Emergence of Global Surgery
Global Surgery is a new word for an effort that has been carried out by generations of orthopaedic surgeons in our department. It means: making quality surgical care accessible and affordable to our community. Recently, ‘Global Surgery’ was popularized by the Lancet Global Surgery Initiative and has emerged as a new research and educational focus. But an indigenous centre to address these challenges does not yet exist (in Africa), although low and middle income countries represent about 90% of the injury and infectious disease burden worldwide. Therefore, most research and educational efforts are orchestrated by foreign programs and institutions. Whilst their work is crucial in addressing global healthcare in surgical patients, local efforts must grow and address our challenges with sustainable solutions.
Unique Opportunity to Shape a New Field
Orthopaedic surgery is a relatively neglected aspect of public health, both nationally and internationally. With our program we turn this neglect into an opportunity to provide our registrars and students not only with insight into challenges of our orthopaedic health care burden but with simple and affordable solutions to address these.
Our Vision regarding Global Orthopaedic Surgery
We want to promote UCT as the primary training and research centre for Global Orthopaedic Surgery in Africa through three components: education, research and outreach.
Our Aims
We want to create a ‘bottom up’ solution to Global Orthopaedic Surgery with the centre of our aim focused around the patient seeking surgical care and the health care provider.
The following five points are the centre of this plan:
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Access to our health care
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Making our health care affordable to the system and patients
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Assessing outcome of our patients to ensure quality
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Teaching our techniques and principles
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Engaging with community and outreach
Current programs run by our Department
Outreach
We run national and international outreach clinics and surgical lists, including our secondary level township hospitals, as well as hospitals in rural areas of the Western Cape, Eastern Cape and Northern Cape. International outreach programs are tied to University hospitals as far as Windhoek in Namibia, Harare in Zimbabwe and Nairobi in Kenia.
General Orthopaedic Training (Diploma)
We offer a 2-year training course for general surgeons from Africa with focus on care of trauma and infections. Hands-on supervised surgery, bedside teaching and daily tutorials are being offered to prepare the surgeon for the Diploma in Orthopaedic Surgery from the Colleges of Medicine South Africa.
Fellowship Programs
Our 1-year fully sponsored fellowship programs for Orthopaedic Surgeons from South Africa and Africa include Orthopaedic Trauma, Shoulder Surgery, Spine Surgery and Arthroplasty. This fellowships are run at our tertiary care hospital with exposure to local pathology and resources and also include clinics and surgical lists in our township hospitals.
Research
Our research streams have been aligned with the need of our community and the burden of disease we face. Our main focus is trauma, infections and innovations, which are useful to our patients.
For orthopaedic infections, our focus lies on surgical site sepsis but also on HIV and TB affecting the musculoskeletal system. Trauma research is focused around polytrauma and motor vehicle accidents, as well as interpersonal violence. We see over 1000 gunshot injuries admitted to our trauma unit with 300 extremity injuries which forms another research stream.
This represents a unique internet based educational platform tailored to local pathology and provided by our students and educators. We promote participation and content generation by our students. Open access to these peer reviewed videos insures availability without restriction. We also stream our lectures for our postgraduate students to remote hospitals and have a wide range of orthopaedic surgeons and trainees in Southern Africa who tune in to be part of our teaching program.
Last year, we have introduced our departmental Quality Improvement Program. Empowering the front line of the Orthopaedic Department, our registrars, to be the centre of our iQUAL program led to valuable input on how we can make significant changes to improve quality.
MSC (Med) Global Surgery
This MSc will provide a research component resulting in a degree to above programs. It will be a one-year research based degree.
This program will be run by Dr Held. Additional Orthopaedic Specialists with MMeds will be involved in supervision as needed. Students will go through an online course (Clinical Research Methods I) with the department of Emergency Medicine which is the prerequisite for admission.