Orthopaedic surgeons in Thailand work 40 hours or more each week in government-run hospitals, then provide care in the evenings and on weekends in their private practices

In October 2006, a group of physicians representing AAOS travelled to Pattaya, Thailand, as part of a combined meeting of AAOS, the Association of Southeast Asian Nations Orthopaedic Association (ASEAN-OA), the Royal College of Orthopaedic Surgeons of Thailand (RCOST) and the Thai Orthopaedic Association (TOA). This marked the third time AAOS and ASEAN-OA had arranged a combined meeting.

The AAOS attendees—who included Mathias P.G. Bostrom, MD, chair, William P. Barrett, MD; Peter M. Bonutti, MD; Bryan J. Nestor, MD; Douglas E. Padgett, MD; Michael L. Parks, MD; Mark A. Snyder, MD; and James B. Stiehl, MD—hoped to foster a spirit of cooperation with orthopaedic societies in other countries. AAOS Immediate Past President, Stuart L. Weinstein, MD, attended as an honorary guest and was inducted into RCOST during the visit.

The AAOS program focused on hip and knee surgery. According to Dr. Barrett, who related some of the experience on his Web site:

“Eighty percent of the joint replacement procedures done in Thailand are for knee arthritis. Of interest is the rarity of hip arthritis in Thailand; 20 percent of total hip replacements are replaced due to osteonecrosis. They have a higher incidence of osteonecrosis of the femoral head due to the over-the-counter availability of prednisone and other steroid-derived medications. These are often used in excess by patients […]”

Hospitals in Thailand

Before traveling to Pattaya for the meeting, many of the AAOS members took the opportunity to tour two hospitals in Bangkok—located only about 90 miles away from the host city. King Chulalongkorn Memorial Hospital is a large facility of 1,600 beds that serves a community of 1.2 million people. Police General Hospital is somewhat smaller, with 550 beds in a community of 100,000. The visitors were impressed with the high grade of technology available and the sophisticated level of care.

Dr. Barrett notes that orthopaedic surgeons in Thailand work long hours—spending 40 hours or more each week working in government-run hospitals, then providing care in the evenings and on weekends in their private practices.

Many of the faculty members who took the hospital tour regarded it as highly educational and one of the highlights of their trip. All felt that the tour provided them with insight into medical facilities in other parts of the world and gave them an understanding of Thailand’s unique orthopaedic issues. The visitors agreed that local hospital tours should be considered for inclusion on future AAOS international education programs.

Gracious hosts; attentive crowds

The AAOS program focused on hip and knee surgery and consisted of 10 management topic presentations, eight symposia, six instructional course lectures, two case presentations, two free paper sessions and two guest speaker presentations. Dr. Weinstein participated in all the sessions and stated that the AAOS faculty “did an outstanding job under the direction of Dr. Bostrom.”

Although the faculty might have hoped for larger crowds (peak attendance at an AAOS session was about 100 people), those who attended came away very pleased. Of 271 completed participant evaluations, 97 percent stated that the AAOS program was relevant and applicable to their practice, and 98 percent indicated that they would attend another AAOS/ASEAN-OA program in the future. Furthermore, 93 percent reported gaining new knowledge that would benefit their patients and practice.

In addition to allowing AAOS faculty to present at the meeting, ASEAN-OA and RCOST provided AAOS with complimentary exhibit space. That space was well-positioned in a high-traffic corridor between the exhibit area and the primary scientific lecture hall. The staff estimated that at least 600 of the meeting’s 1,500 attendees visited the AAOS booth, which showcased the Academy’s Guest Nation program, international affiliate membership (IAM), and the Annual Meeting, along with offering select AAOS products for sale. Visitors to the booth were also able to submit raffle tickets to win complimentary IAMs.

Team members felt that the organizers of the meeting worked well with the AAOS faculty and staff, who described them as very attentive and considerate of their needs. One faculty member said the Thai group “graciously hosted us,” and Dr. Weinstein reports that “The ASEAN Orthopaedic Association values its working relationship with AAOS.”

To be sure, the sense of appreciation was more than just a one-way street—attendee evaluations contained such positive comments as “I got a lot of new knowledge about new techniques of operations, and I will use these techniques to cure my patients in the near future,” and “The AAOS program was of great interest to me. It provided me [with] new knowledge about total hip reconstruction and total knee reconstruction [and] how to deal with infection.”

“This region of the world relies heavily on AAOS teaching, as well as educational products, and this relationship is one that should continue to be fostered in the future,” says Dr. Weinstein.

Although most AAOS programs are targeted at improving the quality of care in the United States, bringing orthopaedic education to other countries fosters a spirit of cooperation and unity across national borders. Attendees would probably agree that visits to Thailand and other countries bring those borders just a little closer.