5/9/2014 No financial disclosures to report Richard Coughlin, MD, MSc Director, IGOT Friday 9 May, 2014 Inman Abbott Alumni Annual Meeting UCSF, Mission Bay San Francisco, CA Shortage of health care Africa lacks an estimated providers is a fundamental underlying issue in global health One Million health care workers 1
5/9/2014 Causes of Impairment A traditional outlook Malnutrition 20% Infectious Diseases: HIV, TB, Malaria 11% 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 Causes of Impairment A Different Outlook Road traffic injuries: the facts Accident, Congenital Diseases Trauma 20% .24 million 16% 1 3 out of 4 road traffic deaths occur every year. road deaths are among men # 1 Malnutrition 20% Accident/Trauma 16% cause of death among those aged 15-29 years Infectious Diseases 11% Non-Infectious Diseases 20% Congenital Diseases 20% Other (including ageing 18%) 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 DISABILITY IN DEVELOPMENT - A Human Rights Issue 2
5/9/2014 In 2010: 1990 2020 1 LRI IHD Injuries 11.2% of DALYs 2 Diarrhea Depression TB 1.99% of DALYs 3 Perinatal RTA Diarrhea 3.61% of DALYS 4 Depression CVD Malaria 3.33% of DALYS 5 IHD COPD Cancer 7.6% of DALYs 6 CVD LRI HIV 3.29% of DALYS 7 TB TB 8 Measles War � Injuries alone account for more DALY’s than 9 RTA Diarrhea TB, Malaria, and HIV COMBINED 10 Congenital HIV � 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 3
5/9/2014 UCSF Orthopedic Global Elective UCSF Orthopedic Global Elective Nepal Nicaragua Ghana Tanzania Malawi 44 South Africa 8 8 5 3 1 Nicaragua Ghana South Africa Tanzania Malawi Nepal � Past Models of Orthopedic Surgery and Global Health � Volunteerism and Service � The “ New Orthopedic Surgery and Global � Short-term Missions Health ” � Sustainable Partnerships Purpose of study: � Research, Education and Capacity Building Assess the impact of an international health elective on orthopaedic residents 4
5/9/2014 IGOT, the Institute for Global Orthopaedics and Traumatology, is a non- profit program started by the faculty and residents of the University of � Global Research Initiative California, San Francisco (UCSF) Department of Orthopaedic Surgery � Design, mentor & support for partner research � Research Accelerator � Global Knowledge Exchange � Resident Rotation � Educational Courses � Global Network 5
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5/9/2014 MOI | Muhimbili Orthopaedic MOI | Muhimbili Orthopaedic � May 28-June 1 2014 Institute, MUHAS |Dar es Institute, MUHAS |Dar es Univ. of Utah Univ. of Utah Salaam, Tanzania Salaam, Tanzania Dept. of Ortho Dept. of Ortho � Dar es Salaam, Tanzania HDRC | Hospital for HDRC | Hospital for � Anticipated ~100 East African Attendees Rehabilitation of Disabled Rehabilitation of Disabled Children | Katmandu, Children | Katmandu, KATH | Komfo Anokye KATH | Komfo Anokye � Addition of: Nepal Nepal Teaching Hospital | Teaching Hospital | Kumasi, Ghana Kumasi, Ghana � Rotational Flap Curriculum IGOT | UCSF IGOT | UCSF � Evaluation of Impact on limb salvage � Cost Effectiveness of locally driven course University of Malawi University of Malawi Hospital Lenin Fonseca Hospital Lenin Fonseca | Managua, Nicaragua | Managua, Nicaragua | Blantyre, Malawi | Blantyre, Malawi 7
5/9/2014 IGOT Conferences Trail ’13-14 Chicago, IL Yale, CT Phoenix, AZ San Francisco, CA Trinidad & New Orleans, LA Tobago Ghana Tanzania � 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 � UCSB Dept. of Global & � HVO International Studies � SIGN � COAN � University of Utah, Dept. of � SHOT-Societe Haitian Orthopaedic Surgery Orthopaedic Tramatologia � OTC � SICOT � UC Berkeley Dept. of Public � AMM Health � Northern Medical Unit at � OTA University of Manitoba � WHO � Inuit Health & Human � Operation Rainbow Services 8
5/9/2014 � 4 International Summits (~250 Orthopaedic � Requires political will Surgeons all from developing countries, ~150 Residents, ~20 Faculty) � Need to work within University/ACGME � In collaboration with SIGN policies � Partners: ACGME Accredited 5 Resident Global � “Neglected Stepchild” of Global Health Rotation Sites � Opportunity costs • Ghana, Tanzania, Nicaragua, Malawi & Nepal � Personal Health/Travel/Time from family � Global Research: Average 1-2 publications a � Funding/funding/funding/… month (66 to Date) � Knowledge Exchange: 75 IGOT Ambassadors & Scholars to and from our partner institutions � Pairing an alumnus with a current resident to � Established from a history of volunteerism join or support the global elective rotation and clinical mission trips with residents experience � Established formal rotation in South Africa � 1-4 weeks at approved rotation site with HVO/OO emphasizing teaching/training � HVO-OO tax deduction (volunteer) model � Travel support $2,500 per resident � 2006 formalized IGOT as an academic initiative Active endowment fund(McConnachie Fund) � Emphasize sustainable academic to academic for global elective (needs investment) model 9
5/9/2014 IGOT and Health Volunteers Overseas Malawi and UCSF www.globalorthopaedics.org Coughlin@orthosurg.ucsf.edu Todd Kim, MD Henry Krigbaum, MD Malawi Thanks Rick and UCSF “Warm heart of Africa” 10
5/9/2014 Providing Specialty Care Challenges without Specialists… � In 1985 no permanent � Top Ten List: orthopaedic surgeons Poorest Countries � Dr. Ed Blair began a formal training program for � 15 million people “orthopaedic clinical officers” � Neonatal mortality: � Medical assistants undergo an 109 per 1000 18-month program; similar to a “mid-level” provider � Life expectancy: 41 � Focus on nonoperative and � 266 MDs urgent operative management � 9 orthopaedic surgeons of orthopaedic trauma and infections What happens in a district hospital? � 93% Trauma; 5% Infections � Nonoperative treatment � Since 1985 approximately 150 of fractures OCO’s have been trained � Simple surgical treatment � All orthopaedic care in the 26 of fractures outlying district hospitals is � Urgent surgical treatment provided by OCO’s of open fractures, severe � None have left Malawi to trauma practice elsewhere � Surgical treatment of � Vast majority of care provided infections, amputations by OCO’s 11
5/9/2014 What should OCO’s do? Also need more MDs How do we integrate MD’s? � 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 Malawi Trauma Health Volunteers Overseas UCSF � Professor Nyengo Mkandawire � HVO volunteer program well established � 2014 Partnership with UCSF 12
5/9/2014 Hip Fusion Looking Ahead Open Knee Dislocation � Carry on and re- invigorate HVO volunteer program � Continue to develop residency training program � Build on the new partnership with UCSF Prospective study: skeletal traction vs. SIGN nailing of simple, closed femoral � Resident exchange shaft fractures � Research 13
5/9/2014 And the Lake… You and Malawi � Orthopaedic Equipment � “used” ex fix components � C-spine Halo equipment � Alumni Partnership with Residents � Come for a visit � Support a resident � Research 14
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