ROYAL NATIONAL ORTHOPAEDIC HOSPITAL, STANMORE from 10/9/07 till 12/09/07

It was time again for the annual BOA-ASEAN traveling fellowship and this time round we had a new member joining the fellowship of which was a representative from Vietnam. Thus the fellowship this time round with its representatives are:-

Dr. Fong Shee Yan (Coordinator)                                               SINGAPORE
Dr. Ludwig Andribert P Pontoh                                                    INDONESIA
Dr. Kamil bin Mohd. Kasim                                                        MALAYSIA
Dr. Kachain Namsirikul                                                              THAILAND
Dr. Nguyen Veit Tien                                                                 VIETNAM
Dr. David L. Alagar                                                                   PHILIPINES

All of the representatives had to make their own way to Premier Travel Inn Hotel in Burnt Oak Street; Edgeware in the city of London after each of them has landed in Heathrow Airport. We all checked in the hotel at different times on the 9th September, 2007 except for the Indonesian representative who checked in the hotel on 10 thSeptember,2007. All of us met up for the first time on the next day prior the journey to the Royal National Orthopaedic Hospital at Stanmore. We were lucky that there was a shuttle van service from the Edgeware Railway Station to the RNOH at a regular basis through out the whole day. We took the shuttle service and reached the hospital at about 0800 H and was met by Mr. S. Cannon at the front of the Seddon Building.

Staff of Bioengineering Department explaining the services present in the unit.

All of us were then given a short tour of the RNOH by Mr. S. Cannon and we had the opportunity to see the various wards in the hospital. . The RNOH is an elective hospital and has been in service for about 100 years and most of the original buildings are still standing. It is a center of training for the Spine, Musculoskeletal oncology, Peripheral Nerve injuries, Arthroplasty and Pediatrics. It also has a research wing and an established biomedical engineering department which develops custom made implants for the various cases.treated by this hospital.  

We then each was introduced to the Prof. David Marsh, Mr. John Skinner, Mr. Peter Calder and Mr. Marconi who each gave us short talk of their interest and specialities. We then each had to also to do s short presentations of our work and interest to the group. This extended til the afternoon of which there was a lunch break in between The presentations were then started again at 1330 H and managed to finish by late afternoon. We then made our own way back to the hotel by a cab and was treated with an English style dinner by the Mr. S. Cannon in a quaint restaurant called St. James in Bushley town in the evening.

On the next day, we went to the RNOH again and was met by the senior registrar who took us around the hospital grounds in detailed. We visited the physiotherapy department, private wing wards and bioengineering department.  After an early dinner, we all then went back to the hotel for a good rest. On the next day, we then made our way to the railway station and took the train to journey to the town of Norwich and checked into a hotel there.

NORWICH & NORFOLK HOSPITAL, NORWICH from 13th September till 15th September, 2007

Arriving at the Norwich Train Station

There was a small miscommunication of our arrival but this was resolved after we met the staff in the Norwich & Norfolk hospital. We were then quickly sent to the X ray department and each of us had a chest X ray taken and reported immediately. While this was being done, we were sent to the orthopedic department meeting room where we were broken up into various teams under the respective consultants of Spine, Artroplasty and Hand & Upper limb. Some of us were brought either to clinics or the operating theatres and this extended till the late afternoon. After these sessions, we then all met up at the McKee meeting room where we sat in and hear the case presentations done by the senior registrars within the department. It was here that we were introduced to Mr. Keith Tucker who welcomed us to the hospital and we each introduced ourselves to the whole unit. The presentations finished pretty late at about 1800 H and we all were then brought straight for dinner by the faculty to enjoy an Indian cuisine at the Spice Lounge within Norwich town.

On the next day, we were still broken up into three groups and joined the consultants assigned to us in the theaters and clinic session. We all met up at the McKee room in the afternoon to present again our work to the consultants, registrars and doctors in the unit. Only four of us presented our work since the time was limited and Mr. Keith Tucker and his group were quite impressed with the work done by our group.

We said our farewell to the consultants of the hospital and Mr. Tucker and thank him for the wonderful time that we had there. We spent the whole of next day exploring the town of Norwich and the Hay market in the center of the town. After an exhausting day, we retired to the hotel with an early dinner and preparing for the journey on the next day.

SHEFFIELD from 16th September till 18th September, 2007

We traveled to Sheffield by bus coach and reached the town by about 1800 H in the evening. We had light dinner at the Sheffield train station before departing to the Premier Travel Inn Hotel in town and where we finally managed to get a good rest for the night.

We made our own way to the Northern General Hospital to meet up with Prof. J. C. Getty in his office within the orthopaedic department early in the morning. We then joined up with the rest of the doctors of the unit in a Monday morning meeting discussing the cases that were seen in the weekend and also those put up for elective surgery. It was here that we were introduced to the doctors within the unit and later was broken up into three teams with respective consultants taking care of us. We then followed the consultants assigned to us to the respective clinics that is Hand, Spine and Arthroplasty. This clinics session continued till the late afternoon with a short break in between at midday for lunch. Most of the cases seen in the clinic today were new and follow up elective cases seen by the respective consultants. We met up again with Prof. Getty after the clinic sessions and had a group picture with him at the hospital compound.

Group photo with consultants at Sheffield Children’s Hospital after free paper presentation.

On the next day, we made our way to the Royal Children Hospital near the University of Sheffield compound where we were met with Mr. Stanley Jones and his team. After a short introduction, we then were given a short tour around the hospital. This hospital was around for a very long time since after the second world war and new buildings were just added around the compound as the years went by. This hospital mainly treats children below the age of 16 years old with orthopaedic problems and act as a main referral center for the area nearby.

 This hospital has an environment which is friendly to children and this can be seen by the various paintings and graphics all around the walls of this hospital.  We joined Mr. Stanley’s team while they were doing the ward round and some interesting cases related to the spine was shown to us and discussions about these cases were the main topic in the morning. The wards appeared full with nurses busy doing their daily chores. This hospital is known for the its services of reconstruction of limbs and spinal deformities in children. For the reconstruction of limb deformities, this hospital has the highest number of cases in this country and is the main referral center for such problems. It also has two fellowships available for surgeons interested in the field of orthopaedics and one international fellowship open for any surgeons practicing outside of United Kingdom. We were quite impressed at the registry that was made for the cases related to the limb deformities and was quite surprised at the number of cases that was treated over the past few years in this hospital.

After lunch, we then went to the conference room where two of us gave short presentations of our work which was well received by the audience which mainly consists of the consultants and senior doctors in the orthopaedic department. We had an early afternoon off for ourselves and visted athe museum just nearby the Royal Children’s Hospital. It was quite a refreshing break to be in the museum to see the brief history of the town of Sheffield and other interesting exhibits. We later went back to the hotel and had an early night off and a good rest.

EDINBURGH from 19th September till 22nd September, 2007

We then traveled by rail to our next destination which was up north at the town of Edinburgh and the whole journey took us about four hours to reach the historical town. At the railway station, we were met by Mr. Porter, Mr. Burke and Mr. Watts who brought us straight to the hotel booked for our residence which was the Premier Travel Inn.

On the next morning, we were broken up into various small group and visited these hospital for the whole day which were:-

            i . Princess of Margaret Rose Hospital               Hand Surgery               Fife
            ii. Royal Infirmary Hospital                              Arthroplasty                 Edinburgh
            iii. Royal Hospital for the Sick Children              Paediatrics                  Edinburgh

At the Princess of Margaret Rose hospital, the group was involved in the morning rounds with the consultants discussing the cases admitted to this hospital the previous night. After a hearty discussion, they were then allowed into the operating theatre to observed the elective hand cases being done with Ms McKechan. Whereas for the group in the Royal Hospital for the Sick Children, they observed some elective paediatric cases being put up for operation  with Mr. Adams for the whole day .For the group that was with Mr. Porter, they had the opportunity to joined the clinic sessions at the Royal Infirmary Hospital.

On the next day, the schedule was similar as the previous day but the program was only at the latter two hospitals. We were again in the similar small groups and joined the respective consultants for their clinic and operative sessions in the morning. In the afternoon, we met Prof. Hamish Simpson at the meeting room in the medical school just beside the Royal Infirmary Hospital. We then each presented our papers to the staff of the hospital and the audiences were quite impressed with the work that was done by all of us. The session ended at about 1700 H and we had the whole evening to ourselves to roam the streets of Edinburgh.

Observing Ms. Mc Kechan doing elective hand cases at Princess Margaret Rose Hospital

Overall we were quite impressed with the setup and running of the services at the main hospitals at Edinburgh. Paediatric orthopaedic problems are treated at the Royal Hospital for the Sick Children only and the environment at the whole hospital is made specially for children with large pictures and cartoon pictures drawn specially for the kids similar to the environment at Sheffield Children’s Hospital. Within the hospital, they have special anaesthetist and caretakers that are trained to take care of children while in the ward or in the operating theatres. Whereas for hand related problems, the cases are sent to the Princess of Margaret Rose Hospital, where there is a full time hand surgeon present there with few fellows training under the surgeon. There are few consultants at this hospital running the General orthopaedic services also to ensure that trauma work is being taken care of.

WRIGHTINGTON Hospital 23rd September till 25th September, 2007

We traveled by rail to our last destination that was Wrightington and the whole journey took about 3 hours. The journey was uneventful and we were put up at the Wrightington Country Club which was nearby the hospital. We were met up by the consultant, Mr. Anil Gambhir and his colleague and after formal introductions sent us straight to the hotel for a good rest after a good dinner. On the next day, we were sent to the Wrightington hospital by the delegated registrars and met Mr. Anil Gambhir at his office in the hospital. We were then joined by three Indian Orthopaedic consultants who also was doing a traveling fellowship but to hospitals with arthroplasty interest.

Patient information centre at Wrightington Hospital

Our first agenda was a short tour of the hospital and we were shown the Patient Information Center which seems interesting because it explains to the patient in detail of the problems and steps taken in dealing with an osteoarthritic hip/knee from admission to operation and ending up with steps taken on discharge from the ward. The concept of this center with pictures, show of implants and short video clips seems to be a very god way to explain to prospective patients in a simplistic manner. We then had a short tour of the Charnley Musuem and it was quite impressive to see the evolution of the implants used for the total hips and kness here. Also within this museum, we can some research projects done by Prof. Charnley in improving the implants that he has produced. The Musuem although seems to be in disarray however holds much valuable information on the evolution of the Charnley prosthesis that is being used today by most surgeons. We then had the opportunity to hear a lecture on some research projects that has been done by the Wrightington hospital by a senior professor and later adjourned for lunch.

In the afternoon, we were broken up into three groups and had the opportunity to observe some elective operations in the areas of arthroplasty and hand surgery. At about 1700 H, we all met up at the Wrightington Hall where three of us had to present their work to the hospital consultants and registrars. After the presentations, we were then entertained to a sumptuous English style dinner at a restaurant nearby and a good night rest after that. On the next morning, we again were broken up into small groups and observed again the cases being operated electively and for the group at the Hand surgery section, they had the opportunity to meet up with Prof. John Stanley and see him do some interesting cases. We only had time till the afternoon at about 1200 h and although most of us still wanted to stay on for the interesting cases, we had to move on to Manchester which is a two hour drive from Wrightington to attend the Precongress of the Annual British Orthopaedic Association Annual Congress 2007.

Overall this trip was a good experience for most of us since this was a first hand overview of the orthopaedic services rendered in a established and well known centers. Despite the fact that there are some similarities in the management of the cases, how each patient is approached in treatment especially the Patient Information center at Wrightington Hospital is unique and very practical for the patients going for hip or knee replacements. Also we noted that the consultants have good records and a decent registry of their patients for research and long term results as can be seen at the Sheffield Children’s Hospital for the reconstructive cases and in Wrightington Hospital of the arthroplasty cases. The information from these records can easily be recovered by the attending surgeons for research purposes.

Also in almost all these hospitals, research has an important place in all the units and emphasis and funding is provided to ensure that this is an ongoing thing. At centers like Royal National Orthopaedic Hospital at Stanmore, they have a bioengineering department which makes custom made prosthesis available at a short notice for the surgeons concerned.

From left: Dr. Ludwig Andre Pontoh (Indonesia) Dr. Fong Sheeyan (Singapore) Dr. David L. Alagar (Philippines) Dr. Nguyen Viet Tien (Vietnam) Dr. Kachain Namsirikul (Thailand) Dr. Kamil Mohd Kasim (Malaysia)

We feel that this fellowship is a good way of learning the good practices available at United Kingdom while also exposing the medical practitioners there of the work that is being done down here in the ASEAN countries.