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Accessible and Sustainable Global Hand SurgeryMr Vaikunthan RajaratnamMBBS(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
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 of Visitor 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
IndiaSri LankaBangladeshCambodia
Maslow's hierarchy of needs
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
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
Inadequate health systems damage the growth of developing nationsDr Brian Brink explains why healthcare systems should be understood as a core part of a country's GDP
"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.”
Photo Essay of medical relief mission to Tamil EllamDr K.Thambyrajah F.R.C.S..orthopaedic surgeon
Dr R.Vijayasingam F.R.C.S.general surgeon
Dr V. Rajaratnam F.R.C.S.hand surgeon
Team members
From left:- Dr V Rajaratnam, Dr K.Thambyrajah, Dr R.Vijayasingam and Mr Kathirgamaththamby ,Radiographer
Team with local leaders
Residual mines and their effects
A below knee amputee following land mineInjury with prosthesis
Open air out patient clinic
AO Instructional course for medics/nurses
Compressed air unit for power tools
“Portable” Xray unit using dental Xray tube
Surgery with implants and power tools
Median and ulnar nerve injury treated with sural nerve cable graft bridging gap
SSG done by member of nursing staff
Sample of Clinical cases 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
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
PoliticsEducationSocialEconomicsTechnologyManagement
Humanitarian Aid: Are Effectiveness and Sustainability Impossible Dreams?
Janice K. Kopinakhttp://sites.tufts.edu/jha/archives/1935
Emergency/Relief (E/R)
Rehabilitation/Development (R/D)
Humanitarian Aid: Are Effectiveness and Sustainability Impossible Dreams?
THE GLUE THAT HOLDS IT ALL TOGETHER
Max Stirner
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
Why bother ?
Makings of an equitable, just and accessible system of sustainable global health for the needy
Glocal
Education
Management
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. The Journal of bone and joint surgery. American volume, 94(9)
Glocal
Education, Education and Education
1. Quality care/optimum outcomes - education 2. The current UG curriculum inadequate3. Currently PG hand programs - exclusive 4. Need
• flexibility, • student centred • on-demand learning that is • universally accessible, • affordable and • locally relevant.
1. designed for practising doctors 2. universally accessible3. e-learning platform4. modular in nature5. catering to working doctors educational
needs
The Solution
An on-line modular programme Three levels of qualifications:
PG Certificate, Diploma and Master’s degree,
MOODLE LMSInternational faculty - 8 Deployed on line (handsurgeryedu.com).Open University Malaysia
• 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.
Management
Intangible Tangible
People
Organisational
Relationships
Real Estate
Equipment
CollaborationCommunicationCoordinationEducationPassionCompassionConcentrationEffort
International CollaborationLocal SurgeonsSystemsStructureStrategyValues
Management
EMR in UnderdevelopedCommunity
Academia in global health delivery
1. Delayed presentation of congenital tibial pseudarthrosis andneurofibromatosis: 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 bentfemoral nail: A case report - In submission
4. TOTAL HIP ARTHROPLASTY REHABILITATION IN CAMBODIA – BRIDGING THEGAP - In submission
5. Store, forward and conference – a new approach to telepathology inCambodia - In submission
6. Acid burns in Cambodia: The human, medical and surgical legacy of241 victims - In submission
7. Antibiotic beads for the developing world - premade, prepackagedand preloved - an in-vitro study (accepted as MSc Trauma SurgeryDissertation) - 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 telemedicineexperience 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.
WIIFM
Maslow’s need fulfilled
Ethical practice
Pushing the envelope
Enriching your practice
Legacy
Accessible, transparent and sustainable hand surgery
Beyond competency
Commitment
Compassion
Passion
Management
Governance
Funding
Human Capital
Surgeons
Organisation
Established non union of humerus with good hand function needing bone grafting and ORIF
Established non union of radius and ulna with good hand function needing bone grafting and ORIF
Major flash burn contracture of post axillary fold needing release and reconstruction
Painful degenerative hip secondary to neglected hip dislocation with avascular necrosis of head treated with formal arthrodesis with Cobra plate and bone graft ( 32 year old female )
5 year old boy congenital abnormalities of both upper limbs. On the right, he has a one bone forearm (ulna), radially deviated hand and four fingers (of which 2 are in syndactyly) He is able to flex his elbow actively and passively. On the left, he has a very short humerus, and three fingers in the hand.
42 year old male. severe electric burn on 2nd June 2013 (held electrical wiring with both hands) which had been treated at provincial hospital. Both hands - gangrene and both legs second degree burn
34 years old female, Right hand dominant. weakness in the left arm since birth, no history of injury - exact delivery / birth history unclear. Obvious wasting left shoulder, upper arm. C5/C6 weakness - cannot abduct shoulder / flex elbow. Some triceps function maintained. Good wrist extension / finger abduction but some reversible deformities of PIPJs / DIPJs (actually present in both hands). Normal sensation in hand.