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.   

Thank you vaikunthan@gmail.com

www.handsurgeryedu.com