Share Your Story of Diversity, Equity & Inclusion

Everyone has a story. AOFAS celebrates member diversity through storytelling. Read stories from your colleagues below or share your own.

Alexis E. Dixon, MD

I'm not a native Spanish speaker, but I'm fluent in Spanish. At least half of our patients at the LA County Hospital, where I spent medical school and residency, were Spanish-speaking only. I took the clinic charts for Spanish speakers preferentially because many of the other residents would have been slowed down by what we called "County Spanish." Everyone did their best and got the job done, but there was a lot of Spanglish and gesticulating. Patients were incredibly grateful when I could speak with them on a deeper level and answer more of their questions. Many of our patients were minimally educated and the entire medical system was as foreign to them as English. Having someone who could not only spend a few extra minutes but communicate effectively allowed them to place confidence in their surgical teams.

I rarely use Spanish in my private practice now, but I do still help settle legal cases for Workers Compensation cases in California and about half of these injured workers also speak only Spanish. Because of this, they see me as their doctor more so even than their treating physicians, and we establish immediate rapport.

I never imagined that studying a foreign language from middle school would be so valuable to my ability to practice good medicine. I've since joined AALOS and wish to see more Latinx Orthopaedic Surgeons and people with a heart for this community.

Luigi Andrew Sabal, MD

It’s 2:00 AM during the pandemic. I am a board-certified, fellowship-trained orthopedic surgeon and I am exhausted. My wife and children are asleep when I arrive home. I am still in my scrubs, tired after a full day of work, but I still have things to do because there is no water flowing to the house. Public utilities and infrastructure are severely lacking in my hometown in the Philippines. Water flows from the tap at midnight and stops at about 5:00 AM. I have been fetching water in pails and buckets trying to fill eight 30-gallon water containers for my wife and kids to use the next day. I carry the buckets up and down the stairs, across rooms multiple times, and store them in places where needed. The bathroom, the kitchen, the laundry area, the utility room for cleaning, and other places to water the plants and clean the pets. This will take me about 3-4 hours. Then I can get some rest before I must wake up, get dressed, go to work, and do it all over again…

I finished medical school and residency in a developing country with limited resources. My training involved a lot of trauma and neglected injuries. During my training, we were visited by a lot of US-based orthopedic surgeons. They showed us how to do things differently. They brought us tools to help us in our under-equipped health care system. They helped us, and by doing so, we helped our patients who would otherwise not have a standard of care that is found in the United States. They inspired me to be one of them.

So, I tried my best to pass the requirements: the USMLEs, the clinical rotations, the published articles, etc. It was not easy to study and work at the same time. The value of money was 50:1 to 60:1 USD. I worked in more than five different hospitals, traveled to underserved centers, and left my infant and toddler for weeks at time to make ends meet. My wife would ask me not to go to the underserved areas. A lot of them were unsafe. Doctors were considered easy targets to get money from. During this time, even the director of our university hospital, a respected urologist who trained many doctors, was gunned down by an assassin for $30 USD. Outside our hospital, gunshots would ring out in broad daylight, and we would see people fall on the streets. My wife and I were scared for our kids whom we would often bring to our clinic since we could not leave them at home. I was very scared I would be next. My concentration was all over the place, but I believed that if I could just reach the US, our lives would change.

I was accepted into the Foot and Ankle Fellowship program in Hershey, Pennsylvania. I was able to bring my family to the US. For once we felt safe. For once we felt at ease knowing that if we walked down the street, we would be greeted with smiles instead of being on our guard all the time. Our lives changed. I could see joy in my children’s eyes just by being here and we could finally get the much-needed treatment for my daughter with ADHD (which she got from her dad who was treated with good old 1980s corporal punishment).

I am very grateful to my program director. Unknowingly, he has saved my life and lives of my wife and daughters as well. Thank you, Dr. Aynardi. Thank you, Dr. Juliano. I owe you a life debt of gratitude that I hope in my own way I can repay. In my culture this is called “utang kabubut-on,” or life debt. Culturally translating into something like “I will repay you with my life, the life you have saved.”

I am an International Medical Graduate (IMG). Training was and is not easy for me. I had a crash course on how to survive in a US medical training facility, but it was like merging into traffic on a highway and not knowing what the squiggly signs on the side of the road meant (I failed my US driver’s license practical test when I first got here). This is what US foot and ankle orthopaedics is like. It is so different from what I learned back home. Foot and ankle surgery in the Philippines is only one of two things: fix or amputate. Charcot: what is that? Flat feet or bunions: never heard of it. Ankle replacement: who cares. Suture anchors: too expensive. Foot looks ugly: cut it off. Prosthesis: nobody can afford that since one family member has to stop school or work to care for the amputee. The list of things I had to unlearn went on and on.

I was demolished. It was so embarrassing having residents know more about foot and ankle surgery than the fellow. My morale was low, but luckily, I had very supportive mentors. They provided me the tools and resources to help me. It was tough love, but I had to unlearn, relearn and readjust. Just like merging traffic.

All the while trying balance my newfound knowledge and skills, settling in a new country and figuring out all the non-written and nonverbal social cues that are unique to US society. Little things like what to say when people say: “Hello, how are you doing?” Probably my favorite reply to this was taught to me by a resident who says: “Livin’ the dream!” My knowledge of US culture comes from the internet, Hollywood, the US music scene, frequent visits to the US as a kid, or having friends and family from the US visit me. Putting that into actual real human interactions was an entirely different thing.

I was always in awe of US orthopedic surgeons and considered them levels above me. I have always heard of the cool “ortho-bro” stereotype that is often portrayed in medical societies. That perception also changed when I went to an AOFAS meeting. Sure, the guys were cool and “ortho-bro-ish,” but the members also exuded an aura of warmth, caring and humility which I honestly did not expect. High-ranking, well-respected members were some of the nicest human beings I have ever met, and it still surprises me that they would recognize me even though they have met me just once prior. And for that very reason, I am grateful I felt that I belong.

In the past year during my training as a Foot and Ankle Fellow, I had many ups and downs. I am still learning and have learned to love what I have been doing. Now on the precipice at the end of my training, I am still in limbo on what the future holds for me. Applying for fellowships as an IMG is extremely difficult. I don’t qualify for so many reasons. I did not graduate from a US/Canadian residency; I do not have the proper visa; I do not have the requirements to fulfill the state license; I do not have enough years of US based training and the list goes on. But I am grateful that even for one brief year, one shining moment in my life, I was able to reach the heights of what I have dreamed. This is why I would tell US orthopedic residents “you are living someone else’s dream. You are living mine.”

Publicly accessible data of the AAMC show that 25% of all US active physicians are IMGs. Across all specialties, Orthopedics has the lowest percent of IMGs both in training and in practice. I am not alone, there are many of us ortho IMGs who have come to the US for various reasons but with the same goal. We, the orthopod IMGs are here, willing to learn, ready to train, and eager to bridge the gaps in healthcare distribution equality in the US and the world. We thank organizations such as the AOFAS and its members that are willing to help IMGs by teaching; training; providing skills and by welcoming us with a sense of community and support.

Thank you, Dr. Aynardi. Thank you, Dr. Juliano. Thank you, Dr. MacDonald. Thank you, Penn State Health. Thank you, AOFAS. I am Luigi “Gio” Sabal from the Philippines, and this is my story.

Robert R. Gorman, III, MD

As a white, male orthopaedic surgeon, it can be difficult to understand the personal relevance of DEI issues and initiatives. As I have engaged with orthopaedic colleagues who are underrepresented minorities, it has become clear that I often cannot identify with their professional and personal experiences. I've never been mistaken for a nurse or non-medical staff. When standing near a valet stand, no one has ever asked me to get their car. Biases exist, everywhere and in everyone, but I am much less likely to be harmed by another's bias than would my underrepresented peers. Inevitably, that leads to an uneven playing field while pursuing an orthopaedic career and is a driving factor for the poor diversity in our specialty. If nothing else, we white males should be willing to accept this harsh reality. And whether we are struck with feelings of guilt, helplessness, or even ambivalence, we should also be willing to acknowledge a need to try, with intention and effort, to do better.

Sandra Marie Abda, MD

My journey in Orthopedics began in 1974 when I was accepted into the University of Pennsylvania program. It was daunting at first as I graduated from an all-women’s college and a predominantly women’s medical school.

I had many champions along the way but did not always realize it.

I started in general surgery with Dr. William Fitts. He treated me with respect and the hand of a friend. I had a few interns under me, and they played a few tricks on me—they once stuffed my stethoscope with paper—but I took it in fun. At Penn, we rotated through nine hospitals, so we saw many ways of doing things. There were a few surgeons that would not have me on their rotations- and I was the lucky one. On Rothman’s service, I had to stay until the last ProTime was reported: usually 10pm and then be on call, up all night the next day.

I was assigned to a 3-month rotation with Dr. John Joyce who brought arthroscopy to our program from Japan. He was famous for his outspokenness. He took one look at me and said: “I asked for an Orthopedic resident and got a “Girl Scout.” I answered that I didn’t want to be there either, but I’d make the best of it! He laughed and became a great supporter, a mentor, and a friend.

Hand service was limited, too, but only a few got that. We had a few other minorities in the program. Once a fellow had a horrible accident and the program did everything possible to support him through a rough patch. All in all, I felt I was treated fair and square, made many friends, and left with a great love of Orthopedics and Penn. Later at age 40, I took as many foot and ankle courses as I could and narrowed my focus. Dr. Ken Johnson helped me on this path.

Sometimes in my life with raising three children, I wish I liked another specialty better, BUT ORTHO WAS FOR ME AND NEVER SEEMED LIKE WORK.