SICOT e-Newsletter

Issue No. 36 - September 2011

Editorial by H.K.T. Raza
President, Asia Pacific Orthopaedic Association
hktraza@yahoo.com

The Concept of Social Orthopaedics


Introduction:

Orthopaedic Surgery has shown rapid progress in the last decade. The new millennium has ushered in new techniques of minimally invasive surgery with rapid progress also in joint replacement surgery, arthroscopic techniques, spine surgery and trauma management. However, what is important to know is:

1. Have the benefits of this technical advancement and our pursuit for excellence reached vast populations of the under privileged across the world?
2. Are we doing enough for the ailing humanity beyond the confines of our clinics/hospitals.
3. Do we realize that in our race to create top quality facilities for our patients in the burgeoning 5-star hospitals, we have a responsibility to the society/community which should extend to the periphery?

The Concept of “Social Orthopaedics” addresses these questions. It is not a mere slogan. It should be taken as a movement by Orthopaedic Surgeons to show our commitment to Society. There is a debate on whether the concept should be “Social Orthopaedics” or “Community Orthopaedics”. Community Orthopaedics as an outshoot of “Community Medicine” sounds too professional and does not carry the far reach of “Social Orthopaedics” which envisages involvement of not only Health Professionals under its banner but also Social Workers, philanthropists, politicians and all personnel concerned with the general well being of the common men. It includes in its domain all social factors which may have a bearing on the health of the population. Through this small article I would like to appeal to colleagues to reach out to the community rather than work only within the confines of our clinics/hospitals.
 

Broad Areas For Social Orthopaedics:

1. Disaster mitigation and preparedness.
2. Road traffic accidents.
3. Orthopaedic physically challenged people.
4. Epidemiology of orthopaedic diseases.
5. Public awareness campaigns for various orthopaedic problems.
6. Social economic and psychological aspects of trauma/orthopaedic diseases.
7. Study of lifestyles of people affecting the musculoskeletal system.
8. Advising government on formulating policies for the above.

  

1. Disaster mitigation and preparedness: With the ever increasing incidence of major natural and man made disasters large population across the world are at risk of sudden loss of life, property, and means of livelihood. There have to be sustained actions to reduce or eliminate long-term impacts and risks associated with natural and human-induced disasters. Vulnerable populations include individuals expected to need special assistance during an emergency.
   (a) Low-income populations; (b) Older populations; (c) Populations living in mobile homes; (d) Populations in assisted living facilities; (e) Mental health population; (f) Incarcerated.
   We need to contribute effectively to disaster mitigation efforts through community preparedness by public education and by organizing disaster simulation exercises. Identification and listing of all available manpower, hospitals, ambulances, and so on, for rapid and effective disaster management is essential. We need to train the available manpower and thereby create a “Disaster Management cadre”.
     
2. Road traffic accidents: One hundred and fifty thousand injured worldwide every day, three thousand deaths, fifteen thousand disabled for life: these are alarming statistics. Road traffic accidents have grown to be the leading contributor of the global burden of disease and disability. While public awareness programmes and training of the general public are undertaken regularly in some developed countries there is a lot to be done in this direction in developing and underdeveloped nations. Effective pre-hospital care of the injured cannot be over-emphasized. Orthopaedic Surgeons, as one of the main stakeholders, have a great responsibility to reach out and train the “first-responders”, i.e. the man on the street, for basic resuscitation, first aid and transport of casualties.
     
3. Orthopaedic physically challenged people: There is a huge burden of physically challenged people requiring corrective surgery, especially in the third world with limited resources there are always long waiting lists even in tertiary care hospitals. Organization of properly managed camps under strict protocols helps to decrease this burden. Medical volunteers from the developed world should, and many do, donate equipment, manpower and expertise for such projects.
     
4. Epidemiology of orthopaedic diseases: The “Bone and Joint Decade” Campaign has brought into focus the need for us to assess the global burden of Musculoskeletal diseases. A lot needs to be done in this direction by setting up agencies for proper surveillance and planning. Orthopaedic Organizations across the world can identify specific areas of work and provide adequate funds for research in this neglected field.
     
5. Public awareness campaigns for various orthopaedic problems: Public Health Education Programmes are a domain where Orthopaedic Surgeons engage in, I dare say, mainly for commercial reasons, like joint replacement surgery. “Preventive” Orthopaedics of awareness regarding sports related injuries, injuries in the work place, osteoporosis, degenerative disorders, are not as widely taken up as major issues as the global burden demands.
     
6. Social economic and psychological aspects or trauma/orthopaedic diseases: While treating patients we seldom go into the details of their social milieu and what economic impact their illness is causing to them or their family. Psychological aspects are very rarely addressed by busy consultants wanting to get “on with the job” – treating the body but never bothering to dwell on what is going on in the mind. A postgraduate thesis on trauma victims and subsequent work with spinal trauma patients have revealed alarming facts which are routinely missed. What happens to the patient after we hand him/her the “Hospital Discharge Card”. Ever pondered on this for a spinal trauma patient who goes back to his mud house which does not have a cot and is poorly ventilated?
     
7. Study of lifestyles affecting the musculoskeletal system: This may be an extension of epidemiology of diseases and building up of subsequent public awareness campaigns. In the fast changing world to computerization and “hand on the mouse” lifestyles we need to draw back our children to the playgrounds. The era of “fast food” is also taking its toll on long-term health problems of teenagers. Does the buck stop at someone amongst us to take up these issues?
     
8. Advising government on formulating policies for the above: Many of the activities noted above require framing of effective policies and allotment of funds. Engaging politicians on these various issues is the need of the hour. Orthopaedic surgeons are very influential people in the community, and can use their influence with politicians to serve the community on a larger scale than they realize they are capable of.

   
I have raised several issues. There is a need for collective work in these areas. I salute the “Bone & Joint Decade” campaign for bringing into focus many of these issues but there are miles to go before any of us go to sleep.