Scholarship recipients appreciate the opportunity to study with American surgeons

Each year, several surgeons from around the world are selected to take part in the AAOS International Surgical Skills Scholarship Program. The goal of the program is to improve the quality and outcomes of orthopaedic care worldwide through the awarding of scholarships to applicants who have demonstrated a desire and ability to positively affect their communities by providing the highest quality musculoskeletal care for patients. Since 2001, the AAOS International Committee has helped bring more than 35 orthopaedic surgeons from 27 countries to the United States, where they train with their American colleagues.

Each year, the scholarship program rotates to one of four regions. The 2010 program participants are predominantly from the Asia and Pacific region and include Vikas Trivedi, MD, Meerut, India; Dave Anthony G. Dizon, MD, UPCM–Philippine General Hospital, Manila, the Philippines; Jun Li, MD, PhD, Xi’an, China; Sami Yosufzai, MD, Kabul, Afghanistan; Dipak Shrestha, MD, Dhulikhel Teaching Hospital, Dhulikhel, Nepal; and Olayinka Adegbehingbe, MD, Ile Ife, Osun State, Nigeria.

On Oct. 21, 2010, Drs. Dizon, Shrestha, and Trivedi met at AAOS to talk about the state of orthopaedics in their home countries and what they hoped to gain during their visits.

Mostly trauma
“The Philippine General Hospital in Manila is the largest state-run hospital in the country,” said Dr. Dizon. “We have about 1,200 beds, with 70 beds dedicated to orthopaedics. Orthopaedics has five sections: spine, adult reconstruction, trauma, hand, and pediatrics. Each operates autonomously.”

According to Dr. Dizon, the most common orthopaedic conditions in the spine section are tuberculous spondylitis and neglected deformities.

“Across the whole department, I think the bulk of our work is mostly trauma,” he explained. “We get a lot of motorcycle accidents.”

Dr. Dizon also has his own private practice, “to put food on the table,” he said. “We cannot survive on the salary of a government hospital, so we have to supplement with private practice. I have a practice that extends across three other hospitals.”

Trying to specialize
In addition to teaching, Dr. Shrestha works at Kathmandu University Hospital—a 350-bed facility with 32 to 36 orthopaedic beds, although as many as 50 beds are available if needed.

“We encroach on the other departments,” he laughed.

His hospital sees many trauma cases mostly as the result of falls.

“People may fall from a cliff or fall from a tree,” he said. “This is an occupational hazard. Without any safety precautions they climb trees to collect leaves for the cattle, and they sustain a variety of injuries. When they come to us, it’s usually very late.”

The hospital is about 30 km east of Kathmandu and is the last hospital before the border with Tibet. Aside from a few scattered 3- or 4-bed hospitals, it is the only care facility for more than 1 million people.

“We now have five people in the orthopaedic department,” he said, “so we’re trying to develop specialties. I want to focus on spine and adult reconstruction.”

Expanding his knowledge
Dr. Trivedi serves as an associate professor in orthopaedic surgery at the Subharti Institute of Medical Sciences in Meerut, India. The hospital is attached to Subharti University, and has about 100 orthopaedic beds.

Dr. Trivedi’s interests lie primarily in the areas of pediatric spine and general pediatric orthopaedics, but in India, he said, there is very little surgical specialization. On any given day he may assist at spine surgery, work with pediatric patients, or perform arthroscopy or a joint replacement.

“I’m trying to expand my knowledge by applying to international fellowship programs, preferably in the United States, to get more clinical experience in my preferred areas of study.”

According to Dr. Trivedi, medicine in northern Indian cities like Meerut lags behind that found in southern cities like Mumbai, making it a prime area for the introduction of modern orthopaedic techniques. He was the first person in his region to use the Ponseti technique to treat children afflicted with club foot.

“We used to see neglected clubfoot patients,” he said. “Now we can treat them very early, with a dramatic change in results. I’m also doing some deformity correction procedures that hadn’t been done in my region before.”

To learn how you can support the program, either financially or by hosting a scholarship recipient, contact Lisa Cohen, manager, international education programs, at cohen@aaos.org

Peter Pollack is a staff writer for AAOS Now. He can be reached at ppollack@aaos.org

Hosts and sponsors
The AAOS and the international scolars thank the following surgeons and institutions who hosted observership programs: David Templeman, MD, Hennepin Health Center, Minneapolis; Stefano Bini, MD, The Permanente Medical Group, Oakland, Calif.; Mininder S. Kocher, MD, Children’s Hospital Boston, Boston; Dave Dominique, MD, Pinnacle Health Center, Harrisburg, Pa.; Richard J. Coughlin, MD, San Francisco General Hospital, San Francisco; Charles Saltzman, MD, University of Utah Orthopaedic Center, Salt Lake City; Joseph Cass, MD, Mayo Clinic, Rochester, Minn.

Funding for the AAOS International Surgical Skills Program is provided by the following: Arthroscopy Association of North America, The Foundation of Orthopedics and Complex Spine, The Global Arthroscopy Foundation, The Pediatric Orthopaedic Society of North America, The Permanente Medical Group, Sociedad Española de Cirugía Ortopédica y Traumatología, Società Italiana di Artroscopia, and Stetson Powell Orthopedics and Sports Medicine.

For more information about the AAOS Scholarship Programs, visit www.aaos.org/internationalscholarship