This is Alan Condon with the Becker's Healthcare
Podcast, and I'm delighted to to be joined
today by doctor Ravi Bashial, director of outpatient
hip and knee replacement surgery at Endeavor Health.
Ravi, a pleasure to have you back on
the podcast with us today. For any of
our listeners who might be as as acquainted
with you or Endeavor Health, can you take
a moment to give us a little bit
more insight into your role and your background?
Absolutely, Alan. A great pleasure to be on
and thank you
to the entire Becker's team and Scott Becker
for hosting us. You guys do a great
job with disseminating information, which is just really
critical.
As you mentioned, my name is Ravi Vishal.
I'm a hip and knee surgeon,
with Endeavor Health,
specializing in minimally invasive hip and knee replacement.
I run our outpatient program, here at Endeavor
Health, which is a large multi hospital, multi
specialty group in the Chicagoland area, performing an
extremely high volume of total joints as a
system,
as a whole.
Fantastic. Thank you so much for the brief
intro. So really important topic. A fascinating story
that I wanted to pick your brains on
today.
I know for many years, you've been making
a mission trip to Nepal with fellow Endeavor
Health team members.
Would love to dive a little bit more
into this story,
this initiative. First and foremost, could you tell
us a little bit about what inspired you
and the Endeavor Health team to partner with
Operation Walk for these missions in Nepal?
Yeah. Absolutely.
It's been this really interesting organic journey,
for both myself and many of the Endeavor,
team members, that I travel with.
Operation Walk Chicago is an organization
that was started by Victoria Brander and doctor
David Stahlberg,
to travel to initially sort of envision as
an opportunity to travel to parts of the
world that were less served and provide hip
and knee replacements
for free to those in need.
The mission to Nepal began about 15 years
ago,
prior to me joining Endeavor Health.
And they had just started to go to
Nepal
and had made an introduction at the Nepal
Orthopedic Hospital. I think they'd gone on an
introductory trip,
at which point, I became involved with the
organization
soon after I completed my training in 2011.
And it truly was an organic story. As
it turns out, my father is from Nepal.
He was born in Nepal in the 1930s
and immigrated to the United States in the
60s. And I was born here in the
U. S. In the late 70s. So, it
became sort of this serendipitous
meeting where we had myself, a Nepalese American,
being able to work
with the group that traveled to Nepal.
And over the past,
now 13 to 14 years, this has really
developed into an amazing
opportunity for us to interact. And it's changed
from
an opportunity to just go and perform hip
and knee replacements,
and then leave to really working with the
hospital and with the doctors in Nepal,
to train them to be experts in hip
and knee replacement. And we've now gotten to
a point where we are going on an
annual basis performing these charity hip and knee
replacements,
but have really gotten to the stage where
the doctors there are able to perform these
procedures for those who can afford it,
when we are not there. And when we
are there, we are really focused on the
charity side
side of the mission and being able to
provide these for free to those in need
who could otherwise
not afford it.
I mean, it's such an important mission. And
no doubt in terms of taking care of
some of these patients that needed care in
the orthopedic area, but also training that next
generation of Nephilim Providers as well.
Before we get to that, could you talk
just a little bit about the challenges that
you typically encounter when performing surgeries in a
setting like La Pal compared to your work
in the US? And how do you overcome
these challenges?
Yeah, absolutely. You know, I think anybody that's
ever played a sport understands,
what home court advantage is, where you're used
to,
playing in your own field, you're staying at
your own house and any time you transport
that there's challenges.
In Nepal
particularly,
there are some significant challenges when we've traveled.
The operating rooms are not
at the same sort of
level of technology that we have here.
We often are forced to
work through logistical issues. But at the end
of the day, our goal is to provide
the same high level of care that we
provide in the United States. So, we don't
do that by compromising on what we do.
We do that by identifying what the challenges
are and then making sure that we have
the infrastructure and support in place in order
to provide high quality joint replacement for those
in need. And that includes bringing over,
using state of the art technology in the
operating room. And through close partnerships with many
of our corporate donors, we're able to achieve
that. So, we don't really have to compromise
care, but instead are able to bring that
same level of care
to Nepal. But certainly, there's some things that
are out of our control. I've been in
the operating room when the power has gone
off and the hospital has a generator, but
if you're in the middle of a case,
you may not have any lights for a
minute or 2 while that kicks on. And
I can remember many occasions where we've operated
by the light of an iPhone,
kind of keeping going with the case while
we're waiting for the lights to come back
on. So certainly, these places present their own
unique challenges, but we do our very best
to overcome those and provide the same high
level of care that we provide to our
patients here in the United States.
Yeah. Yeah. I love that. I guess, sounds
like you really happen to be flexible, sometimes
maybe thinking on the fly while also not
sacrificing that that high quality care that you're
no doubt providing to those Napoli patients as
well.
Ravi, could you talk about obviously, there's 2
key components of this mission. It's balancing can
you talk a little bit about providing balancing
providing care for patients in need in Nepal,
while also training that next generation of Nepali
providers?
Yeah, absolutely.
And some of this, also goes back to
your prior question about challenges. So
if the disease that we see in Nepal
is often far different than what we see
in the United States,
one particular case comes to mind. I literally
just got back last night, so I hope
these are very fresh in my mind. But,
on this trip, I happened to have taken
care of a
young 24 year old female who had juvenile
rheumatoid arthritis. And by the time we saw
her, her left knee was essentially fused and
her right knee wasn't far behind.
And, certainly, juvenile rheumatoid arthritis exists in the
United States, but in most cases, patients
are able to be treated,
and certainly,
they most likely end up with needing some
sort of intervention later in life. But to
do a bilateral total knee on a patient
with knees that are essentially fused at age
24
is a unique disease state that we don't
really see frequently in the United States. And
even aside from that example, many of the
deformities that we see are so far advanced
because they have not been able to access
care. So, while we are doing the same
operation as we do here, we're often doing
them on much more complex patients. And that
translates into our training as well. And it's
important to remember that joint replacement doesn't live
in a vacuum. It's not just the surgeons
knowing how to do the surgery. It's the
entire spectrum of care. Anesthesia has to be
on board with the plan, physical therapy, the
nursing staff. And we've really been blessed with
a
large and diverse group of volunteers that has
helped us train
all of these various stakeholders
in joint arthroplasty. So, we've had leaders from
therapy, leaders from nursing, leaders from anesthesia join
us in order to be able to provide
these protocols
and best practices
in order to have these patients have the
best possible outcome. So again, it's not just
teaching the surgeons, but sort of setting up
a system
in the entire hospital. On our first trip,
there wasn't even really a proper post operative
unit set up for these patients, and we
had to work on that with the Nepalese
and our donors to build that. And the
best way I can put it is that
you need hardware and software. So, some of
these needs are intrinsically
material.
You need the implants, the beds,
the physical technology.
And that's half the battle. But the other
half is really the software, which is,
if we want to continue on that analogy,
downloading the protocols and the knowledge in order
to be able to use the hardware in
the appropriate manner. And, again, it extends beyond
just the surgeons to the therapists, the nurses,
and the anesthesia teams as well.
Yeah. It's fascinating work. And, again, hats off
to you and your team, also in partnership
with Operation WA Chicago. Like you said, Endeavour
Health, previously NorthShire have been involved with this
for many, many years,
as have you. Last question on this before
we wrap up, Ravi. I guess what do
you hope the younger medical professionals or the
next generation of surgeons take away from really
participating in these
important missions in the past?
Thanks, Alan. I think that's a really important
question. I think that when we look at
the value of doing these trips, the initial
reaction is to the patients we are helping,
which is
the initial reaction is to the patients we
are helping,
which is absolutely fundamental. We are changing the
lives of some of these folks. In the
United States, when we do hip or knee
replacement,
we take care of patients in need. My
patients are grateful, and I'm grateful to have
the pleasure of taking care of them.
But for the most part here with the
diseases states that we're seeing, we're changing their
lifestyle and their quality of life, them being
able to get back to the things that
they want to be able to do. In
Nepal, we are literally changing lives. And I
always make that
analogy. In the United States, hip and knee
replacement changes lifestyles,
but when we go to Nepal, it changes
lives. We take people who are unable to
sort of move forward physically or socially. I'll
use that 24 year old girl as an
example again. Her knees being fused prevented her
from walking normally, a very physical attribute, but
they also prevented her from being able to
move forward with her life. We actually took
care of another 20 something year old last
year who, because of her, juvenile rheumatoid arthritis,
wasn't able to go to school, wasn't able
to do the things that she wanted to
do within her family, and was socially a
little bit viewed differently.
By fixing her knees, we did see her
back for her 1 year follow-up. She's now
been able to go to school, move forward,
and and really has changed her whole life
aside from just the physical walking side of
things. So number 1 is our patients. Number
2, as you've alluded to, is training the
next generation. Nepal Orthopedic Hospital, where we've been
going consistently now for about 15 years,
now does more joint replacements than any other
single hospital in Nepal. And to us, that's
really meaningful. These folks are really able
to provide best in class care for their
patients. But the side that's often missed that
I often think is the most important
is how we change the volunteers that go
on this trip.
We often have a meeting with our volunteers,
before we go and I say to them,
as sad as it is, if you're born
the child of a shoeshiner on the streets
of Kathmandu, Nepal,
you're most likely going to die a shoeshiner
on the streets of Kathmandu. There's not a
lot of room for mobility and for change.
And for those folks,
they have a very difficult life. And while
we in the United States face our own
set of challenges, I think going on a
trip like this really gives people perspective. They
can see, how the other half lives and
people
or them not trying hard enough. It's sort
of the luck of where you're born. And
for
those of us that do live in the
United States of America or other developed nations,
we really have an advantage just by where
we were born. And I think with that
advantage
comes an obligation to give back. And I
think that's really what these volunteers learn, and
when they come back, they become agents for
change. I think they become better Americans,
for those that live here in the United
States. It really allows us to be more
compassionate,
more understanding, and more giving back to our
fellow
man
in terms of other people that are around
us. And I think it gives really a
unique perspective.
And I think that's really one of the
biggest benefits of a trip like this.
So Ravi, it sounds like you've trained the
surgeon, you and your team exceptionally well. Can
you give us a little bit more insight
into the barriers that they're looking to overcome,
in places like Nepal, which are a little
bit disadvantage
compared to what we might experience in the
US?
Yeah. Thanks, Alan. Yeah, I do think that
the surgeons, the therapists, and the nurses have
been trained very well.
The biggest barrier for marginalized populations is that
they cannot afford the cost of the implant.
So there is no nationalized insurance that will
pay for their implant or their surgery.
So, that's been the biggest barrier. However,
really pleased to announce that on this trip,
we were able to inaugurate,
the Pritzker, arthroplasty fund through the generosity,
of Tom and Margo Pritzker, who are Chicago
based. They provided a significant donation that is
going to be used to fund the cost
of the implant,
for disadvantaged and marginalized folks. So now, we
have
the software in place with the surgeons and
the team at the hospital, but now, we
have a resource by which to provide the
hardware, in this case,
the implants themselves,
even when we're not there and using donated
implants,
again, through this Pritzker arthroplasty fund that was
generously donated by Tom and Margo Pritzker.
Got it. And Ravi, such an important mission.
Thank you so much for taking the time
out of your busy schedule to educate us
on this. Is there any last notes or
final words that you'd like our audience to
know about this?
Yeah. You know, I'd really like to thank
the the groups that helped enable this. This
includes Operation Walk Chicago, obviously, which is the
group that I'm a board member on and
near and dear to my heart that organizes
this trip.
Tom and Margo Pritzker, who again provided the
arthroplasty fund that we're going to use for
implant use in marginalized
folks going forward. And I'd also like to
thank, Endeavor Health for providing a lot of
the human resource that went on this trip.
We had numerous members of our Endeavor Health
team, including 2 of my joint arthroplasty fellows
that are training with us, anesthesia and other
subspecialties that helped, really make this mission a
success. And I think it falls in line
with the credo of endeavor and what we
try to do in helping our patients here
every day. Being able to extend that
to marginalized populations overseas is very important as
well. And I'd also like to acknowledge Smith
and Nephew who provided all of our implants
at no charge to us, which is the
single biggest barrier in terms of cost. So,
Smith and Nephew provided all of the implants.
Neck Science provided all of the irrigation that
we use, the same high-tech irrigation that we
use in the United States. And I'd also
like to thank Heraeus
USA, which provided the same high quality palakos
cement that we use here. So, kind of
to my earlier point, through these generous donations,
we were able to use the same standard
of care equipment that we use here,
and again, would not have been able to
do it without these generous donations. We do
fund a lot of the travel and the
lodging. But without the donations of this equipment
and and implant, we would not have been
able to do it. So really want to
acknowledge those sponsors as well.
Absolutely. Thank you so much, Ravi, for taking
time to speak with us today. Very, very
important to wrap up. And again, big, big
thank you to Operation Walk Chicago,
yourself and the excellent providers and team members
that you work with at Andeavor Health with
this mission.
Thank you, Alan. It's been a great pleasure
and really the honor of my life to
be able to do this every year.