Robert E. Stein, MD, and Dr. Gado Tshering, the Secretary of the Ministry of Health in Bhutan.
Courtesy of Richard B. Ressman, MD

AAOS Now

Published 5/1/2009
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R. Richard Coughlin, MD, MSc

Orthopaedics Overseas celebrates 50 years of service

Bringing medical experience and education to needy countries

Orthopaedics Overseas (OO), an idea that grew into an organization, is celebrating 50 years of global service in 2009. The idea originated with the Orthopaedic Letters Club, which, at an AAOS meeting in January 1959, appointed a committee to look into ways “to donate medical practice, experience, and teaching” to needy countries.

Driven by a desire to counter the negative images of Americans featured in the best-selling novel, The Ugly American, the founding members of OO were convinced that sharing knowledge and expertise with their colleagues in other countries would forge lasting bonds of friendship and respect. They focused their efforts on education, knowing that it was the key to long-term development. The first site selected was Jordan, and the first volunteer was Allan McKelvie, MD. Other pioneers in this effort include Paul E. Spray, MD; Andrew C. Ruoff III, MD; Samuel T. Moore, MD; Charles Hauser, MD; Richard Dodge, MD; and Mark Coventry, MD.

Orthopaedics Overseas was originally affiliated with MEDICO, which became part of CARE in the early 1960s. It became an independent organization in the early 1980s and in 1986 became the founding division of Health Volunteers Overseas (HVO). Lost in time are the exact numbers but data from MEDICO indicate that between 1959 and 1975, orthopaedic surgeon volunteers donated 559 months of service. From 1986 through the end of 2008, more than 735 orthopaedic surgeons have completed nearly 1,700 assignments.

The impact in Bhutan
As part of this celebration, Dr. Gado Tshering, the Secretary of the Ministry of Health in Bhutan, addressed the OO Annual Luncheon on February 27, 2009. Dr. Gado spoke about the impact of the Orthopaedics Overseas program and other HVO initiatives on health care in his country, the world’s newest democracy.

When Robert E. Stein, MD, first went to Bhutan 19 years ago to determine the level of interest in an OO program, Bhutan had no trained orthopaedic surgeons. Since that time, thanks to the time and commitment of more than 200 volunteers, Bhutan now has two trained orthopaedic physician assistants, eight orthopaedic technicians, and four more orthopaedic technicians in training. The presence of the OO volunteers stimulated the interest of Bhutanese physicians in orthopaedics; the country now has four trained Bhutanese orthopaedic surgeons.

The orthopaedic program was the starting point of an extremely productive partnership with the Ministry of Health in Bhutan. In 1996 Health Volunteers Overseas (the parent organization of OO) initiated a physical therapy training program in Bhutan. Last year, HVO finalized the details for a new program training nurse anesthetists.

Robert E. Stein, MD, and Dr. Gado Tshering, the Secretary of the Ministry of Health in Bhutan.
Courtesy of Richard B. Ressman, MD
A grandmother and child in an orthopaedic ward in Bhutan.
Courtesy of Health Volunteers Overseas

Dr. Gado credited these programs with significantly improving the quality of patient care in Bhutan through training and upgrading the skills of local health care professionals, greatly expanding the resources at the medical library, and facilitating the donation of millions of dollars worth of implants and other medical equipment essential to improved patient outcomes.

He noted that one way to measure the impact of the orthopaedic program can be seen in the reduced referral rate of patients to other countries for treatment. All health care in Bhutan is free and is provided by the government. Savings from this reduction in patient referrals overseas enable resources to be reallocated to more productive uses in the health sector.

Dr. Stein was recognized for his commitment to the program in Bhutan with the Orthopaedics Overseas Leadership Award. Since 1990, the year negotiations began with the Bhutanese government, Dr. Stein has developed and managed the program.

He believes the connection with OO volunteers opened the door to Bhutan and allowed local providers to understand the level of care they could offer to their people. Thanks to the commitment of HVO volunteers and to the Bhutanese health care providers, complex cases are now handled locally and are rarely sent to India as had previously been the case.

Looking forward
Bhutan is an excellent example of the difference in patient care that has resulted from the dedication of healthcare providers who share their knowledge and skills with their colleagues in developing countries. Who knew that an idea discussed 50 years ago among members of the Orthopaedic Letters Club would grow to have such a dramatic impact on so many lives around the world?

It will be exciting to see the changes that occur over the next 50 years! If you would like to be a part of that change, contact HVO to see how you can make a difference. Call (202) 296-0928.

R. Richard Coughlin, MD, MSc, is chair emeritus of the Orthopaedics Overseas division at Health Volunteers Overseas.