One Million health care workers 1 5/9/2014 Causes of Impairment - - PowerPoint PPT Presentation

5/9/2014 1

Richard Coughlin, MD, MSc Director, IGOT Friday 9 May, 2014 Inman Abbott Alumni Annual Meeting UCSF, Mission Bay San Francisco, CA

No financial disclosures to report

Shortage of health care providers is a fundamental underlying issue in global health

Africa lacks an estimated

One Million

health care workers

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Causes of Impairment

A traditional outlook

Malnutrition 20% Accident/Trauma 16% Infectious Diseases 11% Non-Infectious Diseases 20% Congenital Diseases 20% Other (including ageing 18%)

DISABILITY IN DEVELOPMENT - A Human Rights Issue

Infectious Diseases: HIV, TB, Malaria 11%

Malnutrition

20%

Causes of Impairment

A Different Outlook

Malnutrition 20% Accident/Trauma 16% Infectious Diseases 11% Non-Infectious Diseases 20% Congenital Diseases 20% Other (including ageing 18%)

DISABILITY IN DEVELOPMENT - A Human Rights Issue

Accident, Trauma

16%

Congenital Diseases 20%

3

• ut of 4

road deaths are among men

1 .24 million

road traffic deaths occur every year. cause of death among those aged 15-29 years

# 1

Road traffic injuries: the facts

Source: Global status report on road safety 2013 www.who .int/vio le n ce _injury_p re ve n tio n /ro ad _ sa fe ty_ sta tu s

5/9/2014 3 1990 2020

1 LRI IHD 2 Diarrhea Depression 3 Perinatal RTA 4 Depression CVD 5 IHD COPD 6 CVD LRI 7 TB TB 8 Measles War 9 RTA Diarrhea 10 Congenital HIV

Injuries alone account for more DALY’s than

TB, Malaria, and HIV COMBINED

In 2010: Injuries 11.2% of DALYs TB 1.99% of DALYs Diarrhea 3.61% of DALYS Malaria 3.33% of DALYS Cancer 7.6% of DALYs HIV 3.29% of DALYS

From 1992 through 1998 Short term missions under the auspices of

Operation Rainbow to Central America

15/36 residents joined the program 6 continued after graduation 3 became mission leaders

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UCSF Orthopedic Global Elective

Nicaragua Nepal Ghana Tanzania South Africa Malawi

5 8 44 8 3 1 Nicaragua Ghana South Africa Tanzania Malawi Nepal

UCSF Orthopedic Global Elective

Purpose of study: Assess the impact of an international health elective on orthopaedic residents

Past Models of Orthopedic Surgery and

Global Health

Volunteerism and Service Short-term Missions The “New Orthopedic Surgery and Global

Health”

Sustainable Partnerships Research, Education and Capacity Building

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IGOT, the Institute for Global Orthopaedics and Traumatology, is a non- profit program started by the faculty and residents of the University of California, San Francisco (UCSF) Department of Orthopaedic Surgery

Global Research Initiative

Design, mentor & support for

partner research

Research Accelerator

Global Knowledge Exchange

Resident Rotation Educational Courses

Global Network

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IGOT | UCSF IGOT | UCSF

MOI | Muhimbili Orthopaedic Institute, MUHAS |Dar es Salaam, Tanzania MOI | Muhimbili Orthopaedic Institute, MUHAS |Dar es Salaam, Tanzania KATH | Komfo Anokye Teaching Hospital | Kumasi, Ghana KATH | Komfo Anokye Teaching Hospital | Kumasi, Ghana

Hospital Lenin Fonseca | Managua, Nicaragua Hospital Lenin Fonseca | Managua, Nicaragua

University of Malawi | Blantyre, Malawi University of Malawi | Blantyre, Malawi

HDRC | Hospital for Rehabilitation of Disabled Children | Katmandu, Nepal HDRC | Hospital for Rehabilitation of Disabled Children | Katmandu, Nepal

• Univ. of Utah
• Dept. of Ortho
• Univ. of Utah
• Dept. of Ortho

May 28-June 1 2014 Dar es Salaam, Tanzania Anticipated ~100 East African Attendees Addition of: Rotational Flap Curriculum Evaluation of Impact on limb salvage Cost Effectiveness of locally driven course

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Ghana Tanzania

IGOT Conferences Trail ’13-14

Trinidad & Tobago Chicago, IL Yale, CT Phoenix, AZ San Francisco, CA New Orleans, LA

Sept 2013: WHO GIEESC WCSOT |Trinidad and Tobago Oct 2013: OTA Annual Meeting | Phoenix, AZ Best Resident Paper: Flexible Nails Paa Kwesi Baidoo (KATH ‘16) & Scott Kaiser (UCSF ’13) Feb 2014: WACS | Kumasi, Ghana April 2014 ASE Association of Surgical Educators | Chicago, IL Unite for Site | Yale, CT UCSF Global Health Consortium | San Francisco, CA Wilson Bost Interurban Society | San Francisco, CA March 2014: AAOS | New Orleans, LA May 2014: MOI Tanzania Trauma Course | Dar es Salaam Tanzania

AAOS HVO SIGN University of Utah, Dept. of

Orthopaedic Surgery

OTC UC Berkeley Dept. of Public

Health

OTA WHO Operation Rainbow UCSB Dept. of Global &

International Studies

COAN SHOT-Societe Haitian

Orthopaedic Tramatologia

SICOT AMM Northern Medical Unit at

University of Manitoba

Inuit Health & Human

Services

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4 International Summits (~250 Orthopaedic

Surgeons all from developing countries, ~150 Residents, ~20 Faculty)

In collaboration with SIGN Partners: ACGME Accredited 5 Resident Global

Rotation Sites

• Ghana, Tanzania, Nicaragua, Malawi & Nepal

Global Research: Average 1-2 publications a

month (66 to Date)

Knowledge Exchange: 75 IGOT Ambassadors &

Scholars to and from our partner institutions

Requires political will Need to work within University/ACGME

policies

“Neglected Stepchild” of Global Health Opportunity costs Personal Health/Travel/Time from family Funding/funding/funding/… Pairing an alumnus with a current resident to

join or support the global elective rotation experience

1-4 weeks at approved rotation site HVO-OO tax deduction (volunteer) Travel support $2,500 per resident

Active endowment fund(McConnachie Fund) for global elective (needs investment)

Established from a history of volunteerism

and clinical mission trips with residents

Established formal rotation in South Africa

with HVO/OO emphasizing teaching/training model

2006 formalized IGOT as an academic

initiative

Emphasize sustainable academic to academic

model

5/9/2014 10 www.globalorthopaedics.org Coughlin@orthosurg.ucsf.edu IGOT and Health Volunteers Overseas Malawi and UCSF

Todd Kim, MD Henry Krigbaum, MD

Thanks Rick and UCSF “Warm heart of Africa”

Malawi

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Top Ten List:

Poorest Countries

15 million people Neonatal mortality:

109 per 1000

Life expectancy: 41 266 MDs 9 orthopaedic surgeons

Challenges

Providing Specialty Care without Specialists…

In 1985 no permanent

• rthopaedic surgeons
• Dr. Ed Blair began a formal

training program for “orthopaedic clinical officers”

Medical assistants undergo an

18-month program; similar to a “mid-level” provider

Focus on nonoperative and

urgent operative management

• f orthopaedic trauma and

infections

Since 1985 approximately 150

OCO’s have been trained

All orthopaedic care in the 26

• utlying district hospitals is

provided by OCO’s

None have left Malawi to

practice elsewhere

Vast majority of care provided

by OCO’s

93% Trauma; 5%

Infections

Nonoperative treatment

• f fractures

Simple surgical treatment

• f fractures

Urgent surgical treatment

• f open fractures, severe

trauma

Surgical treatment of

infections, amputations

What happens in a district hospital?

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College of Medicine of the

University of Malawi started 1991

Now graduates

approximately 50 new doctors each year

2004 began orthopaedic

residency training

Currently 2 trainees;

funding for 4 more to enroll in the next year

Also need more MDs

What should OCO’s do? How do we integrate MD’s?

Professor Nyengo

Mkandawire

HVO volunteer

program well established

2014 Partnership

with UCSF

Malawi Health Volunteers Overseas UCSF

Trauma

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Hip Fusion Open Knee Dislocation

Carry on and re-

invigorate HVO volunteer program

Continue to develop

residency training program

Build on the new

partnership with UCSF

Resident exchange Research

Looking Ahead

Prospective study: skeletal traction vs. SIGN nailing of simple, closed femoral shaft fractures

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Orthopaedic Equipment “used” ex fix

components

C-spine Halo equipment Alumni Partnership with

Residents

Come for a visit Support a resident Research

You and Malawi And the Lake…