If you've been following me on Instagram, you probably know that I was recently in Washington for the SIGN Fracture Care International conference. For those unfamiliar with SIGN, it’s a humanitarian organisation that provides orthopaedic implants to low-resource countries, free of charge, with the goal of creating equality in fracture care worldwide. My journey with SIGN began 8 years ago when I started my internship at Emergency Surgical Centre, one of over 400 SIGN programs around the world. Fresh out of med school, I was full of enthusiasm, but with no clear plan. Life always has a way of leading us to our purpose.
Fast forward a few years, I decided to specialize in orthopaedics. The rest, as they say, is history. I've attended many conferences over the years, but this one hit differently- it was personal. My twin brother probably knows better than anyone just how much this conference meant to me. He's heard every detail of my SIGN surgeries and milestones, so often that I joke he could do a SIGN nail himself!😂 But SIGN didn't just give me surgical experience. It gave me hope, confidence and a sense of purpose. The lives transformed by these surgeries, including my own (as a surgeon), are countless. Meeting the entire SIGN family and Dr Lewis Zirkle, the founder, felt like a full-circle moment, and just thinking about it brings tears to my eyes.
Back in 2016, my mentors introduced me to SIGN nails. That was a game-changing moment for me. As a medical student, I'd never seen an actual orthopaedic surgery. Whatever little I knew about orthopaedics was from books. So witnessing my first intramedullary nailing- seeing a fracture come together like that was fascinating. For my non-medical friends, it's like placing a metal rod inside a broken bone to stabilize it. My mentors patiently explained each step and after assisting in several surgeries, I was ready to take the scalpel as the operating surgeon. Everyone was celebrating my 'first SIGN nail,' and even my consultant posted a picture on Facebook: "Coco's first SIGN nail." (Yes, Coco was my hospital nickname, and yes, it was that big of a deal!) That moment was golden, especially for someone who wasn't sure what the future held.
As time went by, my confidence grew and I started handling more complex cases. I remember one where I fixed both femurs with SIGN nails in the same surgery- it was exhilarating. SIGN surgeries weren't just procedures to me, they became milestones that shaped my journey. They built my confidence and ignited my passion for becoming an orthopaedic surgeon. For the longest time in my early training, I didn't even realize there were other types of nails because all we had were SIGN nails. And honestly, that was enough for me- I just wanted to get better and perfect my skills with them.
A few years after my first SIGN surgery, I received a comment from Dr Zirkle himself on one of my cases. He said "Marcella, you do excellent SIGN surgery. Congratulations". I was floored! OMG- it wasn't just a comment on the x-rays as he usually did, he mentioned my name! That felt like a stamp of validation, a sign that I could conquer anything. It was the motivation I needed to keep going and it strengthened my belief that my hands can be trained to change lives. Later that year, I took the plunge and started my residency.
"SIGN didn't just give me surgical experience. It gave me hope, confidence and a sense of purpose. The lives transformed by these surgeries, including my own, are countless."
During my residency, I don’t get to do SIGN surgeries, because our hospital doesn’t have a SIGN program. But whenever I'm home, I make it a point to work at my old hospital and perform SIGN surgeries. Every time, it feels like coming home. SIGN is deeply etched in my heart. As someone who dreams of improving orthopaedic and trauma care back home, I always wondered about Dr Zirkle's journey. How did he build this life-changing organization? I first heard about the SIGN conference years ago when one of my mentors presented at it. Back then, I thought, 'someday I want to do that too.' I didn't know then that I would become an orthopaedic surgeon myself. Funny how dreams manifest when we least expect them!
Last year, I reached out to Jeanne Dillner, SIGN's CEO and asked if I could attend the conference. She kindly said yes but unfortunately, I had missed the deadline to apply for the travel scholarship. And as many of you know, I'm still a broke resident (lol), so globe-trotting wasn't an option. Jeanne promised to keep me in mind for the next conference, and she did. She even sent reminders, made sure I submitted my abstract in time, and eventually, I got the travel scholarship! Fast forward to two weeks ago, and there I was- on a flight to Washington for the conference.
Now that you know the backstory, you understand why meeting Dr Zirkle was a dream come true. Believe it or not, when I introduced myself to him, he already knew my name! Not because of the SIGN surgery database, but because he's on one of the Orthopaedic Trauma Association (OTA) committees. I have an OTA Humanitarian Scholarship but that's another story. It was like everything had fallen into place, and I had no idea he was part of that committee. God really works in mysterious ways! We talked about his journey, and I shared my own dreams of improving trauma care in Sierra Leone. We also got a tour of the lab to see how implants are made. Walking around the lab, it dawned on me that I am truly living in answered prayers and honestly, if I ever pursue a PhD, it might just be in biomedical engineering!😅🙈
Afterward, I sent a photo of Dr Zirkle and me to one of my former colleagues, and his response was, 'so he's real?!' 😂 It was the perfect reaction- Dr Zirkle is such a legend in the orthopaedic world especially in low-resourced countries that he almost feels mythical! Meeting him in person was definitely one of those moments that I'll never forget. It was such a special opportunity to thank him for everything SIGN has done for countries like mine.
The SIGN conference brings together surgeons from all over the world. It’s a small but powerful community of people working in difficult conditions but choosing to stay and make a difference. Every one of those surgeons could have taken an easier path, but they chose to dedicate themselves to transforming lives. I had the honour of presenting data from some of the SIGN surgeries in Sierra Leone and hearing inspiring stories from other surgeons. It was a truly heartwarming experience. It reminded me of how much I miss home and my hospital family. I also got to reunite with my friend and mentor, Dr Kebba Marenah, The Gambia’s first orthopedic surgeon. He inspires me in so many ways, and seeing him again after five years was beyond amazing!
The conference wasn’t just about the incredible surgeons and their stories; it was also a showcase of exciting innovations in orthopedic care. I was really impressed by the telementoring and teaching platforms provided by Televu and Ohana One, which are making remote training possible for surgeons in low-resource settings. There were also low-cost external fixation devices and vacuum machines for wound care introduced by Sona Global, along with even more vacuum machines from the Darwin Project. One of the coolest innovations was a device designed by a SIGN engineer for people with MS. It lights up and changes color when their feet hit the ground, helping those who have lost sensation in their feet become more aware of their movements. Seeing these innovations reminded me just how much creativity and dedication are shaping the future of orthopedic care.
Before I wrap up, I have to share one more highlight- to tell you about the Surgical Management and Reconstructive Training (SMART) course I attended. The SMART course is organized by the Institute for Global Orthopaedics and Traumatology at University of California San Francisco to provide training for surgeons in low-resource settings in soft tissue reconstruction techniques. For the last few years, I've wanted to take this course and thanks to SIGN's partnership with IGOT, it was offered at no extra cost. Working on fresh cadavers for three days, practising reconstruction techniques, felt like a rare privilege for a trainee from a low-resource setting. I was like a kid in a candy store!
I could go on and on, but this post is long enough. My heart is full and I'm so grateful for the opportunities I've been blessed with. SIGN has shown me that I am capable of so much more than I ever imagined. Looking back on the videos from the conferences and all my presentations, I have truly come a long way. The road ahead may not always be smooth, but this heart of mine is strong.
Until next time, enjoy the photo dump from my one week in Richland😊
XOXO
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