The reality I will face as President of SBOT

  Patricia Fucs 
  SICOT Active Member - São Paulo, Brazil

As the President-Elect 2018 of one of the oldest orthopaedic societies in the world, I will take the office of the Brazilian Society of Orthopaedics and Traumatology (SBOT) in January 2018. SBOT has almost 12 thousand members, and it is smaller only than the American AAOS and EFORT, the European Community. It is a large and complex society, with an important role in medical education and public health campaigns in Brazil, a country with 207 million inhabitants. 

Administering SBOT requires knowledge of business management and a strong commitment to human relations. Brazil is a country of continental dimensions, with extremely marked cultural and material differences: the infrastructure of a large hospital in metropolitan areas such as Rio de Janeiro or São Paulo has little to do with the reality of the orthopedist working in the Amazon. The orthopaedic surgeon trained in large cities who moves to the interior regions of the country is faced with multiple shortcomings. To cite one real case, a patient with a pelvic fracture in Manaus recently had to be stabilized and placed in a canoe, to be transported to a well-equipped hospital to be operated... only after 21 days of travelling.

This is indeed one of the difficulties I will face when assuming the SBOT presidency; being the president for all the 11,772 associated orthopedists of my country, with such different realities. In administering SBOT, I know it will be difficult to manage these differences. It will not be simple to remind the chiefs of the best Brazilian hospitals, that equal the best centres in the world, that the SBOT President will have to take care of young surgeons and of those working in the public health system too. The orthopedist of the great metropolis and the one working in smaller cities seem to live in different countries. One works without conditions in the poor interior and another has computed tomography devices, magnetic resonance equipment, and adequate instruments, and their profoundly different needs need to be known and fulfilled by the same SBOT, the society that represents both of them.

I have to look for these young doctors who, after nine years of studying, move to regions with Zika virus outbreaks and find out that infected pregnant women gave birth not only to children with microcephaly but also 26 children affected with congenital malformation of the lower limbs. A team of orthopedists is researching this and this work gives us great pride. I have been hearing these young orthopedic surgeons and one of them told me that for the surgery of a congenital dislocated hip of a child with microcephaly caused by Zika, he received as payment from the Government the total amount equivalent to US$ 26.00. The amazing part of this sad story is that this surgeon did not complain about the payment he received; instead, he asked SBOT to urge the authorities to eliminate underreporting of cases of orthopaedic malformation. Although the peak of the microcephaly epidemic occurred more than two years ago, there are still patients who are only cared for by general practitioners in their small towns. These children have never been taken to a hospital for a specialist diagnosis.

Among these young orthopaedic surgeons, there is an increasing number of women. Our society has 581 female orthopaedic surgeons, one woman for every 20 male orthopedists. I will be the first female President of SBOT in 82 years of history, and I hope I can work well for everybody. I take this job, however, confident, because by electing a woman at the Brazilian Society of Orthopaedics, my peers honored me with their confidence and proved that SBOT is a leading institution that pioneered in the way it responds to the current changes in the world, challenges, and differences. The importance of having a woman running the Brazilian Society of Orthopaedics has nothing to do with feminism, but with the growing importance of women's workforce in Medicine and Orthopaedics in particular.

In a globalized, equal world, that requires a lot of training and competence, gender is not the determining factor for a professional career. In Brazil, until recently considered a Third World country, we already have 378 women at the top of the hierarchy of big companies, and women represent 44% of the total Brazilian labour force. In Medicine, women are 40% of the 400 thousand physicians in Brazil and the majority of young doctors, who are under 29 years old. In 11 years, we will have more female than male doctors. I can observe this tendency in the postgraduation course of Santa Casa Medical School in São Paulo, where the number of men and women is already similar.

The developed world is no longer dominated by men. In many countries, the patient chooses the doctor for his/her training, or for the competence, without worrying about gender. Unfortunately, however, it is still harder for women to growth professionally and the acceptance of women as equals in traditionally male professions does not occur in the same way in all cultures. Recently, it was reported that among refugees arriving in Europe, fleeing from conflicts in North Africa and the Middle East, men refused to be cared for by women doctors. The refusal was for religious reasons and because they understand that it is up to the woman to have children and take care of the house only. Schools have just been blown up for having female students in countries where the right to education is not extended to women. And I remember the Pakistani Malala Yousafzai, who was shot for defending the right to literacy and was awarded the Nobel Prize. These pitiful facts show that the battle for meritocracy, the battle for creating an egalitarian society, where capacity is valued — not gender —, is not over yet, there is still a long way to go. But I want to remind everyone that the specialty we have chosen, Orthopedics, is a pioneer in offering equal opportunities. And a pioneer worldwide. The result of this pioneering practice ultimately benefits our patient, the ultimate goal of the physician's work. This equality of opportunities offered by Orthopedics Specialty has benefited me personally.

I was the third woman resident of the largest Department of Orthopaedics and Traumatology in Brazil. The first woman to join the staff of the Department of Orthopaedics of the Santa Casa de São Paulo - Pavilhão Fernandinho Simonsen, while I was trained for the subspecialty I chose, Paediatric Orthopaedics. This was and still is a long journey, in which it is necessary to coordinate all work activities with the role that I also perform in the family and at home, where I have always had a lot of support. I believe we all face difficulties throughout life, although for the woman the family obligations are still greater than for the man - after all, this is part of the learning of life. And one of the things I have learned is that we need to search and accept support from others.

In fact, the work in the associative entities has always motivated me. I joined several Board of Directors of the Brazilian Paediatric Orthopaedics Society, which I ended up presiding. Later I presided over the Latin American Paediatric Orthopaedic Society (SLAOTI), which confirms that not only Brazil has defeated gender prejudice, but also South America. I was also part of the Board of Directors of SICOT for six years and I am currently the chair of its Paediatric Orthopaedics Committee. I can say that it has not always been easy to deal with the male world of Orthopaedics, but I believe the result of my work has been and still is quite good. More recently, I became a full professor at my Medical School, Santa Casa de São Paulo, with undergraduate and postgraduate activities, and now I prepare to take over the SBOT presidency, a huge new challenge.

In the future, men and women from all professions will have their work valued by knowledge and competency, and also in Orthopaedics. When that time comes, I will not forget that we have reached this point as the result of the work that began so long before.