Jamaican Orthopaedic Association 25th Conference Publication

ANNUAL SYMPOSIUM

MAY 6-7, 2023

PIONEERS IN JAMAICAN ORTHOPAEDICS

A LOOK AT OUR HONOUREES

THE ENDURING LEGACY OF PROF. JOHN GOLDING

THE CONTRIBUTION OF ONE OF JAMAICA'S LEADING ORTHOPAEDIC SURGEONS

MEET OUR GUEST SPEAKER DR DUNCAN WHITWELL

ORTHOPAEDIC

Vol

May 2023

EDITOR-IN-CHIEF

Michelle Gordon

imaginitservices@gmail.com

CONTRIBUTORS

Dr Michael Abrahams

Joan Young-Davis

Tiffany Taylor

OUR MAIN SPONSORS

Surgix Jamaica Ltd

Cari-Med Group Ltd

Signature Ortho

PRODUCTION TEAM

ImaginIT Consultancy Services

Dr. Thea-Nicole Davis

Shauté Eldemire

Brian Thompson

GUEST SPEAKER

Mr Duncan Whitwell

Sir John Golding Lecture by Dr Christopher Rose

Dr Charlene Chinsee

Dr. Nicolas Nicolaou

Dr Dayanand Sawh

Dr. Mark Minott

Dr Jermaine Lewis

Dr Yogeshwar Ramcharan

Dr Amanda Chow

Dr Wilton Kennedy

Dr Fazal Ali

Dr Phillip Waite

PRESENTERS MODERATORS

Dr Orville Samuels

Dr Shomari Prince

Dr. Dean Wright

Dr Mark Minott

Dr. Orville Samuels

Dr Ian Neil

Dr Richard Reynolds

Dr. Andrew Ameerally

Dr Andrew Bogle

Dr Preci Hamilton

Ms. Sheri-Ann Carnegie

Dr Wayne Palmer

Dr. Havalee Henry

Dr Derrick McDowell

Dr Maxim Christmas

Dr. Mellanie Didier

Dr Paula Dawson

Dr. Cary Fletcher

Dr Patrice Taylor-Irvine

THE PRESIDENT'S MESSAGE

I would like to begin by thanking my colleagues for allowing me the honour of holding the position of President of the Jamaican Orthopedic Association [JOA].

It has been an honour and a pleasure

The JOA is beyond thrilled to be hosting the 25th iteration of our annual conferencelive and direct, and in person. I am pleased about this year’s presentation following on our 2022 Conference which unfortunately we had to present on a virtual platform

You may recall that our last few years have been extremely challenging with the Covid 19 Pandemic turning the world on its head. The effects of this monumental crisis resulted in economic and human disasters forcing governments, corporate entities, organizations and individuals to reevaluate and navigate the way forward

Like so many who faced lockdowns, we were forced to stay in place, often times in isolation, and truly examine who we were, where we were going and were we truly fulfilling our purpose. So like the phoenix of Greek mythology - associated with the sun, the JOA has regenerated, obtained new life by rising from the ashes and has emerged with new energy, a new sense of purpose and boundless enthusiasm to reestablish our influence in the medical community, make our voice heard nationally and continue to give exemplary service to the Jamaican people

I am cognizant that this will not be easy, and will take a lot of work, put in by too few people, but I am confident that the collective input from our members and affiliates will increase the number of our colleagues who will put their shoulders to the proverbial wheel, resulting in producing the desired results

Our community has a tremendous history but this alone will not sustain the Association indefinitely - we cannot rest on our laurels We need to maintain relevance which will lead to a robust membership which is key to our continuing mission in the support of our physicians' efforts to maintain the highest level of quality health care to our community,

This year, we are extremely proud to have garnered once again, a diverse and accomplished faculty of presenters who will deliver in their own inimitable style the quality of academic discourse that has been synonymous with our previous conferences.

So to all our esteemed presenters, thank you for imparting and sharing your knowledge, thank you for taking the time to prepare your presentations we truly appreciate you

To my colleagues, thank you for your continued participation, your enthusiasm and your willingness to contribute to the orthopedic community.

To our sponsors and all who have contributed to making this conference possible, we thank you. You can be assured that without your incredible support it would not have been possible.

Dr. Orville Samuels

25TH ANNUAL SYMPOSIUM

AGENDA

The Jamaica Conference Centre

May

6-7, 2023

SESSION 1 - PAEDIATRICS

Moderator: Dr. Dayanand Sawh

8:45am – 9:00am

Nuclear Medicine in Musculoskeletal Pathologies – Dr. Mellanie Didier

9:00am – 9:15am

Utilization of the Modified Grammont Procedure and Medial

Patellofemoral Ligament Reconstruction for Patellar Instability

Dr. Charlene Chin See

9:15am - 9:30am

ACL injuries in Children- The Good, the Bad and the Treatment Options

Dr. Nicolas Nicolaou (Virtual)

9:30am – 9:45am

Surgical management of Patellofemoral Instability in children-Is MPFL reconstruction the answer – Dr. Nicolas Nicolaou (Virtual)

9:45am - 10:00am

Paediatric Osteochondral Lesions - Dr. Shomari Prince

10:00am - 10:15am

Questions and Answers

10:15am - 10:25am

A Word From Our Sponsors

COFFEE BREAK AND VIEWING OF EXHIBITS [20 minutes]

Moderator: Dr. Orville Samuels

10:45am – 11:00am

Reducing Peri-Prosthetic Joint Infection – Control the Theatre Environment

Dr. Fazal Ali (Virtual)

11:00am - 11:15am

Pre-operative Templating of Coronal Alignment in Primary Total Knee

Replacement. How I do it. - Dr. Phillip Waite

11:15am – 11.35am

Treatment of Large Bone Loss in Revision Knee and Hip Arthroplasty

Mr. Duncan Whitwell

11:35am - 11:50am

Management of Extra-Articular deformities in Total Knee Replacement

Dr. Andrew Ameerally

11:50am - 12:10pm

The Infected Joint – What Are Our Options? - Mr. Duncan Whitwell

12:10pm - 12:25pm

Questions and Answers

12:25pm - 1:25pm THE SIR JOHN GOLDING MEMORIAL LECTURE: Controversies in Blount's Disease - Dr. Christopher Rose 1:30pm –2:30pm LUNCH

Moderator: Dr. Mark Minott

2:30pm- 2:45pm

Hand Infections in the Jamaican Paedicatric Population -Dr. Jermaine Lewis

2:45pm – 3:00pm

Delay in Surgical Treatment of Isolated Femoral Shaft Fractures Increase the Likelihood of Blood Loss and Transfusion?-Dr. Yogeshwar Ramcharan

3:00pm- 3:15pm

Osteosynthesis of Neck of Femur Fractures - Dr. Amanda Chow

3:15pm-3:30pm

The Relationship between Self-Reported Use of Cannabis and In-Hospital

Outcomes of Orthopaedic Patients with Lower Limb Injuries Following Motor Vehicle Accidents. Dr. Wilton Kennedy

3:30pm-3:45pm

Questions and Answers

Moderator: Dr. Ian Neil

3:45pm – 4:00pm

Metastatic Spine Disease – Dr. Andrew Bogle

4:00pm – 4:15pm

Minimally Invasive long segments spinal fixation for high-grade

Thoracolumbar traumatic subluxation- deformity correction and spinal column stability - Dr. Preci Hamilton

4:15pm- 4:30pm

Electrodiagnostic/ Nerve Conduction Study for Cervical and Lumbar

Radiculopathy – Dr. Paula Dawson

4:30pm- 4:45pm

Questions and Answers

END OF DAY ONE

Moderator: Dr. Dean Wright

11:00 am- 11:15 am

A Word From Our Sponsors

11:15am – 11: 35am

“Text Neck”. Physiotherapy Management Strategies

Ms. Sheri-Ann Carnegie

11:35am– 11:50am

An Unusual Presentation of a Clavicular Fracture – Dr. Cary Fletcher

11:50am– 12:15pm

Orthopaedic Oncology in the 21st Century - Dr. Duncan Whitwell

12:15pm – 1:00pm

Bridging the Gap Between the Lower Back, Hip and the Pelvic Floor

Dr. Patrice Taylor-Irvine

1:00pm- 1:15 pm

The Use of Stem Cells in the Treatment of Orthopaedic Conditions in Jamaica

Dr. Derrick McDowell

1:15 – 1:30pm

Question and Answers

VOTE OF THANKS

MR. DUNCAN WHITWELL

Mr Duncan Whitwell is a full time NHS Consultant specialising in the treatment of hip/knee and oncology disorders

He was trained in Nottingham, Bristol, Oxford and Brisbane, Australia before he was appointed to a Consultant post at the Nuffield Orthopaedic Centre, Oxford in 2005 and works closely with colleagues in the lower limb arthroplasty, sarcoma and bone infection services.

The Nuffield Orthopaedic Centre is a specialist orthopaedic hospital with a large tertiary referral practice covering the South of England He further subspecialises in complex pelvic and acetabular reconstructive surgery for both oncology and revision arthroplasty indications He has been Chair of the Oxford Sarcoma Network for over 10 years He undertook the prestigious ABC Travelling Fellowship to Canada and the US in 2012.

He undertakes approximately 300 joint replacements a year including a high number of revision procedures and has developed his own large tertiary referral practice for complex joint reconstruction utilising a number of reconstructive techniques for large bone loss

Academically he is a Senior Clinical Lecturer at Oxford University and organises annual arthroplasty and oncology courses. He also hosts visiting surgeons to Oxford and regularly operates abroad supporting local surgeons in complex reconstructive surgeries

Within oncology, "I further subspecialise in the treatment of sacropelvic tumours. This is a demanding area and experience in complex hip revision has complimented my reconstructive procedures in this area "

Undertaking trauma surgery was Mr. Whitwell’s initial attraction to the field of orthopedics. “I liked the idea that the outcome of treating people in a difficult situation is in my hands ”

Mr. Whitwell is married with three children.

What has given you the greatest satisfaction?

“Organizing courses in developing countries and supporting them to see orthopaedic services develop and flourish. I’m passionate about seeing growth in our field.”

Whitwell’s advice to Interns trying to make a decision on which direction to go?

“Get a lot of experience in different specialities Intuitively, you will know what is the one speciality you want to spend the rest of your life doing.”

Whitwell’s advice to the younger generation?

Orthopaedics in the 21st century has a lot to offer people. Implants are so much better than in years gone by, but it’s important to

DUNCAN WHITWELL

remember to be a Doctor as well as a Surgeon, and to care for the whole patient.

PROF JOHN GOLDING

By Michael Abrahams

While speaking at a political conference last Sunday evening, the Jamaica Labour Party's Everald Warmington delivered an incendiary, racially charged tirade against the People's National Party's leader, Mark Golding, solely based on his ethnicity. Even though Golding was born in Jamaica, Warmington dragged his parents into the fray, asking, “Wey Mark Golding mother and father come from? A white man … from England,” adding, “Wey fi dem leader come from? Backra master.”

The reference to Golding's parents in Warmington's diatribe got me thinking about his father. Yes, he was white and hailed from England, but his contributions to our predominantly black country are immeasurable

Therefore, newspaper reporters are trained to write in inverted pyramid style, with all the most important information in the first paragraph or two. If the less vital details are pushed towards the end of the story, then the potentially destructive impact of draconian copy editing will be minimized.

Photographs submitted by Anna Mohammed

Michael Abrahams is an Obstetrician and Gynaecologist, social commentator and human-rightsadvocate

John Simon Rawso

April 15, 1921, and training in England senior lecturer in o opened University now known as the Indies. Six months experienced its firs viral infection takin

1,500 people with

Amid this crisis, Go treating polio patie travelling to visit a disease at their ho U d d b h

HOLISTICAPPROACH

Realising the devastating physical, mental and social sequelae of the disease, he aggressively adopted and executed a holistic approach to managing the disaster. He promptly set up a rehabilitation unit in an abandoned drama theatre, establishing the Polio Rehabilitation Centre When the epidemic subsided, the unit was renamed the Mona Rehabilitation Centre (and later Sir John Golding Rehabilitation Centre), catering to polio survivors and those with physical disabilities from congenital, traumatic, infectious, and other causes. The centre filled a gaping void and served not only Jamaica, but also the remainder of the English-speaking Caribbean. Professor Golding also helped establish Coconut Park, an amusement park at Hope Gardens, which provided income for disabled persons and helped generate revenue for Mona Rehab. In addition, to maximise the care of the disabled, he established the School of Physical Therapy and an orthotics and prosthetics workshop.

But this was just the beginning. Continuing on his holistic pathway to manage mind, body and spirit, Sir John realised that caring for patients and assisting them to mobilise in the limited setting of an institution was insufficient It was also necessary to reintegrate them into society to maximise their social well-being, which is a crucial component of health, and his actions reflected this. For example, understanding the importance of the disabled engaging in sporting activities, he formed the Jamaica Paraplegic Association.

He was also instrumental in setting up the 1966 Commonwealth Paraplegic Games in Jamaica Along with Jamaican Olympian Dr Arthur Wint, he also initiated the Jamaica Sports Medicine Association, providing voluntary support for Jamaican athletes

Recognising the need for the disabled to be educated, he subsequently founded the Hope Valley Experimental School. The institution, a primary school built on the grounds adjacent to the centre, is the first school in the Caribbean to integrate disabled and normally able children

Also, being aware of the continued needs of patients who leave the centre, and the shortage of housing for the disabled in Jamaica, especially for those dependent on crutches or wheelchairs, he built the Cheshire Village, an integrated community of 21 housing units. The community houses both able-bodied and disabled expatients, with the idea that the former would assist the latter when necessary The centre also has a business arm, Monex, which the Mona Rehabilitation Foundation administers, providing jobs for the disabled through various projects, facilitating the transition of its participants into the outside working world

Sir John Golding, (2nd right) Orthopedic Surgeon, Senior Registrar at Middlesex Hospital teaching other orthopedic surgeons in London, 1952

HOSPICEMOVEMENT

Sir John's attention was not solely directed at the rehabilitation centre and its environs. He also developed an interest in the hospice movement and in helping terminally ill cancer patients, and so opened the Hospice Home Care and the Hospice Pain Care centres

At the other end of the spectrum of disease is prevention, and Golding made his presence felt in that arena as well. Many of the injuries that leave people disabled occur due to motor vehicle accidents, and his concerns about this led to the initiation of the National Road Safety Council of Jamaica, an organisation charged with introducing safe-driving laws

At the time of his death, breathalysers had been introduced, and he was negotiating with the Government over legal requirements for seat belts and crash helmets, as well as the institution of drug testing.

Children of the Athlone Wing in 1950's with Sir John Golding

Matron Pringle & Sir John Golding after receiving his Order of Distinction at the national ceremony in 1982.

While directing all the above activities, Golding was also engaged in much research His research included subjects of particular interest in the tropics, such as the bones in sickle cell disease, tuberculosis of the spine, scoliosis and Blount's disease. In 1994, he was elected chairman of the Commonwealth Caribbean Medical Research Council, an organisation promoting and coordinating research within the region.

Golding's work earned him numerous accolades, including the Order of Jamaica (one of the highest decorations the country can give), the Institute of Jamaica's Musgrave gold medal, and being knighted in 1986. His favourite maxim was, “The greatest of all mistakes is to do nothing because we can do so little.” Professor Sir John Golding did not just do a lot; his contribution to our country is of a magnitude few can even approach, and for that, my gratitude to him knows no bounds. He was no “backra master”.

Sammy Henriques, Sir John Golding and Princess Alice touring the Mona Rebalitation Centre in the 1960s

IN JAMAICAN

PIONEERS ORTHOPAEDICS

A

ccording to The Oxford and Merriam-Webster dictionaries, and to the consensus within the Jamaican Orthopaedic community, the reputation built by these gentlemen dictates that they are indeed pioneers.

Highly respected, regarded and even revered. Meet Drs. Kenneth Vaughn, Melton Douglas, Christopher Rose, Warren Blake and Grantel Dundas

DR. MELTON DOUGLAS

Having retired just yesterday in January of 2023, Dr Melton Douglas’ 56 years of dedication to the profession he so deeply loves is rewarded by hundreds of healed patients and the legacy of a successful career.

What was your initial attraction to the field of orthopedics?

I was attracted to the field of orthopedics because of the ability to make a major impact in a very short while From the perspective of the outcome in the treatment of orthopedic injuries, having a bed-bound patient with multiple injuries on day 1, and then taking them from the operating theatre to significant mobility within 24 hours - the road to recovery is what attracted me to orthopedics

Dr. Douglas speaks to his greatest achievement with well-deserved pride. “I was one of the first set of Orthopaedic Surgeons who did spinal surgery in Jamaica I initiated a lot of the background facilities to orthopaedic surgery and am responsible for a lot of the early cases of spinal orthopaedic surgery in Jamaica I’m happy that I contributed to patient well-being and patient treatment in the early stages Thankful that there are more surgeons who are trained in Orthopaedic Spinal Surgery who have advanced the speciality. I am indeed very proud of them.”

However, despite significant contributions over the years, there is alway room for improvement What would Dr Douglas like to see evolving in orthopeadics in Jamaica?

“One of the major bottlenecks in Orthopaedics is the availability of surgery time. There is simply not enough emergency surgical time given to treat emergency cases and the same applies to elective cases If we could expand this area of service it would make a huge difference to patient load management and make a significant impact in overall patient care ”He also cites the need to increase orthopaedic services in other hospitals across the island “All hospitals should be provided with the resources to treat Ortho cases ”

If you could do one thing, leave one mark, to the younger generation in your field, what would it be?

THAT’S THE BEST WE CAN DO AND I THINK WE HAVE DONE THAT WELL."

"WE HAVE CONTRIBUTED TO PASSING OUR SKILLS AND OUR KNOWLEDGE THE YOUNGER GENERATION.

Dr. Melton Douglas

DR. GRANTEL DUNDAS

Like many doctors in the early years, Grantel Dundas’ initial interest in medicine changed from one field to another With exposure and experience being the primary influencers of change, a young Dr. Dundas would shift his previous inclination in cardiothoracic surgery to his destination career choice of orthopedic surgery. “I remember being in a lecture at the University of the West Indies and I saw a patient on whom Professor Golding had done a muscle transfer ” Dundas explains muscle transfer as the process of allowing the patient to use an arm that had been previously paralyzed because of an injury.

“The idea of working on the heart was something that thrilled me But when I saw that he (Prof Golding) made something work that couldn’t I said to myself that this is really what I want to be able to do.” Right away, cardiothoracic surgery immediately paled in Dundas’ mind, and a path formed in his head to his final choice.

Dr Grantel G Dundas is a Consultant Orthopaedic Surgeon, whose reputation for detailed excellence, paired with his impeccable social graces, lay the foundation for countless successful doctor-patient interactions that would ensue during more than five decades of practice

52 years of servic proverb speaks p his journ greatest

“My grea times th who had

For Dr Dundas, his days at KPH and Bustamante Children’s Hospital as an intern and as Junior Doctor meant that one pursued the art of medicine and surgery for its own reward, which was simply ‘the satisfaction of being able to make people function well again’.

“Nothing mattered apart from the fact that our patients recovered and were able to go on with their lives.” Service above self they say, and for this stalwart, this particular period of his professional career allowed him the chance to develop his diagnostic skills, and the art of orthopaedic surgery just for itselfwithout any monetary stimulus attached to it “My reward was that I learned a tremendous amount KPH was an incredible learning ground for me.”

“My greatest fulfillment was in the times that I worked with people who had nothing to give in return.”

GRANTEL DUNDAS

As a Junior Surgeon at Kingston Public Hospital in 1971, the young Resident was ending his night’s duty when an emergency call - a stab wound to the chest, took him to a place of uncomfortable growth that was both instructive and completely necessary. “I realized the knife had entered his heart and that waiting would have been lethal to the patient ” Quick thinking and immediate action saw Dr Dundas’ first unsupervised case where he was able to repair a wounded heart and save the patient’s life "I didn’t know then whether I had the courage to do it I didn’t think I had the courage " But the circumstances demanded the excellence of his training and not the presence of his fear ”

Half a century into the path he chose and loves, Grantel Dundas remains as passionate today as the day he started. Passionate and wise. "As your career unfolds, balance is key," he advises Surgeons make substantial personal sacrifices to practice in their field, and it’s important to find and maintain equilibrium to be able to handle stress “Read extensively, and find a hobby,” he recommends

Dundas describes photography as his safety valve Having fallen in love with the art form many years ago, he admittedly finds pleasure in macro photography - the 'small world', where you see things that you didn’t know were there because they are so tiny.

“There’s a thin line between art and medicine - I walk it by keeping active, and reading a lot.”

One bit of advice to share with the younger generation?

"Always strive to do something better than the generation before. I don’t want the juniors that I have taught to be as good as I am. I want them to be better."

DR. WARREN BLAKE

If one needs to see a picture of a ´ man for all seasons ´´ the face of Dr, Warren Blake would loom ´´big and large´´ as one would say here in Jamaica.

A Pioneer in the field of Orthopedics, an eager and energetic political aspirant, passionate and unrepentant in his commitment to the country of his birth, Dr. Warren Blake has made a mark on the fabric of this nation´ s development.

Currently on a post retirement contract, at the Bustamante Children's Hospital he continues to contribute in his field of expertise publicly as well as in his thriving private practice.

As an young graduate in 1976, he interned at the Kingston Public Hospital before moving onto the public Hospital in Mandeville, now known as the Mandeville Regional Hospital before returning to KPH where he did a stint in neurosurgery. In his own words 'it didn ´t work out too well. Fortunately, he showed an aptitude for orthopedics and benefited from the tutelage of Messrs. MacNeil Smith and Dundas and opted to forge a new path when he decided to move to England to specialize in Orthopedics.

In his pursuit of further training and certification in England, Dr. Blake, worked at several institutions with one particular hospital affording him the opportunity to obtain hand surgery experience which saw him returning to Jamaica in 1986 as a Consultant Orthopedic Surgeon at the Kingston Public Hospital. In 1997, he took the bold move of establishing his private practice while simultaneously pursuing another long held ambition...that of entering representational politics.

In 2011, Dr. Blake was invited to join the staff of the Bustamante Children´ s Hospital....where he continues to give yeoman service.

When asked to speak to his achievements, reflecting on his professional tenure, Dr. Blake noted that on his return to Jamaica, orthopedics was in its infancy and so the time and environment was conducive for trails to be blazed. So, seizing the opportunity to practice his new found skills, he participated in a number of firsts in Jamaica, specifically referring to the first micro surgery done locally where he successfully reattached a hand which was completely detached from the body as well as his participation in the first series of microscopic surgeries in Jamaica.

He continued his pioneering deeds by blazing a trail in joint replacement surgery while finding the the time and expending the energy with other colleagues to recognize the need to and establish the Jamaica Orthopedics Association as well as the Sports Medicine Association.

But what of the future?

Ever the consummate professional, and ever forward thinking, Dr. Blake hopes that the area of hand surgery will get special attention because currently at the Children´ s Hospital they are seeing quite a number of limb deformities presenting and as the ´´closest thing to a hand surgeon in Jamaica´´ when he leaves there is need for others to be trained and ready to fill the void. So it is his greatest wish that some of the young orthopedic surgeons will train and become involved in reconstructive surgery for congenital deformities.

And what would he like to leave to the younger practitioners in his field? Well in his estimation, the most important thing for them to remember is the ethics for practicing medicine....¨¨do your best, do it without fear or favour and conduct yourself with integrity´´ He stated that he was not worried about the technical expertise of those standing in he wings to replace the pioneers, because in his opinion they have been well trained and most of the young graduates go abroad and get some exposure to first world medicine and return to practice their newly obtained expertise. In that area Jamaica is doing very well Dr Blake noted but was characteristically passionate they remember always ´the ethics of medicine´´

In 2022, Dr. Blake was honoured for his services to medicine and was awarded an Order of Distinction, Commander Class A ,CD.

MR. KENNETH VAUGHAN

Very few people are blessed with the gift of prescience showing awareness of and preparation for the future It would be correct and most fitting to ascribe this gift to Kenneth Vaughan who for as long as he could remember had always wanted to be a doctor

So unlike so many others who wanted to but failed to do anything to achieve their goal, he fed this passion for what he felt was his calling and prepared himself every step of the way to fulfill his dream This sense of purpose may also have been influenced and encouraged by his beloved older sister’s dream of also entering the medical profession she wanted to and just like her little brother achieved her goal and became a nurse

A truly interesting and heartwarming backstory to someone who single-mindedly planned his path in medicine Having graduated medical school in 1982, the newly minted doctor did his internship in the Bahamas, returning to Jamaica having decided that surgery was his preferred specialty His exposure to several surgical disciplines at UWI, Mona - general surgery, ENT, and orthopedics, at the end of his stint as a senior house officer doing orthopedics, coupled with the influence of Dr Winston Chutkan, Consultant Orthopedic surgeon, his interest in the field increased He enthusiastically decided that orthopedics would be his preferred subspecialty, and the rest as they would say is history

Having completed the DM Ortho Programme in 1984, off he went to England for further formal training, bagging a Commonwealth Scholarship for a year going on to garner invaluable training and experience at several institutions

Mr Vaughan remarked that his exposure to learning and surgical skills was exceptional during the time he spent in the United Kingdom Upon completion of the Master of Surgery in Orthopedics from the University of Liverpool, and his return to Jamaica, Kenneth Vaughan was appointed Lecturer at the University of the West Indies

nd so began the legend A

Kenneth Vaughan is undoubtedly a pioneer in his chosen field His contribution to the discipline is legendary spanning decades of service as a practitioner treating hundreds of patients as well as a lecturer training and preparing residents enrolled in the orthopedics programme to become specialists in this discipline

In fact, when asked what was one of his greatest achievements it came as no surprise that his love and joy of imparting knowledge to others factored in his answer his pride and joy at the successful completion of the training of forty two graduates to date from Jamaica and other Caribbean islands, in DM Orthopedics at UWI Mona since the official start of the Programme fully prepared for their sojourn abroad to complete their specialty training and returning home to practice as orthopedic specialists But admittedly, Mr Vaughan’s greatest satisfaction has been his treatment of his patient throughout the lengths of breadth of Jamaica.

Although hanging up his shingles and retiring in nneth Vaughan continues o the development of this een appointed Honorary epartment of Orthopedics,

uch, witnessing firsthand ber of specialists in the takes great satisfaction in of specialty has grown, with all the residents who eir training becoming pline As a result, several country which previously geons now have such a ideal services to their several graduates have their subspecialty training eed, Mr Vaughan was note that all heads of ts throughout Jamaica were now trained here in Jamaica

But what of the future? Still dreaming big, the little boy who became not just a doctor but an eminent orthopedic surgeon, Kenneth Vaughan wants to see Orthopedic surgery as a special surgical discipline in every hospital in Jamaica

So naturally when asked if he could do one thing to leave a mark on the younger generation what it would be, without a moment of hesitation he answered “a word of encouragement I would encourage them to train residents in Orthopedics so that with the proposed development of additional hospitals and the conversion of hospitals from Types C and B to A, Orthopedics will be well represented. In fact, Kenneth Vaughan strongly believes that with more Orthopedic surgeons practicing throughout the country, he would ask that more research is done to determine the conditions that affect our population so that we can document and publish the results of the country rather than a specific location

That would indeed be a significant achievement and a great tribute to the work Kenneth Vaughan an outstanding medical practitioner and lecturer in orthopedics – a discipline that he believes he chose so many years ago, but it’s quite evident to us now, that orthopedics chose him.

DR. CHRISTOPHER ROSE

One doesn’t have to meet Christopher Rose in person to determine the measure of the man, in fact just listening to an audio of him reflecting on his life’s work truly offers an insight into an intriguing personality; passionate caring empathetic patriotic progressive enlightened dynamic and audacious This is the essence of a man who understood his assignment in life and will undoubtedly receive that accolade we should all strive to obtain from the Master, “Well done, thou good and faithful servant”

A highly complex character Dr Rose managed to fuse a love of family determination to always stick to his family values a deep and passionate love for his chosen profession, equalled only by his love for his adopted country, having been born in Grenada

Evidenced by his decisions both long and short term, his ability to put others before self was a recurring factor in his life His decision to return to Jamaica from Canada where he received his orthopaedic training, was highly influenced by his desire to “give back” to his alma mater, The University of the West Indies (UWI), and a strong belief that his son should be brought up in a West Indian environment, allowing him a great appreciation of his roots So, it s not surprising the sense of pride portrayed in his voice as he reports that his son having successfully completed university now lives in Japan, Jamaican to the core, and making his contribution to the Japanese Society as a teacher in a Private School

The second driving force in the life of Christopher Rose has always been, and continues to be, caring for the people of Jamaica, the majority of whom cannot afford private care

The orthopaedic landscape when he joined the Faculty of Medical Sciences at The UWI in 1984, saw only six orthopaedic surgeons serving roughly 2 7 million people in Jamaica at a time when there was only very basic orthopaedic equipment available to treat the large volume of trauma cases He saw the need for competent, dedicated, and compassionate surgeons trained to international standards and to meet the needs of patients in the Caribbean

The dreamer became the doer, driven by the belief that the evolution of orthopaedic training and the development of orthopaedics were about the needs that necessitated solutions appropriate to the times Clearly, there was a need for more to be trained in the field

Dr Christopher Rose, against all odds, succeeded in the establishment of an Orthopaedic Training Programme in Jamaica to serve the Caribbean; refusing to relinquish the dream in the face of so many challenges and amidst the doubts and fears of the less confident and courageous It must have been a lonely route for him to have taken, but he persevered, ever bolstered by a quote from Maya Angelo “do your best until you know better When you know better do better”

Forever the Renaissance Man, he had the foresight to recognize the need to get together as a group of professionals against the background of shared needs, love for entertainment and camaraderie This idea led to an invitation to several of his colleagues to get together for a Lime from which The Caribbean Association of Orthopaedic Surgeons was born in 2007

Formally retired from The UWI, Dr Rose continues to give tremendous assistance in his field by doing what he does best teaching, performing deformity correction and limb lengthening, as well as providing orthopaedic care to his patients at his private practice in Kingston, Jamaica

Ever the philosopher and thinker, he believes that where he is now in life and what he has achieved has a lot to do with where he has come from He acknowledges that his roots, his family, and the values they instilled in him have been a significant influence in his life

He succinctly but fervently ended his reflection, by sharing that “whatever I have achieved in this life, I owe to the Almighty, my family especially my wife for her continued love and support, and to my colleagues for their constructive criticisms and support”

As demonstrated by the sheer volume of work, dedication, and commitment evident in the development and evolution of the orthopaedic landscape in Jamaica detailed in the following article authored by Dr Rose, one would be hard put to distinguish between the individual Christopher Rose and the Orthopaedic Field in Jamaica They are both joined at the hip and cannot be detached

ORTHOPAEDIC DEVELOPMENT Contributionto IN JAMAICA AND THE CARIBBEAN

ByDr ChristopherRose

Development of the Orthopaedic Training ProgrammeatMona

The orthopaedic landscape in 1984 when I joined the Faculty of Medical Sciences of The University of the West Indies, was that of six orthopaedic surgeons who served 2 6 million people in Jamaica and they were all situated in Kingston, the capital of Jamaica Only very basic orthopaedic equipment was available to treat the large volume of trauma cases The evolution of orthopaedic training in Jamaica and the development of orthopaedics were about the needs which necessitated solutions appropriate tothetimes

There was a need for many more trained orthopaedic surgeons along with affordable, good quality instruments and implants The people of Jamaica deserved better orthopaedic care The trend, at that time, was for individuals to obtain their orthopaedic training in the United Kingdom I felt that an Orthopaedic Training Programme should be established in Jamaica, and that it would serve the region For many years, I was the sole advocate of that audacious idea, especially since I was informed by many, at that time in Jamaica, that the Training in Jamaica would be inferior to that of the United Kingdom I refused to relinquish that dream, even though I knewthepathaheadwouldbeverychallenging

In1991,Icreated,implementedanddevelopeda structured Post-Graduate Orthopaedic Training Programme at The University of the West Indies, Mona, Jamaica The Programme began with three residents I was assisted by three orthopaedic surgeons two of whom had recently returned from their training in the United Kingdom The goals of the Programme were to produce competent, dedicated and compassionate surgeons who were trained to international standards and also to meet the needsoftheCaribbean

Initially, we did the best with what we had The late sir John Golding’s favourite maxim was “the greatest of all mistakes is to do nothing because you can do so little” - we did everything even though we knew there were better ways As surgeons, we had the passion, we had the ability,andwehadthefortitude However,wedid not have the resources, but we persevered I believed then and still do, that the best investment in the future of any organization, institution or country is in the people I taught medical students, physiotherapists, nurses, radiographers, plaster technicians, Accident and Emergency Residents, surgical residents and my peers It is reported that I taught those who did not want to be taught, and even those previouslythoughtunteachable

The University Hospital of the West Indies was never able to provide all of the equipment which was needed to allow us to provide best care practice for our patients, and that which wasvital to training of residents There was a great void which needed to be filled – good quality instruments and implants Initially, three private companies were established because they saw the financial benefits of providing good service along with the appropriate equipment (total joint implants and instruments, arthroscopic equipment, and most frequently used trauma implants) The cost of the equipment was borne by the patients Despite the long waiting time to surgery, public patients at the University Hospital of the West Indies were finally able to receive much improved surgical treatment I have always strived to offer the same quality orthopaedic care to both public and private patients with regards to empathy, respect, surgical expertise, and education of their conditions This aspect of care was impressedupontoallresidents

During my tenure as Head, Division of Orthopaedics, University Hospital of the West Indies, and Director of the Orthopaedic Training Programme from 1984 to 2010, there were 29 graduates from the Programme The Programme has continued to produceorthopaedicsurgeonsforJamaicaandtheCaribbean.

As of 2022, the Programme has produced 41 orthopaedic surgeons, 31 of whom practice in Jamaica Of the remaining 10graduates, 9 reside and practice in other English-Speaking Caribbean islands One is presently pursuing a Paediatric Surgery Fellowship in the United Kingdom Thirteen of the graduates have obtained Fellowships overseas in the followingsub-specialities:

HipandKneeArthroplasty-2

Knee,ShoulderandHipArthroscopy-1

Upperlimb-1

Spine-4

Hand-1

SportsMedicine-2

PaediatricSurgery-2

IMPACTOFGRADUATESONTHEQUALITYOF ORTHOPAEDICCARE

The prestige and success of any training programme and its institution are measured by its impact locally, regionally and internationally The Orthopaedic Training Programme at Mona, Jamaica, although still in its infancy stage (31 years) as far as academic programmes are concerned, has made strides in the followingareas:

IMPROVEMENTINHEALTHCARE

Richard Whately wrote “ a man is called selfish not for pursuing his own good but for neglecting his neighbours” Our graduates have all made contributions to the quality of orthopaedic care to the people of Jamaica and the Caribbean while pursuing their individual goals Of the 31 graduates who are practicing in Jamaica, 29 are employed to Public Hospitals across the island of Jamaica.

Most orthopaedic surgeries can now be successfully performed in Jamaica due to the competence and expertise of our graduates Of the 13 Fellowship-trained orthopaedic surgeons, 10 surgeons reside and practice in Jamaica, the other three resideandpracticeintheotherEnglish-SpeakingCaribbeanislands

Other Areas of Impact

Our graduates are involved in active research with many publications in Peer-Reviewed Journals.

The success of the Orthopaedic Training Programme in Jamaica, influenced others to start similar Programmes in Trinidad and Tobago and Barbados The Programme continues to evolve in an effort to keep abreast with new innovations; to improve its research output, and to satisfy the needs of the Caribbean people, especially those residing in Jamaica

Orthopaedic Alumni Fund

In 2006, I initiated the formation of the Orthopaedic Alumni Fund

Annual contributions to the fund were made by the graduates of the Orthopaedic Training Programme at Mona The funds ensured that residents in the Programme were able to attend conferences in North America as well as to attend and present their research papers at the Annual Conference of The Caribbean Association of Orthopaedic Surgeons

Development of specialized surgery in Limb Lengthening, Deformity Correction and Reconstruction

In 1996, I accepted a Fellowship to study Limb Lengthening, Reconstruction and Deformity Correction at U S S L Hospital, Lecco, Italy under the tutelage of a brilliant Italian Orthopaedic Surgeon, Professor Mauricio Catagni

An innovative method of treating infected non-unions of bones was born in the Siberian town of Kurgan, USSR in early 1950s by Professor Gavriil Ilizarov The principle of the Ilizarov Method to treat large bone defects without the use of bone grafts, utilized the bone’s ability to regenerate during incremental distraction using wires, rings and rods, a process known as distraction osteogenesis

In addition, Ilizarov’s Method of gradual deformity correction with the use of hinges on a frame and calculation of the location, revolutionized the process of deformity correction This “Siberian Technique” was brought to the Western World in 1981 when Ilizarov delivered his first clinical presentation in Bellagio, Italy

My fascination for this unique method for treating congenital, developmental and acquired deformities; reconstruction of large bone defects and complex fractures, drove me to learn more about deformity analysis and the concept of the centre of rotation and angulation and the osteotomy rules I attended the Deformity Course (2008) which is held annually by Professor Dror Paley in Baltimore, Maryland, United States of America

I was energized by this new found knowledge and excited by the many applications for its use in patients in Jamaica and the Caribbean I introduced the Ilizarov Technique utilizing the circular external fixator into Jamaica in 1998 This technique allowed the treatment of many musculoskeletal conditions which could not previously be treated in Jamaica and if they were undertaken, the results were usually poor

The greatest challenge following my Ilizarov Fellowship was that of obtaining funding for the Ilizarov equipment Ninety-nine percent (99%) of patients who required this specialized treatment are public patients, and many have difficulties in obtaining funds to pay for their surgery at the University Hospital of the West Indies The financial constraints of the University Hospital of the West Indies over the past years resulted, understandably, in the funding of the more urgently needed equipment I therefore sought financial assistance from the private sector and was extremely fortunate to meet a businessman who agreed to adopt Ward 17 with the express purpose of funding all the requisite Ilizarov equipment This annual financial assistance began in 2003 and continued until 2017 All public patients received the Ilizarov external fixator free of cost

This specialized surgery has allowed us to successfully treat patients with the following conditions:

Infected non-unions with multiple draining sinuses and poor adjacent soft tissue

Complex deformities in the lower limbs.

Lower limb-length discrepancies in both children and adults

Charcot feet

Blount’s Disease

Congenital abnormalities in the lower limbs

Grossly comminuted fractures of the lower limbs

Arguably, the most dramatic progress in orthopaedic surgery during the last two decades has been in the field of deformity correction, and patients in Jamaica have benefitted greatly from this revolutionary method of treatment

Formation and Development of The Caribbean Association of Orthopaedic Surgeons

As a result of my initiative, the first meeting of 23 orthopaedic surgeons from eight English- Speaking Caribbean Islands was held in Trinidad and Tobago in 2005 The meeting was borne out of desire for surgeons in the region to develop closer links with each other; to become more aware of the challenges which confront each of us in our respective countries, and to offer technical support to our colleagues working in environments with limited resources

The Caribbean Association of Orthopaedic Surgeons (TCOS) was founded in 2007 I was elected the first President from 2007 to 2009 and re-elected as President from 2009 to 2011 Annual Scientific Meetings are held each year in an English-Speaking Caribbean Island

The development of TCOS has resulted in the following:

A forum at which residents from the Orthopaedic Training Programmes in Jamaica, Trinidad and Tobago and Barbados can develop the art and confidence in presenting their research projects

An annual source of continued orthopaedic education within the Caribbean

In 2010, the Association was incorporated under the Companies Act in Jamaica as a Limited Liability Company, Limited by Guarantee In 2014, the Association was registered under the Charities Act, 2013 as an Approved Charitable Organization Since 2018, annual scholarships have been offered by Professor Douglas Letson, Physicianin-Chief and Executive Vice President of the Moffitt Cancer Center, Tampa, Florida to residents from the Orthopaedic Training Programmes in Jamaica, Trinidad and Tobago and Barbados to attend the Annual Orthopaedic Oncology Course in the Keys, Florida This is an excellent international learning opportunity for the residents on a topic that is not adequately covered locally

Post-retirement from The UWI in 2010, I have been performing Volunteer Service as an Honorary Orthopaedic Consultant at the UHWI My role as a surgeon and teacher is to inspire, nurture, uphold the principles of medicine; be a role model and to teach life lessons to medical students and residents

"A man is called selfish not for pursuing his own good but for neglecting his neighbours.”

Richard Whately

REVAMPING Rehabiliation Orthopaedic

BY DR KAREN PHILLIPS

Improved patient outcome following orthopedic surgery is of primary importance to the Orthopedic team. Post operative rehabilitation irrespective of the modality is critical in this regard. Though an optimal rehabilitation strategy has yet to be determined, it is clear from existing evidence that early rehabilitation, high intensity and high velocity exercise may be successful forms of rehabilitation

Rehabilitation following orthopedic surgery may be carried out in the home environment, in an outpatient clinic or in the inpatient setting Though personal factors may influence the setting in which rehabilitation is carried out, it is important to note that patient outcome can be similar in all settings, however the benefits of inpatient rehabilitation are significant and include:

1. Comprehensive care and support by an expert multidisciplinary team

2. Reduction in the risks of complications

3. Improvement in pain management

4. More intensive therapy sessions

5 Safe, convenient environment

Revamp Rehabilitation Facility is a comprehensive rehabilitation center located in Kingston, Jamaica that offers multidisciplinary rehabilitative care based on best practices

We are proud to state that we offer therapy to patients suffering from stroke, neurological and orthopaedic conditions in both inpatient and outpatient settings

Our core multidisciplinary team comprises:

1) Consultant Physician

2) Consultant Neurologist

3) Physiotherapists

4) Occupational Therapist

5) Speech and Language Therapist

6) Neuropsychologist

7) Rehabilitation Assistants

8) Nurses/Nursing Assistants

Revamp prides itself as being a `beacon of rehabilitative care in the region. Over the years we have contributed to the neurologic and orthopaedic recovery of patients from the wider Caribbean as well as the USA. We proudly stand behind our vision to be the best rehabilitative facility in the region.

We are especially pleased to offer our special package for orthopedic rehabilitation to patients following hip and knee replacement Standard practice suggests that hip and knee replacement begin as early as possible following surgery and we are happy to be able to offer post operative rehabilitation in the outpatient as well as inpatient setting in this regard

Our aim is to facilitate patient recovery and improve the quality of life for all patients

At Revamp, we care about you.

BABY BORN WITHOUT LIMBS TAKES FIRST STEPS

ByTiffanyTaylor-originallypublishedin theSTAR,April01,2021

Itwas pure joy at the Sir John Golding Rehabilitation Centre yesterday as four-year-old Mary took her first steps Mary, a resident of the Missionaries of the Poor Nazareth Home, was born without limbs

Winfield Boban, managing director of Surgix Jamaica Limited, located on the compound of the rehab centre, watched in awe yesterday as his prosthetic technicians set about helping Mary

"Mary can be anyone in life, she can be anything. But all she needs is a chance," said Boban, who added that the road to getting the girl's arms and legs began last November after he was approached by Archbishop Joseph Harris for assistance

Boban said that after meeting Mary for the first time, he saw it as "an awesome challenge to give her hands and feet, so that she can live a normal life "

Mary was not shy to show how she can independently feed herself and properly sit without the assistance of her caregiver She sat attentively listening to Boban's conversation, often sharing a smile or shedding a tear Her faint greeting of "Hi!" to our news team warmed the hearts of everyone in the room

The prosthetic technicians at Surgix, Lasana Pyrce, Tutu Campbell and Orlando Brown were tasked with designing legs for Mary and they could be seen busily finishing up the legs to ensure they would fit. The cost for her prosthetics was covered by Surgix, but Boban explained that it would cost millions to seek rehabilitation overseas for the child

Mary, waiting for her prosthetic legs to be fitted.

"Once we get her up and moving she will be just fine," Boban said, as Mary smiled Yesterday, after months of preparation, it was time to fit Mary's legs She couldn't hide her excitement Carefully, as the technicians fitted her legs, Mary watched attentively, her focus fixed on her shiny new shoes. Boban said that in the early stages she will feel a little pressure as her body gets accustomed to the legs. He added that as she grows, her legs will have to be upgraded but this is the first step in getting her to walk

Mary, with the assistance of her caregivers Miss Pryce and Miss Rose, anxiously took her first steps It was a nervous moment for her and she cried a little

Rose could not hide her emotions as seeing her 'daughter' walk was pure happiness The next phase of rehabilitation for Mary is getting hands, which will happen in another month

"It is good day, it is an awesome thing to see she walk for the first time She can do it but it's just the challenge of her getting used to it and getting those limbs moving, but we will keep her monitored Her next sessions, which will be weekly, will see her undergoing physiotherapy with Dr Deandra Dallas, here at Surgix But it is just a good move and I feel good," Boban told THE WEEKEND STAR

Orlando Brown (right) and Lasana Pryce, prosthetic technicians, fit four-year-old Mary with prosthetic legs.

Caregiver Rose helps Mary take her first step after being fitted with prosthetic legs at Surgix Jamaica, located on the compound of the Sir John Golding Rehab Centre, Mona

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