I was 27 years old when I decided to be a spine surgeon. Like the other subspecialties in orthopedics, in a way it was almost messianic in its potential, it could make the lame walk. But on the other hand it could cause injury or worse, be fatal to the patient. Second only to deaths caused by complications with diabetic feet, injuries to the spine were the most common cause of death in our ward. It was to me the most challenging field in Orthopedics.

I have worked as a resident in a government training hospital in the Philippines. Understaffed, under equipped and overcrowded, we had a lot of patients with spine injuries. Unfortunately we do not have the hardware to deal with them. Spine patients who could not afford the implants and instrumentation necessary for spine surgery had to be treated conservatively and sent home less they acquire pneumonia in the wards.

Our patients consisted mostly of the poor and the destitute from the surrounding areas. Farmers falling off their carabaos (water buffalo), laborers caught in industrial accidents, loggers felled by trees, all of them were part of the lowest social economic bracket of our local population. Our patients have annual average income of less than $1,000 and live a mostly hand to mouth existence. What hope could they have of being able to afford spinal implants and instrumentation that cost more than 5 years worth of their income? Income from which only 2% goes to health care.

Not being able to take care of themselves, depressed and abandoned by friends and family these patients were literally wasting away. Life expectancy for a spinal cord injury patient is generally poor. It becomes more painful when their loved ones are aware that there are modalities of care for the patients but are just too expensive.

In short spine surgery was only available to the rich and capable in our hospital. I was aching to help people by doing spine surgery. But not having the necessary implants and instruments to perform it was depressingly frustrating. There were alternative cheap locally available implants, but these were substandard and prone to fail leading to further complications.

As a resident, doing spine surgery meant finishing four years of training in general orthopedics, then further training was done in spine centers overseas. It was only then that residents like me would have access to standard spinal instrumentation and implants. But spine surgery fellowships are few and far between. Dreaming of being a spine surgeon was just that. A dream.

But that was three years ago.

I am still a resident in a government hospital in a developing country and a few days ago, I was able to do my 1^st spine surgery. Assisted by our spine consultant, I was able to operate on a patient who had an unfortunate fracture of his spine when he dove in a river with his friends. He had an incomplete spinal cord injury, which meant he was not paralyzed, but his leg muscles were weak and he could not stand.  As a young man, he was expected to work for his family. Not being able to walk and work, we aligned his deformity, put in titanium screws and rods and decompressed his spinal cord.

Thanks to the implants he will be able to stand, walk and work again. He will not be depressed in a bed unable to stand. He will not be dependent on a younger sibling who would otherwise stop his or her education to be caretaker. He will be able to support his family and probably start his own. All thanks to the screws and rods that are keeping his spine straight.

Oh, did I mention that the implants were free?

Given the means to operate with international standard implants and instruments, I have scrubbed in more than 30 spine surgeries in 2 years. Not an impressive number in most spine centers, but in our country where instrumented spine surgeries is rare or non-existent in government hospitals,  this is already a gold mine of surgical experience.

Inspired by the generosity and selflessness of the people who have given our center spinal implants and instruments, I have realized that the dream of becoming a spine surgeon was not out of reach after all. Working with what we had, our center pioneered not only surgical management that was the standard in the country, we also improved our non surgical care for our spine patients. We started the 1^st scoliosis screening in our country and gave options for their families. Using locally available materials and internationally accepted principles, we were able to design and fabricate scoliosis braces for our patients.

Surgical or non surgical, the experience we have had with our patients taught us enough to share this knowledge with the world. Even as residents, we have been to North America and Europe sharing our experience and information, and in return learning more in international orthopedic conventions. We were even able to observe operations in some of the best centers in the United States under the tutelage of best surgeons of the world.

It was through Orthopedic Link that all of this came true. It was three years ago that they gave us the gift that still keeps on giving. They didn’t just give us implants and instruments. We got knowledge, experience, skill, the ability to care for our patients like never before.

And the truth is it doesn’t stop there. Since we have seen the centers overseas, it is now our dream to have a Spine/Trauma center of our own. For now that is still a dream, but maybe again in 3 years, it wouldn’t be a dream anymore.

Luigi Andrew “Gio” Sabal is Chief Resident at the Department of Orthopedics, Southern Philippines Medical Center.