The humid heat, the tropical surroundings, all the people! A different world from my home, Vancouver, BC, yet there I was in Davao Philippines, ready for an exciting new adventure. I am a third year orthopedic resident at the University of British Columbia and I had arranged to do an international elective with the help of Dr Lew Zirkle, founder of the SIGN intramedullary nail system. I attended the SIGN annual conference and I was amazed by the system and by the international network that he has developed.

The SIGN program in Davao is well established, doing over 200 surgeries per year. The nail is used for acute fractures, mal and non unions of the tibia, femur and humerus. They occasionally use the fin nail as well. They are understandably very proud of their SIGN results and presented them at the hospital quality assurance rounds as well as at the Philippine Orthopedic Association and the ASEAN Orthopedic Association Annual Conference while I was visiting.

The residents are a very knowledgeable and spirited group. Despite limited resources and elective surgical exposure, their thirst for learning was incredible. I participated in their journal club evening and was happy to contribute to the discussion on arthroscopic shoulder surgery, something they’ve only read about. In return they shared their vast experience of long bone and open fracture management with me. Throughout their four year residency they are on duty every three nights and some live at the hospital every night. They love to sing, dance and eat, three activities that they also shared with me. Let’s hope there’s no recording of karaoke night!

My role on Davao was mainly to observe, though in the Operating Room I was encouraged to scrub and participate as much as I could. I assisted in 20 surgeries ranging from wound debridement to SIGN nailing to total knee arthroplasty at both the charity and private hospitals. Eight of these were SIGN surgeries. I was thrilled the last day when the senior resident offered me the knife for a femoral nailing. Under his watchful eye, the fracture reduced easily and the distal interlock was perfect. How rewarding!

Although I learned a lot from a surgical perspective, it is the cultural experience that impacted me the most. My hosts went out of their way to show me their country. I ate deep fried pig omentum, “balut” a fertilized 14 day old duck embryo, durian fruit and the best mangoes I’ve ever had. I was taken for jungle hikes, a day at the beach, to the base of Mount Apo, the highest peak in the Philippines, and to the famous Philippine Eagle Reserve.

I am returning to Canada with more energy and appreciation than I had when I left. We are so lucky to have a world class universal health care system. What I learned though is that amazing things are possible with modest resources. Creativity, innovation laughter and determination are powerful qualities that Filipinos rely on, with great results.