Medical altruism

1. Accessible andSustainable
Global HandSurgery
MrVaikunthan Rajaratnam
MBBS(Mal),AM(Mal),FRCS(Ed),FRCS(Glasg),FICS(USA),MBA(USA),
Dip Hand Surgery(Eur), PG CertMedEd(Dundee),FHEA(UK),
AFFST(Ed),FAcadMEd(UK).
Senior Consultant Hand Surgeon
INTERNATIONAL
HEALTH AND
EDUCATION

2. Credentials
• > 30 years clinical practice and teaching
• Qualifications in medical education(FAcadMEd)
• Experience in instructional design and technology(MIDT)
• Publications and research in surgical education
• Senior Clinical Examiner – Birmingham/ Singapore
• External Examiner Ortho Exit exams – Indonesia/Malaysia
• Examiner /Faculty Royal College of Surgeons Edinburgh
• Quality Assurance Panel ofVisitor in PG ME&T, UK
• Core Faculty Member Orthopaedic Surgery – ACGME-I
• Core Faculty Member Hand Surgery Residency, Singapore
• Special Committee member for redesign of hand surgery exit exam Singapore
• Fellow HEA UK
• Reviewer for Educational Research Grants HEA

3. India
Sri Lanka
Bangladesh
Cambodia

4. Maslow's
hierarchy of
needs

5. ALTRUISM IN
MEDICINE – a
survey of
medical
professionals’
thoughts and
attitudes
 : 74% of respondents had used their medical expertise and
experience in altruistic behaviour outside of their normal working
role, with nearly 1 in 5 of respondents spending over 6 month
doing so.
 57% was completed in their home country, and 43% abroad.
 83% were willing to commit a period of time each year towards
organised altruistic work

6. Altruism in
Medicine
An analysis of
perception ,
definition and
practice of
altruism among
medical
professionals in
Singapore
 . 79% of the respondents said they had used medical training in
an altruistic manner outside their work , 32% at home and 36%
at home as well as abroad .
 94% said they are willing to commit to a fixed period in a year
towards altruistic activity

7. Inadequatehealth
systems damagethe
growthofdeveloping
nations
DrBrianBrinkexplains
whyhealthcare
systems shouldbe
understoodasa core
partofacountry'sGDP
 "A health system should be run like a business, with the right tools
and training, a properly functioning procurement and supply
chain, proper financial and human resource management, good
governance, monitoring and evaluation, and sound information
systems.”

8. Photo Essay of medical
relief mission toTamil
Ellam
Dr K.Thambyrajah F.R.C.S..orthopaedic surgeon
Dr R.Vijayasingam F.R.C.S.general surgeon
DrV. Rajaratnam F.R.C.S.hand surgeon

9. Team
members
From left:- DrV Rajaratnam, Dr K.Thambyrajah, Dr R.Vijayasingam and
Mr Kathirgamaththamby ,Radiographer

10. Team with
local leaders

11. Residual mines
and their
effects
A below knee amputee following land mine
Injury with prosthesis

12. Open air out
patient clinic

13. AOInstructional
course for
medics/nurses

14. Compressed air
unit for power
tools

15. “Portable”Xray
unit using dental
Xray tube

16. Surgery with
implantsand
power tools

17. Medianandulnar
nerveinjury treated
with sural nerve
cablegraft bridging
gap

18. SSG done by
member of
nursing staff

19. Sampleof
Clinicalcases
seen and treated
 Summary of cases seen
 Approx 300 patients seen in out patients
 12 orthopaedic cases operated on
 Estimate another 1000 cases of reconstruction required with
about 80% involving orthopaedics

20. Summary of
orthopaedic
cases to be done
 Nerve grafts and repair
 Tendon transfer for peripheral nerve injuries – radial,scaitic
 Arthordesis of hip and knee for deranged joints
 Limb lengthening for limb length discrepancies
 Corrective osteotomy and fixation for malunion
 Bone graft and skeletal stabilisation for non union
 Shoulder joint reconstruction with vascularised free fibular
transfer
 Hand reconstruction with toe transfer

21. Politics
Education
Social
Economics
Technology
Management

22. HumanitarianAid:
Are Effectiveness
andSustainability
Impossible Dreams?
Janice K. Kopinak
http://sites.tufts.edu/jha/archives/193
5
Emergency/Relief (E/R)
Rehabilitation/Development (R/D)

23. Humanitarian
Aid:
Are
Effectiveness
and
Sustainability
Impossible
Dreams?

24. THEGLUE
THAT HOLDS
ITALL
TOGETHER

25. MaxStirner
 self-interest to be a universal truth or established viewpoint
 the individual is dominated by illusory concepts ('fixed ideas' or
'spooks'), which can be shaken and undermined by each individual
in order for that person to act fully.
 Max Stirner influence on Nietzsche

26. Makings of an
equitable, just
and accessible
system of
sustainable
global health
for the needy
Glocal
Education
Management

27. annually account for $740 million (in U.S. dollars) and rank first in the order of most
expensive injury types, before knee and lower limb fractures ($562 million), hip
fractures ($532 million), and skull-brain injury ($355 million). Productivity costs
contributed more to the total costs of hand and wrist injuries (56%) than did direct
health-care costs. Within the overall group of hand and wrist injuries, hand and finger
fractures are the most expensive group ($278 million), largely due to high productivity
costs in the age group of twenty to sixty-four years ($192 million).
Why hand surgery
De Putter, C. E., Selles, R.W., Polinder, S., Panneman, M. J. M., Hovius, S. E. R., &Van Beeck, E.
F. (2012). Economic impact of hand and wrist injuries: health-care costs and productivity costs
in a population-based study. TheJournal of bone and joint surgery. American volume, 94(9)

28. Glocal

29. Education,
Education and
Education

30. 1. Quality care/optimum outcomes - education
2. The current UG curriculum inadequate
3. Currently PG hand programs - exclusive
4. Need
• flexibility,
• student centred
• on-demand learning that is
• universally accessible,
• affordable and
• locally relevant.

31. 1. designed for practising doctors
2. universally accessible
3. e-learning platform
4. modular in nature
5. catering to working doctors educational needs
The Solution

32. An on-line modular programme
Three levels of qualifications:
PG Certificate,
Diploma and
Master’s degree,
MOODLE LMS
International faculty - 8
Deployed on line (handsurgeryedu.com).
Open University Malaysia

33. • Future of learning changing
• Everyone can learn.
• Communities of practice can build programs.
• Ubiquitous learning changing the landscape
• Massively open online course - the model
• Alter the relationship of all stake holders
• Viability of this educational model.

34. Management
Intangible Tangible

35. Collaboration
Communication
Coordination
Education
Passion
Compassion
Concentration
Effort

36. International
Collaboration
LocalSurgeons
Systems
Structure
Strategy
Values

37. Management

38. EMR in
Underdeveloped
Community

40. Academia in
global health
delivery
 1. Delayed presentation of congenital tibial pseudarthrosis and
neurofibromatosis: A difficult union. - Accepted for publication
2.The battle with Osteosarcoma - a 10 year experience of 35 patients
- In completion (95% complete)
3. Development of a novel low cost instrument for removal of a bent
femoral nail: A case report - In submission
4.TOTAL HIPARTHROPLASTY REHABILITATION IN CAMBODIA – BRIDGINGTHE
GAP - In submission
5. Store, forward and conference – a new approach to telepathology in
Cambodia - In submission
6.Acid burns in Cambodia:The human, medical and surgical legacy of
241 victims - In submission
7.Antibiotic beads for the developing world - premade, prepackaged
and preloved - an in-vitro study (accepted as MScTrauma Surgery
Dissertation) - in completion
8.An explosion of MRSA in Cambodia of soft tissue and bone infections
- In completion (50% complete)
9.Twinned cities in friendship and orthopaedics - a telemedicine
experience with Bristol and Phnom Penh - In completion
10. Long distant surgical training and mentoring - is it possible -
In completion
11.An article for Surgeons News, Royal College of Edinburgh -
requested by Journal.

41. WIIFM
 Maslow’s need fulfilled
 Ethical practice
 Pushing the envelope
 Enriching your practice
 Legacy

42. Accessible,
transparent
and
sustainable
hand surgery
 Beyond competency
 Commitment
 Compassion
 Passion
 Management
 Governance
 Funding
 Human Capital

43. Establishednonunion
of humerus with good
handfunction
needingbone
grafting andORIF

44. Establishednon
unionof radius
andulna with
good hand
functionneeding
bonegrafting
andORIF

45. Major flash burn
contracture of
post axillaryfold
needingrelease
and
reconstruction

46. Painfuldegenerative
hipsecondaryto
neglectedhip
dislocation with
avascularnecrosis of
headtreated with
formalarthrodesis
withCobra plate and
bonegraft ( 32 year
oldfemale )

47. 5yearoldboy congenital
abnormalities ofbothupper
limbs.
Onthe right, he has aone
boneforearm(ulna), radially
deviated hand andfour
fingers(ofwhich 2arein
syndactyly) Heis able toflex
his elbow actively and
passively.
Onthe left, he has a very
shorthumerus,andthree
fingersin the hand.

48. 42yearoldmale.
severeelectric burnon
2ndJune2013(held
electrical wiring with
bothhands) which had
beentreated at
provincial hospital.
Bothhands -gangrene
andbothlegs second
degreeburn

49. 34yearsoldfemale,Right
handdominant.
weaknessintheleftarm
sincebirth,nohistoryof
injury-exactdelivery/birth
historyunclear.
Obviouswastingleft
shoulder,upperarm.C5/C6
weakness-cannotabduct
shoulder/flexelbow.Some
tricepsfunctionmaintained.
Goodwristextension/
fingerabductionbutsome
reversibledeformities of
PIPJs/DIPJs(actually
presentinbothhands).
Normalsensationinhand.

50. Thank you
 vaikunthan@gmail.com
 www.handsurgeryedu.com