Accessible and sustainable hand surgery international 3.1


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Medical altruism

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Accessible and sustainable hand surgery international 3.1

  1. 1. Accessible andSustainable Global HandSurgery MrVaikunthan Rajaratnam MBBS(Mal),AM(Mal),FRCS(Ed),FRCS(Glasg),FICS(USA),MBA(USA), Dip Hand Surgery(Eur), PG CertMedEd(Dundee),FHEA(UK), AFFST(Ed),FAcadMEd(UK). Senior Consultant Hand Surgeon INTERNATIONAL HEALTH AND EDUCATION
  2. 2. Credentials • > 30 years clinical practice and teaching • Qualifications in medical education(FAcadMEd) • Experience in instructional design and technology(MIDT) • Publications and research in surgical education • Senior Clinical Examiner – Birmingham/ Singapore • External Examiner Ortho Exit exams – Indonesia/Malaysia • Examiner /Faculty Royal College of Surgeons Edinburgh • Quality Assurance Panel ofVisitor in PG ME&T, UK • Core Faculty Member Orthopaedic Surgery – ACGME-I • Core Faculty Member Hand Surgery Residency, Singapore • Special Committee member for redesign of hand surgery exit exam Singapore • Fellow HEA UK • Reviewer for Educational Research Grants HEA
  3. 3. India Sri Lanka Bangladesh Cambodia
  4. 4. Maslow's hierarchy of needs
  5. 5. ALTRUISM IN MEDICINE – a survey of medical professionals’ thoughts and attitudes  : 74% of respondents had used their medical expertise and experience in altruistic behaviour outside of their normal working role, with nearly 1 in 5 of respondents spending over 6 month doing so.  57% was completed in their home country, and 43% abroad.  83% were willing to commit a period of time each year towards organised altruistic work
  6. 6. Altruism in Medicine An analysis of perception , definition and practice of altruism among medical professionals in Singapore  . 79% of the respondents said they had used medical training in an altruistic manner outside their work , 32% at home and 36% at home as well as abroad .  94% said they are willing to commit to a fixed period in a year towards altruistic activity
  7. 7. Inadequatehealth systems damagethe growthofdeveloping nations DrBrianBrinkexplains whyhealthcare systems shouldbe understoodasa core partofacountry'sGDP  "A health system should be run like a business, with the right tools and training, a properly functioning procurement and supply chain, proper financial and human resource management, good governance, monitoring and evaluation, and sound information systems.”
  8. 8. Photo Essay of medical relief mission toTamil Ellam Dr K.Thambyrajah F.R.C.S..orthopaedic surgeon Dr R.Vijayasingam F.R.C.S.general surgeon DrV. Rajaratnam F.R.C.S.hand surgeon
  9. 9. Team members From left:- DrV Rajaratnam, Dr K.Thambyrajah, Dr R.Vijayasingam and Mr Kathirgamaththamby ,Radiographer
  10. 10. Team with local leaders
  11. 11. Residual mines and their effects A below knee amputee following land mine Injury with prosthesis
  12. 12. Open air out patient clinic
  13. 13. AOInstructional course for medics/nurses
  14. 14. Compressed air unit for power tools
  15. 15. “Portable”Xray unit using dental Xray tube
  16. 16. Surgery with implantsand power tools
  17. 17. Medianandulnar nerveinjury treated with sural nerve cablegraft bridging gap
  18. 18. SSG done by member of nursing staff
  19. 19. Sampleof Clinicalcases seen and treated  Summary of cases seen  Approx 300 patients seen in out patients  12 orthopaedic cases operated on  Estimate another 1000 cases of reconstruction required with about 80% involving orthopaedics
  20. 20. Summary of orthopaedic cases to be done  Nerve grafts and repair  Tendon transfer for peripheral nerve injuries – radial,scaitic  Arthordesis of hip and knee for deranged joints  Limb lengthening for limb length discrepancies  Corrective osteotomy and fixation for malunion  Bone graft and skeletal stabilisation for non union  Shoulder joint reconstruction with vascularised free fibular transfer  Hand reconstruction with toe transfer
  21. 21. Politics Education Social Economics Technology Management
  22. 22. HumanitarianAid: Are Effectiveness andSustainability Impossible Dreams? Janice K. Kopinak 5 Emergency/Relief (E/R) Rehabilitation/Development (R/D)
  23. 23. Humanitarian Aid: Are Effectiveness and Sustainability Impossible Dreams?
  25. 25. MaxStirner  self-interest to be a universal truth or established viewpoint  the individual is dominated by illusory concepts ('fixed ideas' or 'spooks'), which can be shaken and undermined by each individual in order for that person to act fully.  Max Stirner influence on Nietzsche
  26. 26. Makings of an equitable, just and accessible system of sustainable global health for the needy Glocal Education Management
  27. 27. annually account for $740 million (in U.S. dollars) and rank first in the order of most expensive injury types, before knee and lower limb fractures ($562 million), hip fractures ($532 million), and skull-brain injury ($355 million). Productivity costs contributed more to the total costs of hand and wrist injuries (56%) than did direct health-care costs. Within the overall group of hand and wrist injuries, hand and finger fractures are the most expensive group ($278 million), largely due to high productivity costs in the age group of twenty to sixty-four years ($192 million). Why hand surgery De Putter, C. E., Selles, R.W., Polinder, S., Panneman, M. J. M., Hovius, S. E. R., &Van Beeck, E. F. (2012). Economic impact of hand and wrist injuries: health-care costs and productivity costs in a population-based study. TheJournal of bone and joint surgery. American volume, 94(9)
  28. 28. Glocal
  29. 29. Education, Education and Education
  30. 30. 1. Quality care/optimum outcomes - education 2. The current UG curriculum inadequate 3. Currently PG hand programs - exclusive 4. Need • flexibility, • student centred • on-demand learning that is • universally accessible, • affordable and • locally relevant.
  31. 31. 1. designed for practising doctors 2. universally accessible 3. e-learning platform 4. modular in nature 5. catering to working doctors educational needs The Solution
  32. 32. An on-line modular programme Three levels of qualifications: PG Certificate, Diploma and Master’s degree, MOODLE LMS International faculty - 8 Deployed on line ( Open University Malaysia
  33. 33. • Future of learning changing • Everyone can learn. • Communities of practice can build programs. • Ubiquitous learning changing the landscape • Massively open online course - the model • Alter the relationship of all stake holders • Viability of this educational model.
  34. 34. Management Intangible Tangible
  35. 35. Collaboration Communication Coordination Education Passion Compassion Concentration Effort
  36. 36. International Collaboration LocalSurgeons Systems Structure Strategy Values
  37. 37. Management
  38. 38. EMR in Underdeveloped Community
  39. 39. Academia in global health delivery  1. Delayed presentation of congenital tibial pseudarthrosis and neurofibromatosis: A difficult union. - Accepted for publication 2.The battle with Osteosarcoma - a 10 year experience of 35 patients - In completion (95% complete) 3. Development of a novel low cost instrument for removal of a bent femoral nail: A case report - In submission 4.TOTAL HIPARTHROPLASTY REHABILITATION IN CAMBODIA – BRIDGINGTHE GAP - In submission 5. Store, forward and conference – a new approach to telepathology in Cambodia - In submission 6.Acid burns in Cambodia:The human, medical and surgical legacy of 241 victims - In submission 7.Antibiotic beads for the developing world - premade, prepackaged and preloved - an in-vitro study (accepted as MScTrauma Surgery Dissertation) - in completion 8.An explosion of MRSA in Cambodia of soft tissue and bone infections - In completion (50% complete) 9.Twinned cities in friendship and orthopaedics - a telemedicine experience with Bristol and Phnom Penh - In completion 10. Long distant surgical training and mentoring - is it possible - In completion 11.An article for Surgeons News, Royal College of Edinburgh - requested by Journal.
  40. 40. WIIFM  Maslow’s need fulfilled  Ethical practice  Pushing the envelope  Enriching your practice  Legacy
  41. 41. Accessible, transparent and sustainable hand surgery  Beyond competency  Commitment  Compassion  Passion  Management  Governance  Funding  Human Capital
  42. 42. Establishednonunion of humerus with good handfunction needingbone grafting andORIF
  43. 43. Establishednon unionof radius andulna with good hand functionneeding bonegrafting andORIF
  44. 44. Major flash burn contracture of post axillaryfold needingrelease and reconstruction
  45. 45. Painfuldegenerative hipsecondaryto neglectedhip dislocation with avascularnecrosis of headtreated with formalarthrodesis withCobra plate and bonegraft ( 32 year oldfemale )
  46. 46. 5yearoldboy congenital abnormalities ofbothupper limbs. Onthe right, he has aone boneforearm(ulna), radially deviated hand andfour fingers(ofwhich 2arein syndactyly) Heis able toflex his elbow actively and passively. Onthe left, he has a very shorthumerus,andthree fingersin the hand.
  47. 47. 42yearoldmale. severeelectric burnon 2ndJune2013(held electrical wiring with bothhands) which had beentreated at provincial hospital. Bothhands -gangrene andbothlegs second degreeburn
  48. 48. 34yearsoldfemale,Right handdominant. weaknessintheleftarm sincebirth,nohistoryof injury-exactdelivery/birth historyunclear. Obviouswastingleft shoulder,upperarm.C5/C6 weakness-cannotabduct shoulder/flexelbow.Some tricepsfunctionmaintained. Goodwristextension/ fingerabductionbutsome reversibledeformities of PIPJs/DIPJs(actually presentinbothhands). Normalsensationinhand.
  49. 49. Thank you  