Surgeon Point of View: Dr. Sutterlin, Nepal
Can you tell us about your background and what drew you to volunteer in Nepal?
I’m an orthopedic spine surgeon, but in the Neurosurgery Department at the University of Florida, so I operate with both of the groups that do most of the spine surgery in the state. I retired at a relatively early age, back in 2000. I decided I would rather teach or operate for volunteer programs instead of putting up with the system that was developing here in the U.S. I also established a not-for-profit as a vehicle for philanthropy (Spinal Health International (SHI) at www.spinalhealthinternational.org). I’m also a mountain climber, not so much anymore but I used to a whole lot. In the seventies, I used to go to the Himalayas in Nepal with my friends who I’ve been climbing with since that time. Some of them would go to Everest and I’d tag along and go part way up the mountain but never really attempted to make it to the top. I did get pretty high, as far as casual hiking goes. While I’d go on these climbing trips, I’d also introduce myself to the local spine surgeons and ask if they needed any help. They were always very gracious and very interested in what I could teach them.
I’ve been living in Australia the past five years teaching and I just happened to be back in the US on Saturday, April 25, at my niece’s wedding. We were sitting there after the wedding ceremony, everybody’s eating cake and drinking wine and all of a sudden I started getting text messages about the earthquake in Nepal. I immediately started texting my surgeon friends (while still trying to act interested in the wedding) trying to find out how serious it was and whether they needed any help. My contacts in Kathmandu said, “Yeah we’re swamped and it would be great if you could come help. We’re also in desperate need of spinal implants across the country.”
I had just been to the Society of Lateral Access Surgery (SOLAS) meeting in San Diego, hanging around my NuVasive friends for a number of days, so it seemed like the path of least resistance on such short notice. I thought I would ask first if they could help. I talked to Pat Miles first, who referred me to Bryan Cornwall and then it was quite simple from there. The NuVasive Spine Foundation was very enthusiastic about helping. It was a pleasure partnering two like-minded organizations: SHI and NSF. Within a few days, I had purchased my tickets, started getting immunizations, and concurrently Bryan and NSF were working on gathering as much of what we needed as they could get their hands on.
What was your first impression of Nepal post-earthquake?
The first earthquake was on April 25 and I arrived on May 7. I’ve been in to the Kathmandu airport many times but when I arrived this time, two huge U.S. military transport planes were on the runway. They had unloaded a bunch of these big helicopters and Osprey. I know they’ve been reported to crash, but those Osprey are amazing. It’s incredible to watch them function. Anyway, it was just obvious that there was a huge International effort to help and not just American either. There were people from everywhere:China, India, the Middle East, Russia, etc. I met a disaster rescue team from Spain climbing around the rubble. Plus, the local people: kids and high school-age volunteers were pitching in to help. It was just amazing to see diverse individuals band together!
Was there any additional info when you landed about the size of this tragedy?
Well, as the weeks wore on, the death toll rose to over 8,000. You can usually count on two to three times that many injuries.
The hardest hit areas were in the remote villages, but the bigger cities get the most media coverage. Everest and the base camp captured the public’s attention just because it’s so exotic. Kathmandu is interesting. They really need to upgrade their building codes. A lot of things are made out of brick and masonry, and once you start shaking it, it just crumbles. The modern buildings, tourist hotels, and such did alright. Even then, some of the buildings have these huge heavy concrete slabs supported by, what looks like, pretty flimsy columns. The ones on the ground floor were the same size as the ones on the tenth floor. They would just pancake or topple over sideways.
What were the conditions like in the hospitals you were working in?
In the newer hospitals, we didn’t have any problems. The only fear was that there were cracks all up and down the walls and you’re wondering if the building is going down in the next earthquake. There’s always that thought in the back of your head.
In the end, after the second earthquake, they did shut down all of the operating rooms and they were operating out of a makeshift O.R. in the cafeteria, on the ground floor so that if anything happened they could all get out quickly. We lost electricity and couldn’t get blood so we ended up having cancel two of the surgeries we had scheduled.
What was going through your head when the second earthquake hit?
We had already done two surgeries. One cervical ACDF at Grande Hospital with Binod Bikukachhe, who is the first fellowship trained spine surgeon in Nepal, on Friday, May 8th and a T12-L1 fracture dislocation at Birh Hospital with Professor Giri. There weren’t any surgeries on that Tuesday, and I was having lunch with Ram Krishna, who is one of my primary contacts in Nepal. Ram does work filming for NBC and has produced his own videos about Nepal, as well. He’s an amazing organizer. Anytime I need anything done, I call him first.
We were eating in Thamil, which is the main hangout for mountain climbers, on the second floor of a restaurant called “Third Eye”. We’d ordered chicken chili and Gorkha beer. The beer came in these big bottles and the meal hadn’t come yet. All of a sudden everything started rattling. You’ve seen those paint machines at Home Depot? You put the paint in and it shakes the crap out of it? That’s what it kind of reminded me of.
At first, you just kind of look at each other, and then all of a sudden Ram yells, “Run!” I had put my cell phone, a brand new iPhone 6, on the table and I had a backpack with my passport in it. I grabbed my backpack and the Gorkha beer, but left my brand new iPhone on the table!
Ram was out like lightning. I couldn’t keep up with him. We go running outside and of course there’s these huge, tall brick buildings on each side of us, so we keep running to the courtyard where it’s a little bit safer. It’s absolutely the strangest feeling I’ve ever felt in my life. I’ve been sailing a lot and I’m used to adjusting my balance with the waves, but you can see those waves coming. When the waves are in the ground, you can’t see them but it’s worse because you don’t have a visual reference so it amplifies that wavey sensation of being on a boat. The first thing that happens is all the birds take off. They know right away that something’s wrong. There are all these birds making a racket and the palm trees and power lines are swaying back and forth. You could see all this stuff happening, it’s like being drunk almost, where you can’t quite keep your balance even if you’re trying. Everybody’s on their cell phones checking on their relatives, making sure they’re okay. Ram, being the ultimate gentleman, went back for my phone. I think he also figured out he could run faster than I could.
Everybody was trying to get out of Thamil because most of the buildings are old. The streets are crowded with a few cars, but gobs of motorcycles and lots of pedestrians. I was thinking, “God, we are going to end up in the hospital just by getting run over here.”
How do you choose who to operate on after such a traumatic event like this?
Far and away, the top priorities are open orthopedic injuries, like upper and lower extremities with open wounds. They get infected so you have to fix those fractures and get them cleaned up quickly; so those cases always go first. The other thing is blunt trauma. Things fall on people that crush their chests and bellies, so those have all these internal injuries and definitely take priority, as well. You almost never have an open wound to the spine. I really don’t participate in those surgeries.
The spine stuff is usually delayed. We go second, because the only indications for acute intervention in spine are an incomplete spinal cord injury, particularly one that is progressing. Then it becomes important, if you want to save neurologic function, to try and get in there and get the pressure off the spinal cord. That situation is actually quite rare. Patients are typically neurologically intact or already paralyzed. Spine cases tend to get canceled and delayed because there are other cases that come in that are more important. That situation doesn’t arrive very often in the U.S., but that’s the way it is when you have a massive disaster in an under-resourced country. We did operate on a women requiring an ACDF to take pressure off the spinal cord and the operation was a success. It was actually a great teaching case because I let the surgeon do the work and we reviewed the result afterwards.
What is the situation like now? Would it be more timely for spine surgeons now that things have somewhat settled down?
Yes. As the urban areas stabilize, injuries start coming in from the outlying villages. They are really hard to get to, as there are no roads. Everything is carried, either on the backs of porters or the backs of yaks. The cases from the outlying villages will start coming in now that the chaos has somewhat settled down.
There was a lot of media coverage during the time I was there. It identified our contributions but please don’t forget about the Nepalese; the need is still there. Thanks to the NSF for leaving behind the cervical implants and equipment. There should be sufficient quantity to take care of an additional 15 to 20 patients. I’m confident this will be put to good use based on the case we performed together.
Check out NBC’s coverage of Dr. Sutterlin’s mission here:
*NSF would like to thank Spinal Health International, Binod Bijukachhe, MD of Grande International Hospital and Professor Giri, of the Bir Hospital, for their partnership in this mission.