History of Orthopedics in Austere Settings

Fig. 1.1

The bright, clean, welcoming entrance to CURE’s Pediatric Orthopedic Hospital in Kijabe, Kenya

The history of Western practitioners working in resource-poor countries cannot be separated from the question of equipment. Some surgeons make it a point to take no donated equipment with them, knowing the problems of sustainability or the lack of experience in treating the complications that such techniques may bring, especially if used without adequate training. Most donations are made with the best intentions, but any volunteer who has walked through a gauntlet of irreparable C-arms crowding already limited space in an operating theater knows that donations have to be realistically considered from many angles.

SIGN (SIGN Fracture Care International) has shown that high-quality implants to treat long-bone fractures can be reliably used by developing country surgeons, working in less than ideal situations, if they are given a sustainable supply and are taught how to use them. SIGN’s program combining feedback, mentoring, and networking has produced a new paradigm that has been especially useful in situations where poverty makes effective treatment of certain debilitating fractures extremely difficult (Fig. 1.2).

../images/270913_2_En_1_Chapter/270913_2_En_1_Fig2_HTML.jpg — Fig. 1.2

US orthopedic volunteer , Carla Smith, introducing SIGN instruments and technique to surgeons in Nepal

Providing disaster relief has been a major idea behind orthopedic work in developing countries, but it is one of the most difficult to realize. Few volunteer orthopedic organizations have been able to build, maintain, and put into action all the components that would allow a reasonably equipped orthopedic disaster-assistance team to become immediately operative in the field. Such an organization could be readily staffed by willing volunteers, but only government agencies, the military, and one NGO, Médecins sans Frontières (MSF or Doctors Without Borders), have the necessary logistics to manage such a team. The surgery needed in disaster situations is similar to war surgery, demanding strict adherence to specialized protocols and triage principles that are unfamiliar to many volunteer orthopedic surgeons (Fig. 1.3).