Patient first
Powerful message from the Sri Lanka Orthopaedic Association
It was not just about treating injuries and diseases of our complex musculoskeletal system which includes bones, joints, ligaments, tendons, muscles and nerves, but an evening where the core of the healer’s vocation was put under the spotlight.
The patient being in the very bones of those gathered for the inauguration of the 11th Annual Academic Sessions of the Sri Lanka Orthopaedic Association (SLOA) on Thursday night, was evident from all the passionate speeches delivered from the podium.
The inauguration of the two-day sessions on the theme ‘Improving orthopaedic care through focused teaching and training’ was at the Galadari Hotel in Colombo, while a pre-congress live operative workshop on unicompartmental knee was held at the National Hospital of Sri Lanka (NHSL) on Wednesday and a post-congress workshop on the ‘Current approach to the management of brachial plexus birth palsy’ is being held today at the Lady Ridgeway Hospital (LRH) for Children.
Setting the tone for the evening, the sessions and orthopaedic care in the country, SLOA President Dr. Sunil Wijayasinghe sent out a strong appeal for the strengthening of “correct goals” which ensured that the patients must come first; there should be professionalism at all times along with evidence-based practice and adequate skills, while maintaining ethical standards.
Quoting ex-American President Franklin D. Roosevelt, he said: “The test of our progress is not whether we add more to the abundance of those who have much, it is whether we provide enough for those who have little.”
He reiterated that their focus should be-cost-effective treatment suitable for
Tracing the improvements in orthopaedic care delivery over the years, Dr. Wijayasinghe said that in 1992 there were only 10 orthopaedic surgeons serving 17.5 million people, with just one surgeon for 1.75 million people. However, by 2019, 27 years later, there are 83 orthopaedic surgeons for 22 million people, with one surgeon per 265,000.
the Sri Lankan setting and maintenance of standards of teaching and training, urging that with the increasing membership of the SLOA there may be challenges such as difficulty in achieving consensus and goals being different at times. “We need to be careful of personal agendas too.”
Tracing the improvements in orthopaedic care delivery over the years, Dr. Wijayasinghe said that in 1992 there were only 10 orthopaedic surgeons serving 17.5 million people, with just one surgeon for 1.75 million people. However, by 2019, 27 years later, there are 83 orthopaedic surgeons for 22 million people, with one surgeon per 265,000.
Orthopaedics in Sri Lanka is at an important juncture. General, arthroplasty, spinal, paediatric – which way should we go? The proposed sub-specialities are adult reconstruction & pelvi-acetabular fractures; orthopaedic oncology; foot & ankle; upper limb; arthroplasty; paediatrics; and spine, he said.
With society undergoing rapid transformation with changing goals, values and technological aids and having more access to information,
Dr. Wijayasinghe had some pertinent advice to the younger generation. “The patient should come first and you should never lose your common sense and the humane touch. This is while you practise evidence-based medicine, encouraging the peer-review process and trying to do the correct thing at all times.”
The Guest-of-Honour, Dr. M. Vasantha Perera, said that over the last four decades, members of the SLOA have provided leadership and guidance in the training of orthopaedic surgeons. Sri Lanka can expect to have a total of around 140 orthopaedic surgeons soon which gives a ratio of one orthopaedic surgeon to
160,000 people. The internationally recognized ratio is 1 in 25,000.
While reflecting on the progress achieved, he also focused on the challenges ahead, placing them in two broad categories – improving training in special interest areas and providing optimal facilities to practise orthopaedics.
“During the last few decades, the field of orthopaedics has expanded and now includes a number of well-developed special interest areas. It is not possible for a single surgeon to have expertise in all these areas. Therefore, sub-speciality development is vital to provide better care to people,” he pointed out.
This training, according to Dr. Perera, can be done either in separate sub-speciality units or by working with a surgeon who has a special interest in a particular area. Currently, there are only three sub-speciality units in the country – two for paediatrics at the LRH in Colombo and in Kandy respectively; and a spine unit at the Neuro-Trauma Unit of the NHSL, the only centre offering correction for spinal deformities.
“Ideally, there should be a paediatric unit in every teaching hospital and even though spinal trauma is managed in all orthopaedic units in the country, at present there are 43 children with adolescent idiopathic scoliosis requiring surgery. More units offering this service are a necessity and will also help in training in the sub-speciality of the spine,” he said.
“The second challenge is providing optimal facilities to practise orthopaedics. The siting of new orthopaedic units is decided by the Health Ministry with an input from the SLOA. These units are either duplications of already existing units in major hospitals or are in areas where access to an orthopaedic surgeon is difficult. These new units in difficult areas often have minimum facilities. The emphasis of these units is the basic management of trauma. Sub-speciality development is not a priority. Unfortunately, many of those who return after overseas training are posted to these newly-established stations where they do not have the opportunity to practise the skills they have learnt,” he said.
Dr. Perera added that with time, they are likely to lose the surgical skills for which they were trained. This is a tragedy as much time, effort and money have been expended on their training. The ongoing problems of lack of funding and infrastructure development need to be looked into.
Meanwhile, an impassioned plea went out from the Chief Guest and Director of the Ponseti International Association, University of Iowa, America, Dr. Jose A. Morcuende who spoke on the ‘Global impact of the Ponseti Method’ and how to overcome the condition of clubfoot.
“The Ponseti Method introduced to the world by Dr. Ignacio V. Ponseti, uses a series of gentle manipulations and plaster casts to return the foot to its normal shape and function,” he said, citing research to prove that this method contributed to an 85% reduction in surgery for children with clubfoot in the first year of their lives. Across the world, a child with clubfoot is born every three minutes.
Reminding the audience of the main elements of the Hipprocratic Oath such as ‘respecting the hard won scientific gains of those physicians in whose steps I walk in’; ‘avoiding the twin traps of over-treatment and therapeutic nihilism’; and that ‘warmth, sympathy and understanding may outweigh the surgeon’s knife’, Dr. Morcuende urged the adoption of the Ponseti Method and the setting up of Ponseti clubfoot clinics to reach all, as a major public health intervention.