Dios le pague are words that Dr. James Gage ’60 has heard often during his frequent visits to Ecuador. Translated “God will pay you,” the phrase is offered by grateful Ecuadorians to whom Gage has given medical attention.
“The people in Ecuador are very grateful, very warm, very kind,” said Gage. They are also very needy, which is why Gage has made 13 trips to the South American country in the past seven years.
“In Ecuador, there are many communities that are rural, poor, and largely Quechua that have no access to orthopaedists,” he said. “I have a good friend there, a medical missionary named Eckehart Wolff. He keeps a list of the children I need to see; then when I go down [there], I try to do as many surgeries as I can.”
The visits have become more frequent for Gage since 2000, when he resigned from his duties as medical director at Gillette Children’s Hospital in St. Paul, Minn. Gage continues as medical director of the hospital’s cerebral palsy clinic, where the country’s second fully automated gait analysis laboratory opened in 1987.
An innovative technological advancement in the treatment of children with cerebral palsy, the country’s first such gait lab was founded by Gage at Newington Children’s Hospital in Connecticut in 1981. Prior to that time, gait laboratories existed, but because they typically required eight hours or more of manual processing to enter data into a computer, they were too labor intensive for routine use in a clinical setting. Gage envisioned a way of incorporating research already being done on gait analysis into an automated computerized clinical laboratory. Although the resources for developing such a laboratory were limited, Gage was determined.
Then director of the cerebral palsy service at Newington, Gage was unsatisfied with the results of surgery performed on patients with cerebral palsy.
“[Prior to gait analysis] I’m convinced we made as many children worse as we made better,” he said. “I would talk to parents, and they were unhappy with the outcomes. We would start out with children who walked badly, and after surgery, they would walk differently — not necessarily better.”
What was needed was a way to better analyze the way a child walks so that doctors could more accurately predict the outcome of certain procedures. “The treatment of cerebral palsy at that time was an art, not a science. Nothing existed to do testing,” said Gage in a 1998 interview with Spark.
Though a chemistry major at Calvin, Gage also had a strong interest in math and had contemplated getting an engineering degree. His analytical side knew there had to be a solution.
First, he approached United Technologies Corporation, a Hartford-based firm specializing in the design of aircraft and defense systems. Here, engineers were able to design a computerized system that would provide useful information about the most important joints and muscles used for walking.
The engineers were then able to devise a system to gather data from individual patients. Reflectors attached to the patient’s critical joints and muscles were videotaped as the patient walked. Data from the cameras was then automatically downloaded into a computer, generating frame-by-frame stick figures that showed where the patient’s gait deviated from a normal gait.
With the technology now available, Gage needed the necessary — and expensive — digital hardware. After contacting a friend, he was put in touch with Digital Equipment Corporation, which agreed to supply the equipment at cost. Thus, the first automated gait analysis laboratory opened at Newington Children’s Hospital.
Now, almost 23 years later, there are more than 50 such labs in the United States and many more worldwide. And now, as a byproduct, the technology, commonly referred to as motion analysis, has become popular in the production of animated movies and computer and video games.
A recently published follow-up on 178 children who had been analyzed in Gillette’s gait lab and later were operated on showed very positive outcomes.
“We were very happy with the results,” said Gage. “You can’t fix an engine if you don’t know how an engine works. We felt the same way about children with cerebral palsy. You can’t improve results unless you assess the outcomes of their treatment.”
Gage has shared his success through the publication of two books: Gait Analysis in Cerebral Palsy (MacKeith Press, 1991) and The Treatment of Gait Problems in Cerebral Palsy (MacKeith Press, 2004). He also has written many articles and has helped train many others in the operation of gait labs.
Gage continues to be involved with the gait lab at Gillette, the busiest in the country. “I cut down to half time so that I could spend more time in Ecuador, though,” he said. “If I quit operating here altogether, I would not be able to keep my skills up to be effective in Ecuador.”
Both his work in Ecuador and the U.S. reflect his values based on his faith, said longtime friend and colleague Dr. Steven Koop, who is now the medical director at Gillette Children’s Hospital. “Jim is my idea of a physician,” said Koop. “He thinks of a particular problem in the context of a whole person; he thinks of the future. He listens well, and he recognizes that care is given by a group of people, of which he is one. He is a truly remarkable man.”
Gage is accompanied on his frequent trips south by his wife, Mary Tebrake Gage ’60. Mary is a former teacher who now tutors English as a Second Language to students at a missionary school in Ecuador. “We go down there to get our batteries recharged,” she said.
Jim Gage agreed: “The pleasure in life is giving to people. I feel like I still have a lot to give, and I still have a lot of energy with which to do it.”
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