Four surgeons benefit from International Surgical Skills Scholarships

Imagine being one of just 20 orthopaedic surgeons in a country of 70 million people. Every day, patients stream into your hospital. You must focus on only the most serious cases because of the hospital’s limited resources.

This is the reality for Elias Ahmed Ibrahim, MD, of Ethiopia, one of four 2007 AAOS International Surgical Skills Scholarship winners. The scholarship enabled him to travel to the United States to improve his surgical skills, learn how medicine is practiced here, and network with both U.S. and other international surgeons.

Acquiring new skills in hand and wrist surgery
Dr. Ibrahim selected the “Managing Complicated Hand and Wrist Problems” surgical skills course at the Orthopaedic Learning Center (OLC) because he and his colleagues at Tikur Anbessa University Hospital in Addis Ababa, Ethiopia, treat a large number of hand injuries, especially crush injuries from accidents involving machinery. He plans to share his new knowledge with the residents and undergraduates he teaches. Dr. Ibrahim also spent one day at the Illinois Bone & Joint Institute in Morton Grove, Ill., hosted by one of the practice’s orthopaedic surgeons, Taizoon Baxamusa, MD.

“Dr. Ibrahim was able to assess a number of patients in various stages of care and complexity involving the upper extremity,” said Dr. Baxamusa. “I think what helped him most was seeing our treatment approach, our algorithm, and our diagnostic work-ups.”

Dr. Baxamusa said that cultural variations that affect orthopaedic care became apparent during Dr. Ibrahim’s visit.

“I gave an example of an adolescent athlete with an injury,” explained Dr. Baxamusa. “Dr. Ibrahim said he doesn’t see that kind of injury because those patients go to traditional bone setters who do splinting and other nonsurgical treatments. The differences were eye-opening—not just for me, but for my staff and my patients who interacted with Dr. Ibrahim. They really enjoyed hearing his perspective.”

One of the reasons that Dr. Baxamusa agreed to host Dr. Ibrahim was due to Dr. Baxamusa’s experience on a surgical relief mission to Haiti. The scarcity of healthcare resources that he witnessed there is also evident in Ethiopia.

“Dr. Ibrahim confirmed that he faces a large clinical load that is shared among a paucity of surgeons. Consequently, only the most pressing injuries can be treated,” said Dr. Baxamusa. “When he observed an arthroscopically assisted percutaneous scaphoid fixation, he indicated that he and his fellow surgeons are too busy with the sequelae of nonunions and conditions such as arthritis to operate on a minimally displaced acute scaphoid fracture.

“We are very fortunate to live in a country with access to incredible advances in health care and technology,” continued Dr. Baxamusa. “As innovators of care, we have a responsibility to disseminate this information to others.”

Spine surgery in Uganda
Ugandan scholarship recipient Mallon Nyati, MD, practices at Mulago Hospital and is an honorary lecturer for undergraduate and postgraduate students at Makerere University Medical School. In his application, Dr. Nyati said that participating in the scholarship program would help him in his role as an educator.

After attending the “AAOS/Practical Anatomy at St. Louis University: Minimally Invasive Spine Surgery” course, Dr. Nyati, who specializes in spine and trauma, said that discussions on techniques and the “immense competence” of the faculty were most beneficial.

“The program gave me the opportunity to address the deficiencies in my spine fellowship training—minimally invasive surgery (MIS) and degenerative spine disease,” he said. “My expectations were very high, and the course exceeded them. I also made friends with surgeons in the United States, China, and Singapore.”

Dr. Nyati is now sharing his knowledge of MIS with his colleagues in Uganda. “I have already made many presentations regarding my experience for my fellow physicians, and I don’t pass up opportunities to show the residents how a case would be done using minimally invasive techniques,” he said.

Dirk H. Alander, MD, associate professor in the department of orthopaedic surgery at St. Louis University, enjoyed hosting Dr. Nyati during his observership.

“We were able to reinforce Dr. Nyati’s course experience with three MIS cases, including a diskectomy, a decompression, and a two-level minimally invasive transforaminal lumbar interbody fusion,” said Dr. Alander. “We also discussed and reviewed a variety of spine cases treated in an open fashion, and expanded on both surgical and nonsurgical decision-making processes in separate adult and pediatric scoliosis clinics.”

On his final day in St. Louis, Dr. Nyati attended grand rounds and a resident lecture. “Although the topics covered were not related to the spine, they were helpful to Dr. Nyati because he also covers general orthopaedics as part of the orthopaedic residency program in Uganda,” explained Dr. Alander.

Dr. Nyati wasn’t the only one learning; Dr. Alander also gained a new understanding of the challenges faced by orthopaedists in Uganda.

“I realize that resources can be scarce,” said Dr. Alander, “but Dr. Nyati helped me understand just how scarce they are in Uganda. I also gained valuable insight into how he practices and what he has to deal with on a day-to-day basis. I enjoyed working with him and hope to follow up with him in Uganda someday.”

A dream come true
Ahmed El-Mantawi, MD, of King Abdul Aziz Medical City in Saudi Arabia, attended the “Pelvic and Acetabular Fractures: Advanced Concepts, Details, and Improved Techniques” OLC course at the Academy during his visit.

“I feel the program was very beneficial for everyone,” said Dr. El-Mantawi. “Allowing an international doctor like me to be in direct contact with faculty members of the Academy and to gain experience from them is a dream come true.”

According to Dr. El-Mantawi, the cadaver dissection with faculty members such as Jorge E. Alonso, MD, and course director Lawrence X. Webb, MD, was one of the many helpful parts of the course.

“Dr. Alonso and I went out of our way to take Dr. El-Mantawi under our wing and make him comfortable,” said Dr. Webb. “We exchanged business cards and enjoyed each other’s company. When and if I go to Saudi Arabia I will seek him out. These are the elements of a successful exchange.”

When he returned to Saudi Arabia, Dr. El-Mantawi gave a lecture during grand rounds at National Guard Hospital Jeddah to talk about what he learned during his trip, which included an observership at Rush North Shore Medical Center with Wayne M. Goldstein, MD.

The fourth scholarship recipient, Egyptian Ahmed Al-Sharkawi, MD, is scheduled to attend an OLC course at the Academy in November.

How the program works
The International Surgical Skills Scholarship program was initiated in 2001. The 2007 scholarships were funded by Zimmer, Inc., and provide access to U.S. surgical skills and educational resources for orthopaedic surgeons from economically diverse regions of the world.

The four $4,000 scholarships awarded annually enable recipients to attend a surgical skills course either in the OLC or at another AAOS course. The program also includes one- or two-day hospital and private practice visits.

Scholarships are offered on a rotating basis to orthopaedic surgeons in one of four geographic regions of the world, as determined by the AAOS International Committee. Applicants for the 2007 program had to be 45 years old or younger as of Dec. 1, 2007, and must have completed all basic and specialty orthopaedic training. Applicants must possess good English-language speaking and reading skills and must not have accumulated any previous scholarship, study, observership, or fellowship experience in the United States.

For more information about the program, or to volunteer as a host, contact Anna Gurevich in the AAOS international department at gurevich@aaos.org.