World Health Organization to add orthopaedic consultant

In April, the World Health Organization (WHO) endorsed a new AAOS educational venture—the Africa Cooperative Education (ACE) program, which is scheduled to launch in Accra, Ghana, in November 2008. WHO also agreed to collaborate as a cooperative partner and to lend its world-renowned expertise and reputation to help maximize the impact of the ACE program.

What is the ACE program?
The ACE program was developed by the AAOS and several specialty society partners, including the Orthopaedic Trauma Association, the Pediatric Orthopaedic Society of North America, the Scoliosis Research Society, and the American Academy of Physical Medicine and Rehabilitation. It is planned as an ongoing series of 4-year phased education programs that will begin in West Africa in 2008 and rotate every fifth year to another region in Africa. Ultimately, the program will also reach other continents.

“This is a huge undertaking,” said Miguel E. Cabanela, MD, chair of the International Committee, which conceived the program. “Without a doubt this is the most ambitious global education outreach program ever developed by the Academy. From the onset, we sought to partner with our sister specialty societies, and we have received outstanding support, especially in the areas of topic selection, curriculum development, and program faculty recruitment.”

According to ACE Program Director, AAOS fellow Kamal N. Ibrahim, MD, the overall objective of the program is to strengthen capacities in emergency and essential orthopaedic medical and surgical care in West Africa. The program places particular emphasis on improving child health through better treatment of pediatric trauma and bone infection, providing better trauma treatment and successful outcomes for injured adults so they can return to gainful employment, and improving a country’s financial situation by preserving a productive workforce.

The ACE program includes onsite instruction (didactic and skills labs), annual scholarships, ongoing research and outcomes data assessment, and a “train-the-trainers” approach to orthopaedic education. Initially, program faculty members will be primarily from the United States; over time, however, responsibility for the program will shift and education will be provided almost entirely by local physicians and healthcare providers.

WHO’s interest in surgical care
Recognizing the global need for safe, appropriate emergency surgical care, the WHO established a new Global Initiative for Emergency and Essential Surgical Care (GIEESC) in 2005. GIEESC aims to improve collaborations among organizations, agencies, and institutions involved in reducing death and disability from road traffic accidents, trauma, burns, falls, pregnancy-related complications, domestic violence, disasters, and other emergency surgical conditions, by strengthening a nation’s capacity to deliver effective emergency surgical care at the first-referral level.

In addition, GIEESC will support efforts to strengthen a nation’s capacity for the safe and appropriate use of emergency and essential surgical procedures and to link equipment in resource-limited healthcare facilities, thereby improving the quality of care as well as training and education programs for healthcare personnel.

The AAOS International Committee, recognizing the similarity in goals and objectives between GIEESC and the ACE program, began a dialogue with key principals at WHO. “Our original intent was to seek WHO endorsement of the program, as we felt this would be essential to our gaining the type of foundation and corporation funding support we will need to help support the costs of the four-year program,” said Dr. Cabanela. “We received more than endorsement; we have WHO as a partner, and that is simply beyond our greatest expectations.”

The WHO commitment
The ACE Program Curriculum Development Team has agreed to incorporate a significant amount of preexisting WHO education materials and training tools into its final ACE program curriculum. WHO was enthusiastic over the AAOS approach and amenable to allowing use of its training materials.

In addition, WHO offered to communicate with the appropriate ministries in Ghana and other West African nations, to enlist their support and endorsement of the ACE program. WHO’s involvement will also help ensure cooperation and commitment by member nations to the principles and standards of care that will be taught in the AAOS program.

Further, the WHO has committed to assigning a full-time orthopaedic consultant to the WHO world headquarters in Geneva, Switzerland. The consultant will be dedicated to the orthopaedic aspects of the GIEESC program and training and will assist with gathering data for the global burden of disease assessment evaluation tool and report that will be issued during year five of the established program.

The WHO consultant will also travel to countries in the West Africa region to ensure that the information and healthcare interventions taught in the ACE program are being disseminated to the outlying regions of the countries and not retained exclusively within the major metropolitan areas.

“This aspect of the program alone has huge implications. It is putting orthopaedics on the world health agenda,” said Dr. Cabanela.

A significant final offer from WHO is assistance in identifying appropriate potential grant makers and funding entities whose philanthropic interests intersect with the objectives and goals of the ACE Program.

“We could not be happier,” said Dr. Ibrahim. “From the start, this program has been meticulously planned and researched. We began with an earnest interest to partner with specialty societies and other relevant agencies or bodies. We also have been willing to ask for help and learn from those with preexisting expertise. We have done our homework, and now it is beginning to pay off.

“This partnership with the World Health Organization is simply fantastic—for the AAOS, for orthopaedics, and for musculoskeletal patients and care givers at all levels in the emerging economy nations of the world,” he concluded.

Lynne Dowling is director of the AAOS international department. She can be reached at dowling@aaos.org AAOS Now will continue to bring you news and periodic updates as the planning and implementation of the ACE program proceeds.

ACE program objectives
Teach best practices at appropriate skill levels to the primary musculoskeletal care givers.

Establish a core curriculum in orthopaedics that can be adapted nationally and taught locally over time.

Identify and provide a subset of future local leaders and educators with the resources to do cascade training, and transfer technologies to reach primary healthcare facilities.

Identify trainers who would gain experience in best practices by spending time in the United States before returning to their home country(ies) to adapt these practices to local settings.

Expand the total number of qualified personnel available to administer quality musculoskeletal care.

Expand exponentially the number of patients who receive appropriate and timely musculoskeletal care and disease intervention.

Decrease the rate of Disability-Adjusted Life Years resulting from poor, negligent, or absent musculoskeletal care.

Gather data, develop a global burden of disease evaluation tool, and issue a report during year five of the established program.