Sunday, February 07, 1999
Discussing aspects of the organization at an instructional course, Orthopaedic Surgery in the Developing World, Dr. Dormans presented statistics that graphically dem-on-strated the severity of the need.
People in the developing world have a life expectancy of only 52 years, which is the life expectancy of the people in the United States a century ago, Dr. Dormans said. Furthermore, while developed countries currently have zero population growth, developing countries still demonstrate rapid population growth. By the year 2025, there will be five times the number of people living in developing countries as in the developed world.
Dr. Dormans said that 80 percent of the world's orthopaedic surgeons practice in developed nations. If the United States shared the same proportion of orthopedists to the population as Malawi, only 30 would cover the entire U.S. population.
Dr. Dormans believes that creating and supporting training programs are the most effective ways of addressing the problem and improving care. Teaching how to teach makes the most lasting difference, Dr. Dormans said, reminding the audience of the saying: "Give a man a fish and help him for a day; teach a man to fish and help him for a lifetime."
Problems encountered in these regions include polio, tuberculosis, neglected trauma and neglected congenital disorders, according to Dr. Dormans. The World Health Organization has estimated that 72 million people have polio contracted in this decade.
Dr. Dormans cited factors that hinder orthopaedic care delivery, such as lack of transportation and communication systems. Furthermore, patients are often unaware that medical services exist; they may seek care from a traditional healer; equipment is often not in working order; limited hospital budgets preclude drug, implant or supply purchase; and trained providers, including surgeons, nurses, physical therapists, and prosthetists, are lacking.
Dr. Dormans mentioned that many other organizations provide services for these countries, including the International Center for Ortho-pedic Education (ICOE). Initiated in 1992 by the American Orthopaedic Association, the nonprofit matching service provides training and educational that include observerships, hands on experiences, teaching opportunities, research opportunities, service experiences and conferences. ICOE's services are free.
Indonesia is an example of a "true success story," said Dr. Dormans. Teaching the Indonesians how to teach has enabled them, over the past 30 years, to develop their own orthopaedic organization. In addition, they manufacture their own prostheses and implants and hold their own quarterly review courses.
"Working in another culture is a privilege and makes us better physicians."
Richard Fisher, MD, at the University of Colorado said that in addition to musculoskeletal problems common throughout the world, physicians can encounter other conditions less familiar and sometimes frightening. These conditions can include infections such as chronic osteomyelitis, tuberculosis or leprosy, acute trauma, late trauma presentation, congenital deformity and tumors, polio, war injuries from landmines, and gunshot or machete wounds.
"Approximately 100 million unexploded land mines remain through--out the world," Hugh Watts, MD said. "If all of them exploded, it would be the equivalent of one Oklahoma City bombing per day for 1,700 years."
He said that the need is worsening. The population is increasing, and resources are diminishing. Furthermore, the relative difference in technology between developing and developed countries is getting larger.
"We share this urge to help. What can be done?" Watts asked. "Simply exporting the American version will not work." The work must have a multiplying effect, Watts said. "We cannot treat everyone. They must become self-sufficient." Watts emphasized that teaching is the major way to multiply efforts.
Other things that can be done include breaking the "language log jam." Most medical literature is in English, but simple texts could be translated. Appropriate technology must take into account economic andtechnological capabilities, local medical problems, and climate, geography and culture, Watts said. Cultural differences that cannot be ignored include religions, cure expectations, and local healers.
Treatment should be "simple, with obvious benefits," Watts said. Furthermore, he added, physicians should "know when not to treat."
He discussed reasons why helping efforts so often go awry, citing factors such as inappropriate technology, or local practitioners who may feel they are being looked down on. Politics and rivalries between institutions, such as local sponsors, international organizations and religious denominations, can also hinder efforts.
"Are there enough hours in a day to make an impact"? he asked. "We cannot be the World Health Organization, Mother Theresa and Dr. Albert Schweitzer to all these countries. We must make choices." Watts concluded by saying "don't let reality kill your enthusiasm."