During a recent trip to China, ESCOME Executive Director William C. Horton, MD (sixth from left, top row), received a warm reception from the Chinese spine surgeons who will take part in the spine care training program as well as from the nurses who assist them.
Courtesy of ESCOME

AAOS Now

Published 9/1/2008
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Jennie McKee

Bridging the spine care knowledge gap

ESCOME to launch spinal care training program for Chinese surgeons

In the United States, spine surgeons use their training and tools to help treat patients with scoliosis, spondylolysis, lumbar spinal stenosis, and a host of other spinal disorders, with the goal of increasing their patients’ mobility and quality of life.

Surgeons in developing countries can do far less—or sometimes, nothing at all—to treat people with spinal conditions. Most countries have few surgeons and lack educational and technical resources. As a result, most patients with debilitating spinal injuries and diseases receive little or no treatment.

William C. Horton, MD, executive director of the Emory Spine Center for Outreach and Medical Education (ESCOME), has created a training program to help overcome this problem. The ESCOME initiative, which allows American orthopaedists to share their knowledge and skills with surgeons who haven’t had the same training opportunities, will begin training a group of physicians from China next year. ESCOME’s ultimate goal is to enable physicians from economically challenged countries to develop and maintain self-sustaining spine care centers.

Starting the first program
Although the ESCOME initiative was delayed due to the earthquake that struck China in May 2008, the first group of Chinese surgeons is scheduled to arrive in the United States in January 2009 to begin working with their mentors—experienced spine surgeons who are near retirement or have recently retired. The Chinese surgeons were chosen with guidance from the Global Health Institute, the ESCOME Advisory and Medical Boards, the ESCOME China Advisory Board, and local health ministries.

“Six mentors will train the 12 Chinese physicians in fundamental spine care techniques using an intensive 1-month core curriculum at Emory University,” says Dr. Horton. “Courses will cover the principles of surgical and nonsurgical care, and advanced techniques will be addressed depending on the experience level of the Chinese surgeons.”

Additionally, the Chinese physicians will travel to their mentors’ institutions for 4 to 6 weeks of observational education in operating rooms and clinics. During this time, mentors will emphasize diagnostic skills, surgical techniques, and outpatient care.

Upon their return to China, the physicians will have a secured computer link for weekly conferences with their mentors to discuss cases, problems, and questions.

“The mentors will also travel to the Chinese surgeons’ facilities for four 1-week visits,” says Dr. Horton. “These visits will allow the mentors and partnering physicians to see patients together in clinics, discuss cases, and operate together as the Chinese surgeons mature in their abilities.”

A common objective
At the end of the 3-year program, the Chinese surgeons should be self-sufficient, meaning that they will be able to establish new centers that provide high-quality spine care and foster further local training.

According to Dr. Horton, ESCOME’s success relies on the teamwork and contributions of all the groups involved.

“The ESCOME initiative provides a unique opportunity to combine the talents of academia, near-retirement spine specialists, professional societies, philanthropists, partnering Chinese universities, and partnering governments to support progress in making specialized spine treatment available to patients,” he explains.

In the future, the ESCOME program will be available to any developing country within the mission scope, as capacity allows.

Benefits of mentoring
James W. Ogilvie, MD,
an ESCOME mentor who has performed medical outreach since 1985 in places such as Latin America, Europe, India, and Asia—including at least a dozen trips to China—is eager to contribute his time and effort as an ESCOME mentor.

“This program is revolutionary,” says Dr. Ogilvie. “Dr. Horton is bringing medical outreach education to a new level. He has developed a very organized, systematic way to educate visiting surgeons that hasn’t been done before to this extent.

“Surgeons in developing nations look to the United States as the fountainhead of innovative surgical techniques,” he continues. “It’s one thing for them to read about it, but it’s another thing to learn from an American orthopaedic surgeon one-on-one. Showing the surgeons how to perform the procedure in detail and discussing it with them will, I hope, help keep both surgeons and patients out of trouble.”

Dr. Ogilvie, who practices at Shriner’s Hospital in Salt Lake City, has made medical outreach an integral part of his life because of its impact on the patients.

“If I don’t operate on somebody here at Shriner’s Hospital, another spine surgeon will be able to perform the operation,” he explains. “But overseas, there isn’t another surgeon—maybe not even in the entire country—who can do the job. The feeling I get from helping that patient is the greatest reward in the world.”

Steven M. Mardjetko, MD, who began doing medical outreach in 1992, encourages retired and near-retired orthopaedists to participate in ESCOME. His medical missions to China and Colombia were among the most positive experiences of his life.

“Volunteers learn a lot from local physicians who treat conditions that physicians in the United States sometimes don’t see,” says Dr. Mardjetko. “I’ve seen a few cases of tuberculosis of the spine, for example, but they’ve seen hun­dreds. You can also learn about surgical techniques that local sur­geons have been forced to develop because of the lack of resources. I’ve learned how to do osteotomies on children’s hips without the use of X-rays.

“When you volunteer, you help people who otherwise would get no service,” he continues. “You have the chance to meet with other physician volunteers from all over the country and can learn a lot from them.”

Dr. Ogilvie sums up the thinking behind ESCOME by paraphrasing an old Chinese proverb.

“I can’t correct every crooked spine in the world,” he says. “If I perform surgery on a patient in a developing country, I may help that individual, but if I educate a local surgeon in spine care, I’ve multiplied the impact many times over.”

Jennie McKee is a staff writer for AAOS Now. She can be reached at mckee@aaos.org