1. "Orthopaedic Problems in Developing Countries "- Orthopaedic Association of the Philippines. Lecture to Orthopaedic Surgeons.
2. "The Cripple in Africa"-University of Santo Tomas. Lecture to medical students, doctors and other staff.
3. "Orthopaedic Problems in Africa"-National Orthopaedic Hospital, Manila. Lecture to orthopaedic surgeon, residents, technicians and other staff.
4. "The Cripple in Developing Countries"- Veterans' Hospital of the Philippines, Quezon City. Lecture to orthopaedic staff, residents, nurses, physiotherapists and other staff.
1. University of Santo Tomas.
2. National Orthopaedic Hospital. Ward round, visit to workshop, casualty and other departments. This is a 700-bedded hospital dealing only with orthopaedic and traumatic cases in the ratio of 60% to 40% (approx.).
3. Veterans' Hospital, Quezon City. Visit to orthopaedic wards, workshop, physiotherapy and occupational therapy departments. Approximately 50 orthopaedic beds.
1. Dr. Catalino Jocson and members of the Orthopaedic Association of the Philippines on problems in developing countries. The pattern in the Philippines is very similar to that in Africa. Tuberculosis of bone and joint, osteomyelitis and poliomyelitis are common. No national immunisation scheme for poliomyelitis is yet under way. Gout is also common.
Late untreated trauma is seen frequently and many patients with late untreated congenital deformities are still seen.
2. Orthopaedic Technicians. Discussions were held with Dr. S. C. Pineda, the head of the prosthetic and surgical appliances department of the National Orthopaedic Hospital.
Great interest was shown in the simple polyester resin casts ("Skelecasts") and in simple wheelchairs and other appliances. Details and, if possible, samples were requested both by him and by Dr. J. M. Pujalte of the hospital. It was felt that these might have a considerable application, especially in the outlying parts of the Philippines. At present, only sophisticated appliances were made with machinery from Australia under the Colombo Plan.
3. Training of Staff from the Philippines. Discussions were held with General Protacio R. Sotto, Director of the Veterans' Hospital, Quezon City, and various orthopaedic staff of these and other hospitals on various training schemes which might be of value in the Philippines. It appears that the following are those which would be of most interest and value :
(a) Ortbopaedic Assistants. This grade of male nurse with practical orthopaedic training would be of value, not only to orthopaedic surgeons in Manila, but particularly in the smaller hospitals in the Philippines.
It was suggested that one fairly senior male nurse should be trained in Uganda for perhaps one year, and that he should then be responsible for subsequent training of a suitable category of staff in the Philippines in the future.
(b) Ortbopaedic Technician. An orthopaedic technician trained in the methods of manufacture of simple appliances would be of value in the Philippines where there is a considerable need for these supports in addition to the more sophisticated types.
(c) Training of Ortbopaedic Surgeons. Considerable interest was shown in the training schemes for orthopaedic surgeons at present under way or proposed in Uganda. It would probably be necessary to have additional financial assistance to supplement the salaries of Philippines surgeons working in Uganda as well as to make sure that the qualifications of individual Philippines surgeons were acceptable in East Africa. These vary considerably from one University to another in Manila.
The possible grades of doctor staff who could be recruited in future would be those of junior resident or S.H.O. grade, and those of senior resident or senior registrar grade.
(d) Acceptance of Philippine Ortbopaedic Training by the United States. This is not recognised at present and is considered of great importance by the Philippine orthopaedic surgeons. They asked that I should investigate methods by which their training could be recognised outside the Philippines. The main difficulty appears to be the great difference in standards between hospitals, as is the case in India. These vary from excellent to poor.
There is a considerable range of basic orthopaedic conditions available for teaching in the Philippines. There are also a number of orthopaedic surgeons who have received training in the United States and Britain.
Shortage of finance and administrative difficulties have curtailed part of the possible integrated orthopaedic training scheme which could be an important part of the residency training in Manila. There is already a residency training scheme in operation in the National Orthopaedic Hospital.
Both developed and developing countries could help the Philippines in the future, and closer co-operation on all aspects of training in the orthopaedic field could be of mutual benefit.
Simple appliances such as wheelchairs, simple calipers and "Skelecasts" as made in Uganda, could be of great value in the Philippines.
1. The training of a male nur,e from the Philippines as an orthopaedic assistant for one year in Uganda should be investigated.
2. The training of an orthopaedic technician from the Philippines in the manufacture of si&lple appliances for six to twelve months could be of benefit to the Philippines.
3. The possible training of doctors from the Philippines in major orthopaedic centres in other developing countries might be of mutual benefit provided the basic qualifications of these Philippine doctors was acceptable.
4. An investigation of the training methods in orthopaedic surgery in the Philippines by the American Board of Orthopaedic Surgery, with a possible view to future recognition of at least some of this training, would be appreciated by orthopaedic surgeons in Manila.
5. Uganda should donate a locally made wheelchair and various other simple appliances, with details of their manufacture, to the Philippines so that these can be copied.
Much of value could be achieved by closer co-operation in all aspects of the orthopaedic field between the Philippines, on the one hand, and various other developing and developed countries on the other. These would include training of all grades of orthopaedic staff as well as help in the manufacture of simple orthopaedic appliances.