NHA TRANG, Vietnam (May 21, 2018) - Cmdr. Katharina Pellegrin (right), currently assigned to USNS Mercy (T-AH-19), performs surgery on a patient's hand with local Vietnamese surgeons in support of Pacific Partnership 2018 (PP18). (U.S. Navy photo by Mass Communication Specialist 3rd Class Christopher A. Veloicaza)

A surgical point of view: Global Health Engagement during Pacific Partnership 2018

By Cmdr. Katharina Pellegrin

Editor’s note: Cmdr. Katharina Pellegrin is a Hand/Microvascular, Burn and Trauma Surgeon stationed at Naval Medical Center Portsmouth, and currently aboard hospital ship USNS Mercy (T-AH 19) for Pacific Partnership 2018 (PP18). She has deployed twice (Fallujah, Iraq 2006/07; Afghanistan 2011/12) where she garnered extensive wartime trauma experience.

USNS Mercy departed from San Diego in February of 2018 in support of the thirteenth Pacific Partnership mission.  More than 800 personnel traveled to Indonesia, Malaysia, Sri Lanka, Vietnam and Japan to strengthen relationships, enhance medical readiness, and advance theater security cooperation initiatives.

As a surgeon, every day I witnessed how surgical Subject Matter Expert Exchanges are critical to achieving the Pacific Partnership mission.  In particular, our Partner Nations (PN) were interested in surgical subspecialties.  Aboard USNS Mercy we had experts in: orthopedics, plastics, burns, hands, trauma, pediatrics, urology, ophthalmology, ear, nose and throat, oral and maxillofacial, advanced minimal invasive and robotics surgery, and surgical and gynecological oncology.

These surgical Subject Matter Experts worked cooperatively with partner nations via close surgical collaborations and exchanges, which enabled us to improve patient’s lives around the globe and achieving the PP18 mission of strengthening relationships and interoperability.

The surgical candidates for these collaborative exchanges were identified and prescreened months in advance of our arrival.  A final screening was done just after the ship pulled into pier, and surgeries were performed both at PN hospitals and aboard the ship.

Although the ultimate goal of such exchanges is to improve a partner nation’s surgical care capability and expertise, the learning and teaching experience truly goes both ways.  As an example, we were able to learn skills and techniques from our partners to successfully operate in resource-constrained environments.

An unprecedented highlight of PP18 was having the Da Vinci XI Robot Surgical System on board USNS Mercy.  U.S. and partner nation service members and Sri Lankan surgeons conducted the first-ever robot-assisted surgery aboard a maritime vessel on May 4. Our partners experienced firsthand the robot’s flexibility as it functioned as first assistants to the surgeon.

TRINCOMALEE, Sri Lanka (May 4, 2018) Surgical staff assigned to USNS Mercy (T-AH 19) for Pacific Partnership 2018 (PP18) and the Sri Lankan surgical team from Base Hospital Mutur perform the first shipboard robot-assisted surgery on a patient using the Da Vinci XI Robot Surgical System. Pacific Partnership is the largest annual multinational humanitarian assistance and disaster relief preparedness mission conducted in the Indo-Pacific. (U.S. Navy photo by Mass Communication Specialist 2nd Class Kelsey L. Adams/Released)

A memorable and successful mission for me was our engagement with Vietnam.  Hand and plastic surgeons and dermatologists worked collaboratively on a series of restorative interventions in patients with extensive, severe burn contractures.  After the surgical team performed contracture releases and in some instances applied dermal matrix tissue on patient’s open wound beds, the dermatologists would work to apply a laser to the remaining scar tissue, thus softening the scars. This type of surgery is very rewarding to the surgeon as we can appreciate the immediate result in the operating theatre and during postoperative care when the patient greets us with a smile amazed at how they have regained functionality and appearance.

This was a great opportunity for me to share my expertise in three different specialties (Hands/Burns/Trauma) with surgeons and ancillary staff internationally. What I enjoyed most was exchanging knowledge with my international colleagues, and gaining a glimpse of insight into the challenges they face in delivering high quality health care on a daily basis. Those countries are now part of my reality, rather than just a dot on the map. I hope I will be able to embed this newly gained knowledge and cultural awareness for my next Navy mission.