watched the surgeon manipulate the bones and tendons of her deformed foot into a more normal position. Kristin, my partner on the night shift, and I met her after her surgery. She arrived on a stretcher, and we helped her into her bed. We didn’t have an extra pillow to elevate her foot, so we used one of her father’s bags. Her father looked tired but pleased to see her. That first night she was in quite a lot of pain, but bravely allowed us to give her a shot of pain medicine to help her sleep.

The ‘mayor of the room’

Heidi stayed another two nights, waiting for the swelling to go down on her foot enough to be casted. She was our longest-staying patient, and we were in no hurry for her to leave. The orthopedic room was home to eight patients and their parents, who slept on the floor under their child’s bed. Heidi’s father slept under the windowsill on an old shelf. During her stay, Heidi was the mayor of the room, introducing herself to new patients, always ready for us with a smile and a hello. Michelle and Danielle, the nurses who ran post op during the daytime, bought her a pair of crutches and by day two, Heidi was walking short distances. We also discovered that one of the crutches made a perfect foot elevator when placed across the bedrails. When I brought her a folded-up sheet to pad the crutch, she asked me if she could give it to her father instead.

Two nurses on the night shift in Colombia
Kristen and I work the night shift

One morning, I sat on the balcony next to the orthopedic room and watched the sunlight play games on the peaks and canyons of the Andes, Heidi’s father joined me. “My home is over there, over those mountains,” he said. I asked him how long it took to get to the hospital and he laughed and told me it was eight hours by bus. “Big mountains,” he said. I asked him what he did for work, and he proudly told me he cultivated coffee. He was a gentle and strong man, totally devoted to his daughter, but always willing to help us by moving a bed or lifting a patient.

A hope for next year

On the last day of surgeries, Heidi got her cast and her discharge. Michelle and Danielle gave her father a paper explaining how to care for the cast. He couldn’t read, but Heidi proudly recited it out loud. She left for the bus station in a borrowed wheelchair, accompanied by a well-earned bubble parade, flashing her beautiful smile and laughing. I thought about her often. I wondered how her journey home went, how her foot was healing and how she felt about the whole experience. I remember her bravery that was so far beyond her years. I thought about the unfairness of growing up without treatment for her club feet. Hopefully she will return next year to have her left foot repaired, and finally have the opportunity to walk and play normally, like all children should.

About our blogger: Michael Felber, RN, is a staff nurse on 10 Northwest (surgical programs) at Boston Children’s Hospital and is a 2017 – 2019 Global Nursing Fellow.

Learn more about our Global Health Program.