September 27, 2024 • 17 mins
AHF Podcast Interview: Neil P. Sheth, MD
In this episode of the AHF podcast, host Joseph M. Schwab interviews Dr. Neil P. Sheth, who is taking over the scientific program for AHF 2025. Dr. Sheth discusses his journey with the anterior approach to hip replacements, his involvement with Medacta, and his efforts in building a hospital in Tanzania to provide education and care in underserved communities. The conversation covers the challenges and successes of these initiatives and the future direction of global health efforts.
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Episode Transcript
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Joseph M. Schwab (00:05):
I'm Joe Schwab and welcome to the AHF podcast.
My guest today is Dr.
Neil Sheth Neil You're takingover the scientific program for
AHF 2025.
Is that right?
Neil P. Sheth (00:18):
That's correct, Joe.
Thanks for having me on thispodcast and very excited to be a
part of the AHF board, whichthis is again, the first year
that I've actually been to anAHF meeting and tremendously
overwhelming for me in the sensethat I have not been to a
meeting where I've sat throughevery lecture for a two and a
half day meeting.
Joseph M. Schwab (00:36):
Tell me a little bit about your journey
with the anterior approachbecause you're not coming out of
fellowship having done, 500anterior approach hip
replacements in residency andfellowship, tell me how you got
to where you are
Neil P. Sheth (00:49):
Yeah.
So this is back in 2017.
So at that point I had alreadybeen in practice for about seven
years.
And, I decided I wanted toreally delve into the anterior
approach at that point for threereasons.
Number one, as a hip surgeon and40 percent of my practice is
revision surgery.
So that should be comfortablegetting into the hip from the
front side and back.
(01:09):
Number two, Residents andfellows were asking for this in
their education.
So I was like as a fellowshipdirector, I should be able to
offer this to our residents andfellows.
And number three, there was alot of research and data coming
out on the anterior approach.
And I was like, I don't know ifthe socket's easy.
I have no idea if the femur ishard unless I actually do
something and try it.
(01:31):
I spent a very long time, abouta good three months of actually
adjusting my brain to look atthe hip differently.
I know what all the muscles arearound the hip, but now they're
in the wrong spot.
They're normally over here.
Now they're going to be 180degrees away from, or 90 degrees
away from where I'm actuallyused to seeing them.
This was not a small task for mebecause I was not interested in
(01:55):
actually harming patients whileI'm trying to learn and I was
not unhappy with my posteriorapproaches.
It wasn't an instability issue.
Wasn't a recovery issue.
It was nothing like that.
It was just more of a, anacademic issue for me with
regards to our trainees, as wellas my ability to get into the
hip from any approach that Iwanted to.
Joseph M. Schwab (02:14):
During your process, you ended up
gravitating towards Medacta,right?
As a primary system andeverything that surrounds that.
Tell me a little bit about howyou ended up, taking that
approach.
Neil P. Sheth (02:26):
Medacta's educational approach is very
different.
They wanted me to go seesomebody to watch them do a
total hip replacement.
They wanted me to go to a labwith that individual.
And then that person was goingto come to Penn, and actually
scrub in on my first twoanterior hips, which, and Tyler
Goldberg was my mentor, whotaught me how to do an anterior
hip.
(02:46):
It was amazing having him there,scrubbed in, not touching the
patient, but looking and saying,Yep, your incision is in the
wrong spot, your retractor is inthe wrong spot, you need one
more click of rotation.
But my anxiety was one third ofwhat it normally would have
been.
So I thought Medacta'seducational platform was by far
the best out there.
And at that point Medacta wasnot interested in giving
(03:08):
implants to someone that theydidn't think could do the actual
procedure properly andreproducibly.
But I thought their educationwas by far the best and they
were so dedicated on making surethat I learned what I needed to
learn and to make sure that Iwas, comfortable doing what I
was doing.
And I, again, I think the keything is being reproducible.
You can't do this and you got afluke and you did it well once.
(03:30):
It's got to be every singletime.
Joseph M. Schwab (03:32):
And so seven years in to this process,
anything you would have donedifferently
Neil P. Sheth (03:37):
I don't think so.
I'm now about 80 percent onanterior, my primary hips the,
only patients that I don't do ananterior hip on.
Patients who are, I thinkreally, obese that have a huge
pannus that's sitting over theincision.
And in Philadelphia, we have afairly large sickle cell
population where the whole femuris completely sclerotic.
(03:57):
So I feel like it's better forme to be able to look at the
actual femur as opposed toworking in this position where
I'm not looking at it head on.
That's about it.
Other than that everyone'sgetting an anterior approach.
So I don't think I would havedone anything differently.
I was Very fortunate that I gotto slowly and gradually increase
my practice in this direction.
(04:18):
And it wasn't an all or nonething in 2017.
It was a, Hey, let's do one aweek to let's do two a week.
And slowly growing to now Imight do four or five in a day,
depending on what day it is.
Joseph M. Schwab (04:33):
and you have a fellowship, right?
You're, you have an adultreconstruction fellowship at
your institution, and obviously
Neil P. Sheth (04:40):
Yeah, we have three fellows here.
Joseph M. Schwab (04:42):
Three fellows, and you're now teaching this to
your fellows as well.
Correct?
Neil P. Sheth (04:47):
Yes, correct.
Joseph M. Schwab (04:48):
My understanding is joint
replacement is not your onlypassion and not even your only
academic passion.
You have some interest indevelopment in underserved
communities around the world.
You want to tell me about that?
Neil P. Sheth (05:02):
I was really fortunate to have some great
mentors when I was a resident inthe global health arena.
And so over the last decade,I've spent a lot of time, most
of my time outside of thehospital either nights and
weekends working on building ahospital in Tanzania in east
Africa.
And again, right?
Like you said, Joe, there's alot of people in the world that
have very little access to care,simple, like basic care, nothing
(05:26):
complex.
So I've been really fortunate tohave some great mentors that
taught me to believe in what wasimportant, at least to me.
And I've, I'm really fortunatethat my chairman up until now
has been extremely supportive ofthe work that we were doing over
there.
And so just this past year, weactually finally got our
hospital built in Tanzania.
And so now we're looking atgetting 32 different teams or
(05:48):
different universities involvedto actually come.
And spend time there.
So you're signing out of serviceevery week.
And so the hospitals coveredyear round,
Joseph M. Schwab (05:57):
Wow.
And are those people from aroundthe United States who are going
to service that hospital or isit all around the world
Neil P. Sheth (06:05):
it's all around the world.
Most of the, institutions are usbased institutions, but it's
also schools and universities inSouth America, Central America
Europe and Asia.
Joseph M. Schwab (06:16):
and how did you end up, targeting Tanzania
for this effort?
Neil P. Sheth (06:19):
So I got to go to operation walk in 2012, which
was the first time I went onoperation walk in first time.
I went to Tanzania and that wasthe first time OpWalk went to
Africa.
And I fell in love with thepeople, fell in love with the
country.
And I realized in that shorttrip we did 53 joint
replacements in four days withsix surgeons and 50 other
(06:42):
ancillary staff members andeveryone was high fiving and I
was like, something's off, Idon't feel so great about this.
So eight months later, I wentback to Tanzania with one of our
chief residents and what theorthopedic surgeon who was there
during our trip, who lives inTanzania.
What he said to me changed myentire outlook on everything.
He said he's we're not so happywhen you guys come here.
(07:05):
He goes, I don't mean to bedisrespectful.
You guys are very good.
And you're very fast.
You can take care of a lot ofpeople in a short period of
time, but you have left me withproblems that I cannot fix,
right?
Four knee replacements gotinfected.
One hip was chronicallydislocating.
He goes, I don't know how to doa revision hip replacement.
I don't know how to take care ofan infected knee.
The second thing he said to mewas even more jarring.
(07:26):
And he said after you left, hegoes, I had no business for
three months, patients came tothis hospital to get free
surgery from us surgeons.
No, one's paying an Africansurgeon until they realize that
you're not coming back anytimesoon.
So I realized in that instant.
Everyone has the best intention,but maybe what we're doing today
(07:48):
is not the right model.
We got to do somethingdifferent, right?
I didn't teach anybody on theground in 2012 cause I was
nervous.
I was barely a year out offellowship and I had six boxes
to make someone's hip work.
I can't be two millimeters off,right?
If you're down in Philadelphia,Pennsylvania hospital, I've got
800 boxes on the shelf to beable to make your hip work.
(08:09):
Within a millimeter of what itneeds to be.
So this guy's statement made merealize that it is not
acceptable for us to come into acountry, no matter what the
intention is, but disrupt thisguy's life.
And disrupt the ability for himto take care of patients for
even if it's one day, let alonethree months, maybe we should do
(08:30):
something different where we canhelp this guy become better.
Change his standard of what hewants to provide for his
patients in his own country.
Joseph M. Schwab (08:38):
Wow.
That's incredible.
So does this hospital alsoprovide education for local
providers?
Neil P. Sheth (08:45):
Yeah.
So we just recently, this isfresh off the press.
Literally a week and a half ago,we just hired an orthopedic
surgeon.
Who's going to be living there.
Who lives in Tanzania, but who'sgoing to be working there full
time.
So now having 30 schools comein, each school come in for
about a week.
Sign out of service to anotherschool.
You're just basically bringingin 30 fellowships.
You stay there.
(09:05):
But the best part is that if I'mthere for a week and I do a
total hip replacement on someoneand they slip and fall out of
bed and they break their femur,but the next team's coming in,
they'll say, no problem.
We can fix this, but we willteach this guy who lives here
all the entire time and workshere on how to fix this problem.
So in essence, I think we'rejust basically building his
(09:26):
local brand, right?
Over time.
I want to do that fellowshipmyself.
I'd like to be there for a yearand hang out with 30 different
like experts who come in and dowhat they do.
But in six months, in a year,two years, like this guy would
be a different surgeon, right?
And if he goes to somewhere elsein Tanzania, we'll provide a
different level of care based onwhat he has learned.
Joseph M. Schwab (09:48):
So are your fellows involved in this project
too?
Do they get to go and experiencethis or.
Neil P. Sheth (09:54):
Yeah.
So we're going to probably startgoing next year.
You can imagine the logisticswith the government and in the
private setting of life, but thehospital takes some time to get
everything in order.
The plan is next year to start.
Initially we will have one teamgo per month for six months for
us to figure out the system, ourfellows.
(10:15):
So we, it will be available forsenior level residents, senior
level and fellows who who can gofor this one week, right?
Take a week of vacation.
When each team will fundraise ontheir own to take their team
over.
This is the best way tosustainably teach somebody and
to build a system that actuallyworks.
As opposed to let's go in, docases for a week and leave.
(10:38):
I can tell you now, Joe, if I doa surgery on a random day,
whatever it is, And I leavetown, I'm nervous.
If something happens to mypatient and I am not there
physically present.
Now I have eight other partnersthat can take care of anything
that happens to one of thesepatients, but I still don't feel
like a very good doctor that I'mnot there.
I can't imagine if you're in aforeign country and forget not
(11:02):
being there, like you're 10, 000miles away.
And you have no intention ofgoing back because that's not
home, right?
You got to get back to your lifeand take care of patients
locally.
So I think the best thing thatwe can do is to help build
somebody's brand, but also helpbuild someone's education and
experience on how to take careof these patients so that we're
not inadvertently adding burdento their healthcare system.
Joseph M. Schwab (11:23):
What an incredible undertaking.
Not just the infrastructurewithin the country that you're
creating, but the opportunitythat you're creating for your
learners as well to learn how tofunction within an entirely
different system and within anentirely different level of
resource.
That's incredible.
Neil P. Sheth (11:41):
Thanks.
Yeah.
This has been, I've been, again,I've been really fortunate to
have some amazing mentors, andthis is the part of my job that
doesn't feel like work.
I spent a lot of time on it.
But it's never felt like work,right?
This just has always felt likethis is the right thing to do.
So I'm very happy that over adecade, it's taken a long time,
and the pandemic definitely didnot help.
But I'm happy we got to a pointwhere now we actually have a
(12:03):
structure.
We have a 3 OR 60 bed hospitalbuilt.
And we're just working throughthe logistics over the next six
months to make sure that we cando this safely.
Reproducibly with the, with allthe teams in place.
And we've got 32 teams that havealready signed on and given me a
non a non committal sort ofletter to say that we'll be one
of your teams.
The nice thing is that we'vealso got a implant company
(12:27):
that's actually based out ofIndia, but they have a
distributorship in Tanzania.
So they can give us implants forone ninth the cost.
Joseph M. Schwab (12:33):
Wow.
Neil P. Sheth (12:34):
And it's the same implants I use here in
Philadelphia.
I don't care what the like brandname is.
And I've been to their facilityin India and everything is.
Properly made.
Everything is sterilized.
Everything is made by a laseretched with robots.
It's very high tech, but they'vefigured out a way to do this
very cheaply and luckily beingat the university of
Pennsylvania, I had the accessto the Wharton school and the
(12:56):
Wharton school has actuallycreated our business model where
we can actually have a crosssubsidized model where paying
patients will help pay for someof the patients that are really
poor.
Good things.
I'm offering them the component,which is the most expensive,
which is volunteers.
We don't get paid.
And I'm offering you the highestlevel of talent that can do what
they do.
I'm not fixing your anklefracture.
(13:18):
My trauma guy will.
But if there's a hip and kneeissue, like that's my concern.
And so what better way than toteach the guy who's on the
ground, how to fix an anklefracture by the guys who are
trauma surgeons who do thisevery single week.
And right.
They can show you sometechniques that's less invasive.
That's nicer to the softtissues.
And, Hey, I don't need any fancyvariable angle locking plate.
(13:43):
Give me a one third tubularplate and I can fix any bone in
the body.
At least that's how most of thetrauma guys think.
And what a better, what betterway than to teach somebody on a
daily basis to say, this is howyou do it.
Don't come to Philly to see howwe do it.
Let me work with you here.
You stay at home.
We'll bring the talent to you.
(14:03):
And so I don't think I'd be ableto do this without a Scott Levin
as my chair, who has been sosupportive over the last decade
and a half.
Joseph M. Schwab (14:11):
So where do you see this project going in
the next 10 years or in the next20 years?
Neil P. Sheth (14:16):
So I think the, model that we have created
should be franchised.
Go build this in Nicaragua, gobuild this in Cambodia.
The model shouldn't change.
What should change is thecultural needs of that country
compared to Tanzania.
It's different.
Think in the next 10 years, mygoal is to get this up and
(14:37):
running properly, make it selfsufficient so we can leave
Tanzania, but then go build thissomewhere else.
Joseph M. Schwab (14:43):
Wow.
again I just find this wholeidea rather fascinating and,
having sprung from this ideathat you were doing some good
initially and recognizing theproblems with that model and
being able to tackle that andtake it head on very,
impressive.
I, I'm happy to have somebody ofyour vision and your leadership
(15:05):
and your sense of purpose as a,as part of the AHF to help that
organization as well.
Neil P. Sheth (15:10):
Thank you, Joe.
And I think it was great that wehad actually are one of our guys
from Tanzania was here as aBurkle fellow for the AHF this
year.
I actually spent a lot of timewith the international folks
that were at the meeting andit's interesting I think that
there are certain things thatthey see that we don't see at
all, right?
Patients have different needs incountries outside of the United
(15:31):
States.
And there was a lot of interest,I think, on the anterior hip
side for these surgeons becausethey have patients that want to
hyper squat after surgery,right?
Whether to go to the bathroom orto eat or to pray or do their
job and maybe this is, anteriorapproach is what I need to
actually spend time learning.
This is better for my patientpopulation.
Joseph M. Schwab (15:52):
And not only a perspective on what they see,
but a different perspective onadditional benefits that we
might not even think about froman anterior approach in the
United States that culturesaround the world are seeing
because of their
Neil P. Sheth (16:06):
Yeah.
There's no question, right?
We are so focused on incisionlength and pain and length of
stay and can I do this in asurgery center at all important.
Joseph M. Schwab (16:17):
Yeah.
Neil P. Sheth (16:18):
It's very different when you are from
coming from a country that is apredominantly Islamic country
where patients want to get onthe ground and pray.
if they can't pray five times aday, which they've done their
entire life, now you got to sitin a chair to do this.
You have disrupted that person'slife.
I'm, really excited to see wherethis grows in the next several
(16:39):
years.
I think the amount of buzzthat's going on about the AHF,
this is going to become thepremier anterior hip meeting.
And even as someone who's eightyears deep and getting close to
a thousand anterior hips,there's so much more for me to
learn.
And I love sitting there andlistening to other people who
are masters who have done thisfor years longer, have done it
on every single patient.
(17:00):
There's more to learn, right?
And it's amazing to be involvedat this level, where we can
really impact, I think othersurgeons who are interested in
the anterior hip.
then even personally, like howmuch I'm going to grow in the
next five years and what I'mgoing to learn.
Joseph M. Schwab (17:14):
I couldn't have said it better myself,
Neil.
Thanks for meeting with metoday.
Neil P. Sheth (17:19):
Thank you, Joe.
Great.
Great seeing you.
Joseph M. Schwab (17:21):
Good to see you.
thank you for joining me foranother episode of the AHF
podcast.
If you want more information,you can check us out on
Facebook, LinkedIn, or X, or youcan visit us at our website,
anteriorhipfoundation.
com.
I'm Joe Schwab and welcome to the AHF podcast.
My guest today is Dr.
Neil Sheth Neil You're takingover the scientific program for
AHF 2025.
Is that right?
Neil P. Sheth (00:18):
That's correct, Joe.
Thanks for having me on thispodcast and very excited to be a
part of the AHF board, whichthis is again, the first year
that I've actually been to anAHF meeting and tremendously
overwhelming for me in the sensethat I have not been to a
meeting where I've sat throughevery lecture for a two and a
half day meeting.
Joseph M. Schwab (00:36):
Tell me a little bit about your journey
with the anterior approachbecause you're not coming out of
fellowship having done, 500anterior approach hip
replacements in residency andfellowship, tell me how you got
to where you are
Neil P. Sheth (00:49):
Yeah.
So this is back in 2017.
So at that point I had alreadybeen in practice for about seven
years.
And, I decided I wanted toreally delve into the anterior
approach at that point for threereasons.
Number one, as a hip surgeon and40 percent of my practice is
revision surgery.
So that should be comfortablegetting into the hip from the
front side and back.
(01:09):
Number two, Residents andfellows were asking for this in
their education.
So I was like as a fellowshipdirector, I should be able to
offer this to our residents andfellows.
And number three, there was alot of research and data coming
out on the anterior approach.
And I was like, I don't know ifthe socket's easy.
I have no idea if the femur ishard unless I actually do
something and try it.
(01:31):
I spent a very long time, abouta good three months of actually
adjusting my brain to look atthe hip differently.
I know what all the muscles arearound the hip, but now they're
in the wrong spot.
They're normally over here.
Now they're going to be 180degrees away from, or 90 degrees
away from where I'm actuallyused to seeing them.
This was not a small task for mebecause I was not interested in
(01:55):
actually harming patients whileI'm trying to learn and I was
not unhappy with my posteriorapproaches.
It wasn't an instability issue.
Wasn't a recovery issue.
It was nothing like that.
It was just more of a, anacademic issue for me with
regards to our trainees, as wellas my ability to get into the
hip from any approach that Iwanted to.
Joseph M. Schwab (02:14):
During your process, you ended up
gravitating towards Medacta,right?
As a primary system andeverything that surrounds that.
Tell me a little bit about howyou ended up, taking that
approach.
Neil P. Sheth (02:26):
Medacta's educational approach is very
different.
They wanted me to go seesomebody to watch them do a
total hip replacement.
They wanted me to go to a labwith that individual.
And then that person was goingto come to Penn, and actually
scrub in on my first twoanterior hips, which, and Tyler
Goldberg was my mentor, whotaught me how to do an anterior
hip.
(02:46):
It was amazing having him there,scrubbed in, not touching the
patient, but looking and saying,Yep, your incision is in the
wrong spot, your retractor is inthe wrong spot, you need one
more click of rotation.
But my anxiety was one third ofwhat it normally would have
been.
So I thought Medacta'seducational platform was by far
the best out there.
And at that point Medacta wasnot interested in giving
(03:08):
implants to someone that theydidn't think could do the actual
procedure properly andreproducibly.
But I thought their educationwas by far the best and they
were so dedicated on making surethat I learned what I needed to
learn and to make sure that Iwas, comfortable doing what I
was doing.
And I, again, I think the keything is being reproducible.
You can't do this and you got afluke and you did it well once.
(03:30):
It's got to be every singletime.
Joseph M. Schwab (03:32):
And so seven years in to this process,
anything you would have donedifferently
Neil P. Sheth (03:37):
I don't think so.
I'm now about 80 percent onanterior, my primary hips the,
only patients that I don't do ananterior hip on.
Patients who are, I thinkreally, obese that have a huge
pannus that's sitting over theincision.
And in Philadelphia, we have afairly large sickle cell
population where the whole femuris completely sclerotic.
(03:57):
So I feel like it's better forme to be able to look at the
actual femur as opposed toworking in this position where
I'm not looking at it head on.
That's about it.
Other than that everyone'sgetting an anterior approach.
So I don't think I would havedone anything differently.
I was Very fortunate that I gotto slowly and gradually increase
my practice in this direction.
(04:18):
And it wasn't an all or nonething in 2017.
It was a, Hey, let's do one aweek to let's do two a week.
And slowly growing to now Imight do four or five in a day,
depending on what day it is.
Joseph M. Schwab (04:33):
and you have a fellowship, right?
You're, you have an adultreconstruction fellowship at
your institution, and obviously
Neil P. Sheth (04:40):
Yeah, we have three fellows here.
Joseph M. Schwab (04:42):
Three fellows, and you're now teaching this to
your fellows as well.
Correct?
Neil P. Sheth (04:47):
Yes, correct.
Joseph M. Schwab (04:48):
My understanding is joint
replacement is not your onlypassion and not even your only
academic passion.
You have some interest indevelopment in underserved
communities around the world.
You want to tell me about that?
Neil P. Sheth (05:02):
I was really fortunate to have some great
mentors when I was a resident inthe global health arena.
And so over the last decade,I've spent a lot of time, most
of my time outside of thehospital either nights and
weekends working on building ahospital in Tanzania in east
Africa.
And again, right?
Like you said, Joe, there's alot of people in the world that
have very little access to care,simple, like basic care, nothing
(05:26):
complex.
So I've been really fortunate tohave some great mentors that
taught me to believe in what wasimportant, at least to me.
And I've, I'm really fortunatethat my chairman up until now
has been extremely supportive ofthe work that we were doing over
there.
And so just this past year, weactually finally got our
hospital built in Tanzania.
And so now we're looking atgetting 32 different teams or
(05:48):
different universities involvedto actually come.
And spend time there.
So you're signing out of serviceevery week.
And so the hospitals coveredyear round,
Joseph M. Schwab (05:57):
Wow.
And are those people from aroundthe United States who are going
to service that hospital or isit all around the world
Neil P. Sheth (06:05):
it's all around the world.
Most of the, institutions are usbased institutions, but it's
also schools and universities inSouth America, Central America
Europe and Asia.
Joseph M. Schwab (06:16):
and how did you end up, targeting Tanzania
for this effort?
Neil P. Sheth (06:19):
So I got to go to operation walk in 2012, which
was the first time I went onoperation walk in first time.
I went to Tanzania and that wasthe first time OpWalk went to
Africa.
And I fell in love with thepeople, fell in love with the
country.
And I realized in that shorttrip we did 53 joint
replacements in four days withsix surgeons and 50 other
(06:42):
ancillary staff members andeveryone was high fiving and I
was like, something's off, Idon't feel so great about this.
So eight months later, I wentback to Tanzania with one of our
chief residents and what theorthopedic surgeon who was there
during our trip, who lives inTanzania.
What he said to me changed myentire outlook on everything.
He said he's we're not so happywhen you guys come here.
(07:05):
He goes, I don't mean to bedisrespectful.
You guys are very good.
And you're very fast.
You can take care of a lot ofpeople in a short period of
time, but you have left me withproblems that I cannot fix,
right?
Four knee replacements gotinfected.
One hip was chronicallydislocating.
He goes, I don't know how to doa revision hip replacement.
I don't know how to take care ofan infected knee.
The second thing he said to mewas even more jarring.
(07:26):
And he said after you left, hegoes, I had no business for
three months, patients came tothis hospital to get free
surgery from us surgeons.
No, one's paying an Africansurgeon until they realize that
you're not coming back anytimesoon.
So I realized in that instant.
Everyone has the best intention,but maybe what we're doing today
(07:48):
is not the right model.
We got to do somethingdifferent, right?
I didn't teach anybody on theground in 2012 cause I was
nervous.
I was barely a year out offellowship and I had six boxes
to make someone's hip work.
I can't be two millimeters off,right?
If you're down in Philadelphia,Pennsylvania hospital, I've got
800 boxes on the shelf to beable to make your hip work.
(08:09):
Within a millimeter of what itneeds to be.
So this guy's statement made merealize that it is not
acceptable for us to come into acountry, no matter what the
intention is, but disrupt thisguy's life.
And disrupt the ability for himto take care of patients for
even if it's one day, let alonethree months, maybe we should do
(08:30):
something different where we canhelp this guy become better.
Change his standard of what hewants to provide for his
patients in his own country.
Joseph M. Schwab (08:38):
Wow.
That's incredible.
So does this hospital alsoprovide education for local
providers?
Neil P. Sheth (08:45):
Yeah.
So we just recently, this isfresh off the press.
Literally a week and a half ago,we just hired an orthopedic
surgeon.
Who's going to be living there.
Who lives in Tanzania, but who'sgoing to be working there full
time.
So now having 30 schools comein, each school come in for
about a week.
Sign out of service to anotherschool.
You're just basically bringingin 30 fellowships.
You stay there.
(09:05):
But the best part is that if I'mthere for a week and I do a
total hip replacement on someoneand they slip and fall out of
bed and they break their femur,but the next team's coming in,
they'll say, no problem.
We can fix this, but we willteach this guy who lives here
all the entire time and workshere on how to fix this problem.
So in essence, I think we'rejust basically building his
(09:26):
local brand, right?
Over time.
I want to do that fellowshipmyself.
I'd like to be there for a yearand hang out with 30 different
like experts who come in and dowhat they do.
But in six months, in a year,two years, like this guy would
be a different surgeon, right?
And if he goes to somewhere elsein Tanzania, we'll provide a
different level of care based onwhat he has learned.
Joseph M. Schwab (09:48):
So are your fellows involved in this project
too?
Do they get to go and experiencethis or.
Neil P. Sheth (09:54):
Yeah.
So we're going to probably startgoing next year.
You can imagine the logisticswith the government and in the
private setting of life, but thehospital takes some time to get
everything in order.
The plan is next year to start.
Initially we will have one teamgo per month for six months for
us to figure out the system, ourfellows.
(10:15):
So we, it will be available forsenior level residents, senior
level and fellows who who can gofor this one week, right?
Take a week of vacation.
When each team will fundraise ontheir own to take their team
over.
This is the best way tosustainably teach somebody and
to build a system that actuallyworks.
As opposed to let's go in, docases for a week and leave.
(10:38):
I can tell you now, Joe, if I doa surgery on a random day,
whatever it is, And I leavetown, I'm nervous.
If something happens to mypatient and I am not there
physically present.
Now I have eight other partnersthat can take care of anything
that happens to one of thesepatients, but I still don't feel
like a very good doctor that I'mnot there.
I can't imagine if you're in aforeign country and forget not
(11:02):
being there, like you're 10, 000miles away.
And you have no intention ofgoing back because that's not
home, right?
You got to get back to your lifeand take care of patients
locally.
So I think the best thing thatwe can do is to help build
somebody's brand, but also helpbuild someone's education and
experience on how to take careof these patients so that we're
not inadvertently adding burdento their healthcare system.
Joseph M. Schwab (11:23):
What an incredible undertaking.
Not just the infrastructurewithin the country that you're
creating, but the opportunitythat you're creating for your
learners as well to learn how tofunction within an entirely
different system and within anentirely different level of
resource.
That's incredible.
Neil P. Sheth (11:41):
Thanks.
Yeah.
This has been, I've been, again,I've been really fortunate to
have some amazing mentors, andthis is the part of my job that
doesn't feel like work.
I spent a lot of time on it.
But it's never felt like work,right?
This just has always felt likethis is the right thing to do.
So I'm very happy that over adecade, it's taken a long time,
and the pandemic definitely didnot help.
But I'm happy we got to a pointwhere now we actually have a
(12:03):
structure.
We have a 3 OR 60 bed hospitalbuilt.
And we're just working throughthe logistics over the next six
months to make sure that we cando this safely.
Reproducibly with the, with allthe teams in place.
And we've got 32 teams that havealready signed on and given me a
non a non committal sort ofletter to say that we'll be one
of your teams.
The nice thing is that we'vealso got a implant company
(12:27):
that's actually based out ofIndia, but they have a
distributorship in Tanzania.
So they can give us implants forone ninth the cost.
Joseph M. Schwab (12:33):
Wow.
Neil P. Sheth (12:34):
And it's the same implants I use here in
Philadelphia.
I don't care what the like brandname is.
And I've been to their facilityin India and everything is.
Properly made.
Everything is sterilized.
Everything is made by a laseretched with robots.
It's very high tech, but they'vefigured out a way to do this
very cheaply and luckily beingat the university of
Pennsylvania, I had the accessto the Wharton school and the
(12:56):
Wharton school has actuallycreated our business model where
we can actually have a crosssubsidized model where paying
patients will help pay for someof the patients that are really
poor.
Good things.
I'm offering them the component,which is the most expensive,
which is volunteers.
We don't get paid.
And I'm offering you the highestlevel of talent that can do what
they do.
I'm not fixing your anklefracture.
(13:18):
My trauma guy will.
But if there's a hip and kneeissue, like that's my concern.
And so what better way than toteach the guy who's on the
ground, how to fix an anklefracture by the guys who are
trauma surgeons who do thisevery single week.
And right.
They can show you sometechniques that's less invasive.
That's nicer to the softtissues.
And, Hey, I don't need any fancyvariable angle locking plate.
(13:43):
Give me a one third tubularplate and I can fix any bone in
the body.
At least that's how most of thetrauma guys think.
And what a better, what betterway than to teach somebody on a
daily basis to say, this is howyou do it.
Don't come to Philly to see howwe do it.
Let me work with you here.
You stay at home.
We'll bring the talent to you.
(14:03):
And so I don't think I'd be ableto do this without a Scott Levin
as my chair, who has been sosupportive over the last decade
and a half.
Joseph M. Schwab (14:11):
So where do you see this project going in
the next 10 years or in the next20 years?
Neil P. Sheth (14:16):
So I think the, model that we have created
should be franchised.
Go build this in Nicaragua, gobuild this in Cambodia.
The model shouldn't change.
What should change is thecultural needs of that country
compared to Tanzania.
It's different.
Think in the next 10 years, mygoal is to get this up and
(14:37):
running properly, make it selfsufficient so we can leave
Tanzania, but then go build thissomewhere else.
Joseph M. Schwab (14:43):
Wow.
again I just find this wholeidea rather fascinating and,
having sprung from this ideathat you were doing some good
initially and recognizing theproblems with that model and
being able to tackle that andtake it head on very,
impressive.
I, I'm happy to have somebody ofyour vision and your leadership
(15:05):
and your sense of purpose as a,as part of the AHF to help that
organization as well.
Neil P. Sheth (15:10):
Thank you, Joe.
And I think it was great that wehad actually are one of our guys
from Tanzania was here as aBurkle fellow for the AHF this
year.
I actually spent a lot of timewith the international folks
that were at the meeting andit's interesting I think that
there are certain things thatthey see that we don't see at
all, right?
Patients have different needs incountries outside of the United
(15:31):
States.
And there was a lot of interest,I think, on the anterior hip
side for these surgeons becausethey have patients that want to
hyper squat after surgery,right?
Whether to go to the bathroom orto eat or to pray or do their
job and maybe this is, anteriorapproach is what I need to
actually spend time learning.
This is better for my patientpopulation.
Joseph M. Schwab (15:52):
And not only a perspective on what they see,
but a different perspective onadditional benefits that we
might not even think about froman anterior approach in the
United States that culturesaround the world are seeing
because of their
Neil P. Sheth (16:06):
Yeah.
There's no question, right?
We are so focused on incisionlength and pain and length of
stay and can I do this in asurgery center at all important.
Joseph M. Schwab (16:17):
Yeah.
Neil P. Sheth (16:18):
It's very different when you are from
coming from a country that is apredominantly Islamic country
where patients want to get onthe ground and pray.
if they can't pray five times aday, which they've done their
entire life, now you got to sitin a chair to do this.
You have disrupted that person'slife.
I'm, really excited to see wherethis grows in the next several
(16:39):
years.
I think the amount of buzzthat's going on about the AHF,
this is going to become thepremier anterior hip meeting.
And even as someone who's eightyears deep and getting close to
a thousand anterior hips,there's so much more for me to
learn.
And I love sitting there andlistening to other people who
are masters who have done thisfor years longer, have done it
on every single patient.
(17:00):
There's more to learn, right?
And it's amazing to be involvedat this level, where we can
really impact, I think othersurgeons who are interested in
the anterior hip.
then even personally, like howmuch I'm going to grow in the
next five years and what I'mgoing to learn.
Joseph M. Schwab (17:14):
I couldn't have said it better myself,
Neil.
Thanks for meeting with metoday.
Neil P. Sheth (17:19):
Thank you, Joe.
Great.
Great seeing you.
Joseph M. Schwab (17:21):
Good to see you.
thank you for joining me foranother episode of the AHF
podcast.
If you want more information,you can check us out on
Facebook, LinkedIn, or X, or youcan visit us at our website,
anteriorhipfoundation.
com.
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