Performing surgery at Keila Hospital in 1995. My assistant and colleague is orthopedic surgeon Dr. Erekle Dzotsenidze
Not only is extensive medical expertise required, but an altruistic heart as well, to achieve what Dr. Robert P. Hendrikson has done throughout his career. As an orthopaedic surgeon practicing at Northeast Orthopaedic Surgery and Rehabilitation in Waterbury, CT, Dr. Hendrikson operates on bones, joints, tendons, ligaments and muscles. His specialty is complex arthroscopic surgery of the wrist. Since July1989 Dr. Hendrikson has been travelling to the Baltics to perform medical consultations and surgical procedures pro bono (without compensation), as well as to lecture medical students and staff.
The initial trips were a result of the efforts of the Keggi Foundation, which was founded by Latvian-born Dr. Kristaps J. Keggi, at that time an attending orthopaedic surgeon at Waterbury and St. Mary’s Hospitals, as well as clinical professor of orthopaedics and rehabilitation at Yale. Dr. Hendrikson’s first trip to Latvia involved performing surgeries at the Microsurgical Hospital and the Orthopaedic Institute, both in Riga. He then travelled to Tallinn for the first time in his life to do the same at the Seppo Orthopaedic Clinic and Hospital. Of the medical conditions in 1989 – before the Baltics regained their independence – Dr. Hendrikson recalls, “The facilities and equipment were much worse than I even imagined.
The microscope was the most sophisticated piece of equipment they had – they were 30-50 years behind. I brought my own surgical instruments and supplies. Having two surgical procedures going on in the same operating room was something new for me. Not done in the U.S. because of concerns for complete sterility, it is accepted procedure in much of Europe. When I first visited Latvia, Dr. Gundis Bitte, a microsurgeon there, told me, ‘We (now) have the knowledge, but not the technology.’ The antiquated surgical practices of the Soviet Union had included using razor blades as scalpels and reusing disposable surgical gloves, breathing tubes, and other sensitive equipment.
In those days Russian physicians were earning a salary of $200/month, with office workers receiving $170/month and janitors $120/month. Before Estonia regained its independence, students at Tartu University were wearing overcoats and gloves when studying in the winter due to the lack of heat. The anatomy lab constructed in 1805 was still being used daily. To receive their medical degrees, students were required to pass an exam to prove their knowledge of the communist system. I did find it a beautiful custom, though, that in Estonia students place much emphasis on bringing teachers flowers on the first and last days of school.” Averaging two trips annually to Latvia and Estonia, Dr. Hendrikson performed the first nerve-related surgery and first complex wrist reconstruction procedure by an orthopaedic surgeon in Riga back in 1989. In Estonia Dr. Hendrikson has visited and/or operated at Kesk Haigla, Mustamäe and Magdalena Hospitals in Tallinn, as well as Pärnu, Tartu, Rakvere and Keila Hospitals.
Besides knowing the chiefs and orthopaedic surgeons at all of these hospitals, Dr. Hendrikson’s friends include the only two in Estonia with PhD’s – Dr. Rein Raie and Dr. Tiit Haviko. It was at Estonia’s Seppo Orthopaedic Clinic in 1990 that Dr. Hendrikson performed the first socalled joint replacement surgery (implant arthroplasty) of the metacarpal phalangeal joints in the hand for rheumatoid arthritis on a sixty-year-old medical doctor. Since those early days Dr. Hendrikson has performed over 200 surgeries in Estonia and Latvia. Although he never accepted payment for the operations, some grateful patients presented him gifts of local handmade crafts. An article entitled, “Doktor Hendriksoni õilis üritus” by Harald Leppikson in Estonia’s newspaper, Maaleht [Nr. 40(678) 5. oktoober 2000] explains (in translation) that, as a child of nine, Robert Hendrikson felt he had been blessed by God, and chose to live life as a Christian. Asked why there are so many wars and so much evil in our world, he responded, “It’s because people think that they are on the same level as God. If people were more humble, much of the evil would dissipate.
There’s hope that good will win over evil, when people search within themselves. Goodness can turn the world around.” And it was just such a selfless perspective which guided Henrikson’s decision to study medicine. According to the Maaleht interview, while some youths were protesting the Vietnam war, Hendrikson was spending long hours studying for his college classes. He worked at construction jobs doing wood and stonework, and in his spare time swam and surfed. Cycling was another pastime which Hendrikson has enjoyed for decades, having once competed in a 100km. race. A graduate of the Georgetown University School of Medicine, Hendrikson has since become affiliated with the American Society of Orthopaedic Surgery, American Society for Surgery of the Hand, American Academy of Sports Physicians and the American College of Surgeons. Dr. Hendrikson’s longest operation lasted 16 hours straight, during which he and another surgeon reattached a hand severed during an accident, with their only sustenance being orange juice fed to them through straws.
Visiting the Baltics to teach and lecture is only one part of the program organized by the Keggi Foundation. Dr. Hendrikson’s base hospital in Connecticut has hosted over 200 orthopaedic surgical residents, as well as other associated medical doctors from the fields of plastic surgery, radiology and general surgery from Estonia, Latvia, Lithuania, Ukraine, Kazakhstan, Uzbekistan, Kyrgyztan and Vietnam. As explained by Dr. Hendrikson, “The resident surgeons spend between two and three months studying our medical system as well as our orthopaedic surgical programs and techniques. Many Estonian orthopaedic surgeons have received fellowships to other countries as well, such as Finland, Sweden, Denmark, Germany and France. Upon returning home they can implement their new-found knowledge and experiences, along with significant monetary infusion into the medical system from such sources as the World Bank.
Over the years a number of companies and countries have donated sophisticated new technology in the areas of radiology, angiography and anesthesiology, CT Scans and fluoroscopy. With such constant improvements, there are now over 1,000 total hip replacements performed annually in Estonia, whereas in 1989 there were none.” Dr. Hendrikson’s successes are many, with some notable highlights including using microsurgery techniques to reattach the finger of a man who was injured during a construction accident which severely damaged his index and middle fingers at the knuckles. In this case orthopaedic surgery had to be combined with plastic surgery and neurosurgery since blood vessels, skin, bone and nerves all had to be reconnected. Microscopes enabled Dr. Hendrikson to sew together tiny arteries and veins with sutures thinner than human hair. Although the index finger could not be saved, after the intricate eight-hour surgery, it’s interesting to note that the patient sometimes “felt” pain in the missing finger. As Dr. Hendrikson explained, such “phantom limb pain” is common.
Consultation with patient with difficult hand injury. Performed at Keila Hospital in 1995. Keila Hospital has now been closed and consolidated with Põhja-Eesti Regionaalhaigla as part of a country wide program of consolidation.
At Keila Hospital in Estonia Dr. Hendrikson consulted with a 25-year-old man whose left hand had been rendered useless after it had been caught in a machine four years earlier. Although four previous surgeries in Tallinn had been unsuccessful, Dr. Hendrikson performed a few operations which improved the grasping ability of the patient’s left hand and increased the function and fine motor control of his thumb, index and middle finger. The man’s hand – and therefore his livelihood – would have been lost had it not been for expert orthopaedic intervention. The internet has become a useful tool with which to connect with Baltic patients who have complicated orthopaedic problems. In one case, for four years a woman had suffered an open leg wound which was resistant to any medical or surgical treatment. At the Keila Hospital Burn Clinic Dr. Hendrikson performed a successful skin-graft operation and healed her wound. As an expert in arthroscopic wrist surgery, Dr. Hendrikson states, “Everyone needs their hands. When something goes wrong with them, it can change every aspect of how we live our daily lives, so the preciseness of the surgery and care my patients receive is critical.”
Arthroscopy uses miniature cameras inserted through portals, allowing surgeons to detect and correct problems. As Dr. Hendrikson explains, seeing changes in the cartilage itself is easier that way than with an X-ray. Following the average 45-minute outpatient procedure, patients heal faster than those with incisions. They get back to work earlier and the procedure costs less. Carpal tunnel syndrome has gained increasing prominence because more people are spending long hours on their computers or have jobs requiring repetitive patterns of hand motions, such as check-out clerks, bank tellers and even surgeons. As Dr. Hendrikson explains, “Even those who enjoy handcrafts such as gardening, cooking and knitting are at an increased risk. Other conditions that might trigger the syndrome include arthritis, a thyroid imbalance, diabetes and pregnancy.” He goes on to suggest that treatment can often be simple, painless and inexpensive.
“Changing the height of a desk chair, taking aspirin, applying ice packs or doing some exercises can help. A nighttime splint applied at the wrist will prevent flexing and further damage to swollen tissues. More advanced or demanding cases can call for oral medications or injections. Called a release, outpatient surgery involves cutting or removing ligaments to relieve pressure and the condition rarely recurs.” Dr. Hendrikson’s most recent trip to Estonia was in 2014. Thinking back over the twenty-five years of his efforts there, he muses, “I was amazed at the progress that the medical system has made since the ‘early days’. Estonia’s orthopaedic surgeons are now traveling to seminars in Europe and the U.S. to continue their medical education. Orthopaedic medical care is now on a par with the West, having exceeded my expectations from my first visit. New clinics in Tallinn have state-of-the-art facilities and equipment. A new Orthopaedic Hospital is in service in Pärnu. All of the surgeries which I observed during my 2014 trip were performed in a textbook fashion.
To this day, I am the only ‘foreign’ surgeon with full membership in the Estonian Orthopaedic Association. My job is done, in the sense that the objectives of the earlier trips, beginning in 1989, have been accomplished. I feel like a pioneer in many respects; however, I credit the initative, intelligence, and perserverance of the orthopaedic and plastic surgeons in the Baltics for the current state of affairs and the progress that has been made in medical care.” To conclude with a lighthearted translated portion of the previously cited Maaleht article: “Robert Hendrikson knows and understands life. And for such an expert of anatomy, one cannot avoid asking why it is that men admire women’s calves. ‘At one time farm women had strong calves and they were able to do a lot of work…Men are still searching for strong-calved women, which they find in the curves of women’s legs; the idea being, that beneath the curves there are hidden muscles and that strength lies there. Strong is always beautiful.’”
Virve Jõks Lane
