Contributionto IN JAMAICA AND THE CARIBBEAN ORTHOPAEDIC DEVELOPMENT

ByDr ChristopherRose

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 to the times There was a need for many more trained orthopaedic surgeons along with affordable, good quality instrumentsandimplants

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 knew the pathaheadwouldbeverychallenging

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, and we had the fortitude However, we did not have the resources, but we persevered I believed then and still do, that the best investment in the future of any organization, institutionorcountryisinthepeople

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Itaughtmedicalstudents,physiotherapists,nurses,radiographers,plastertechnicians,AccidentandEmergencyResidents, surgicalresidentsandmypeers ItisreportedthatItaughtthosewhodidnotwanttobetaught,andeventhosepreviously thoughtunteachable

TheUniversityHospitaloftheWestIndieswasneverable toprovidetheequipmentwhichwasneededtoallowusto providebestcarepracticeforourpatients,andthatwhich wasvitaltotrainingofresidents.Therewasagreatvoid whichneededtobefilled–goodqualityinstrumentsand implants Initially,threeprivatecompanieswere establishedbecausetheysawthefinancialbenefitsof providinggoodservicealongwiththeappropriate equipment(totaljointimplantsandinstruments, arthroscopicequipment,andmostfrequentlyused traumaimplants) Thecostoftheequipmentwasborne bythepatients Despitethelongwaitingtimetosurgery, publicpatientsattheUniversityHospitaloftheWest Indieswerefinallyabletoreceivemuchimprovedsurgical treatment Ihavealwaysstrivedtoofferthesamequality orthopaediccaretobothpublicandprivatepatientswith regardstoempathy,respect,surgicalexpertise,and educationoftheirconditions Thisaspectofcarewas impressedupontoallresidents

DuringmytenureasHead,DivisionofOrthopaedics,UniversityHospitaloftheWestIndies,andDirectoroftheOrthopaedic TrainingProgramme,therewere29graduatesfromtheprogramme TheProgrammehascontinuedtoproduceorthopaedic surgeonsforJamaicaandtheCaribbean Currently,theProgrammehasproducedatotalof40orthopaedicsurgeons Ofthe 40graduatesfromtheprogramme,30practiceinJamaica,9practiseinotherCaribbeanislandsandoneiscurrentlydoinga fellowshipintheUK TwelvegraduateshavesuccessfullycompletedFellowshipsinthefollowingsub-specialties:

OneinArthroscopy

FourinSpine

TwoinArthroplasty

OneinHandSurgery

OneinSportsMedicine

OneinUpperLimb

TwoinPaediatricOrthopaedics

TheprogrammehasproducedthefirstfivefemaleorthopaedicsurgeonsfortheCaribbean,twoarepresentlypracticingin Jamaica,oneisinBarbados,oneinBermuda andtheotherispursuingafellowshipintheUK

OrthopaedicAlumniFund

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 residentsintheProgrammewereabletoattendconferencesinNorth America as well as to attend and present their research papers in otherCaribbeanIslands

Mentorship

I can still hear the voices of the people who guided me through Medical School and Residency, and in the early years of my being an orthopaedic surgeon I am aware that the advice they dispensed were critical in my development as a surgeon and a person Therefore, it was natural for me to try to provide the medical students and residents with a set of values that can serve as their moral compass It has always been my belief that a good example has more value than good advice I have always approached my professional and academic career with dedication, integrity, ethical behaviour, passion and trying to make each resident achieve his or herpotential

Many interesting conversations have been had at my home with residents during their training Discussions included: what should be most important in life; how to establish private practice; interpersonal issues and the impact on work; advice on opportunities; andgeneralsupportoftheresidentsduringtraining

Of the many joys that my orthopaedic career brings to me, assisting my residents (mentees) grow and develop into accomplished young surgeons, fills me with energy and life and inspires me to continue to offeradviceandsupportwheneverneeded

I was actively involved in the Mentorship Programme, The University oftheWestIndiesbetween1991and2001

OrthopaedicFellowships

As a result of my initiative, three graduates from the Programme obtainedFellowships:

Fellowshipinspinalsurgery,Vancouver,Canada Fellowshipinarthroscopicsurgery,Toronto,Canada Fellowshipinarthroplasty,Australia

Awards

My contributions to orthopaedics in Jamaica have been recognized bytheJamaicanGovernmentandMedicalAssociations

2014 Lifetime recognition of my development of orthopaedics in theCaribbean AwardedbytheJamaicanOrthopaedicAssociation

Prestigious award by the Medical Association of Jamaica in recognitionoflongandoutstandingservicetothemedicalprofession andthepeopleofJamaica

2013 Order of Distinction in the rank of Commander (CD) conferred by the Government of Jamaica for outstanding contribution to orthopaedicsandsurgeryinJamaica

2012 TheawardforoutstandingcontributiontotheHealthServices and the advancement of surgery in Jamaica Awarded by the AssociationofSurgeons,Jamaica

2010 First recipient of an award by the Jamaican Orthopaedic Association in recognition of my contribution to orthopaedics through the training of residents in the Orthopaedic Training Programme,TheUniversityoftheWestIndies,Mona,Jamaica

2009 Award for outstanding service for over ten years to the JamaicaAssociationofSportsMedicine

2008 Award for excellence in teaching recognized by The University oftheWestIndies

2001 For outstanding and unselfish contribution to nursing in the area of orthopaedics Awarded by the nursing fraternity, University Hospital of the West Indies Impact of our graduates on the quality of 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, although still in its infancy stage (27 years) as far as academic programmes are concerned, has made significant strides in the followingareas:

1 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, some greater than others, to the quality of orthopaedic care to the people of Jamaica and the Caribbean, while pursuingtheirindividualgoals Nineteenofthe24graduateswhoare practicing in Jamaica are employed to Public Hospitals across the island of Jamaica including the University Hospital of the West Indies

The majority of trauma cases outside of St Andrew can now be adequately treated at the Cornwall Regional Hospital, Mandeville Regional Hospital and St Ann’s Bay Hospital Cases which require specializedsurgicaltreatment,suchasspinaldeformities,revision joint arthroplasties, limb lengthening, reconstruction and deformity correction, complex surgical sports medicine injuries, arereferredtoeithertheKingstonPublicHospitalortheUniversity Hospital of the West Indies depending on the care which is required.

The Bustamante Children Hospital is the only specialized paediatric hospital in the English-speaking Caribbean From 2001 to 2011, one of our graduates has been the only full time paediatric orthopaedic surgeon at the hospital He has significantly improved the quality of paediatric orthopaedic care for the children in Jamaica A recent graduate of the programme will be pursuing a Paediatric Orthopaedic FellowshipintheUnitedKingdom,hopefullyin2019

Most orthopaedic surgeries can now be successfully performed in Jamaica,duetothecompetenceandexpertiseofourgraduates

2 One of the first two graduates established a successful Masters Programme in Sports Medicine at the University of the West Indies The Masters Programme in Sports Medicine has trained the majority of Sports Medicine doctors in Jamaican and the Caribbean He also established the Faculty of Sports Medicine at The University of the WestIndiesin2017andwasappointeditsfirstDean

3 One of the graduates who obtained a Spinal Fellowship from Vancouver, Canada, has partnered with the Duncan Tree Foundation (New York, U S A based organization)toprovidesurgeriesfreeofcosttochildren with scoliosis Many children have benefitted and continue to benefit annually, from this specialized surgicalexpertise

4 One of our graduates is the first Fellowship trained Hand Surgeon in the Caribbean and presently resides in Barbados Her specialized training was obtained in India andtheUnitedStatesofAmerica

5 The success of the Orthopaedic Programme in Jamaica,influencedotherstostartsimilar ProgrammesinTrinidadandTobagoandBarbados

6 A few of our graduates are involved in research, and onehaspublishedextensivelyinPeerReviewedJournals

The Programme continues to evolve in an effort to keep abreast with the new innovations; to improve its research output, and to satisfy the needs of the Caribbeanpeople,especiallythoseresidinginJamaica