Report on Zimmer ASEAN-AOA Traveling Fellowship 2002

Dr Guo Chang Ming
7 May - 5 Jun 2002

It is with great honor that I was selected to participate in the traveling fellowship. Each year, an orthopedic surgeon from the five founding ASEAN countries is invited to visit various orthopedic centers in the United States. This year, the centers selected were located mainly on the eastern coast of the United States.

My four distinguished companions were Dr Agung Saifullah from Indonesia, Dr Trasith Tasnavites from Thailand, Dr Arturo Canete from the Philippines, and Dr Chooi Wai Kit from Malaysia.

The trip commenced on 7 May 2002 and concluded on 5 June 2002. We visited seven orthopedic centers, participated in numerous discussions, toured different research centers and made many new acquaintances.

Although the event formally started on the 7 May 2002, numerous emails and calls between the traveling fellows and our host centers began several months earlier. I was elected as the group leader and made all the arrangements and coordination.

We meet each other for the first time at the airport in Washington D.C. The first hospital we visited was Walter Reed Medical Hospital. It was a military hospital and the centre was named after Major Walter Reed, a pioneer in military medicine. Major Reed discovered the origins of yellow fever. This was the hospital where Winston Churchill spent his last days. We stayed within the military campus in an on site visitors hotel. Our host was Col Kathleen Mahale. Over the next four days, we joined the morning rounds, had active discussions and watched how they performed their operations. We in turn presented our talks and I spoke on unicondylar knee replacement. I also gave a short presentation on Singapore and invited them to attend our 2002 Combined Orthopedic Meeting. This was particularly interesting to the audience and the group of traveling fellows subsequently decided to present this to each center we visited. Walter Reed hospital manages many young men and women with activity related injuries. They also keep close track of each patient and the interns presents each case before and after the surgery. They have a good diagnostic support system and are able to initiate and obtain results quickly. Of course no visit to Washington D.C. would be complete without a short tour to the Washington Memorial, Capitol Hill building, the White House and the Smithsonian institute.

On 11 May 2002, we flew to our next stop at Long Island in New York. Our next host was Dr David Dines. Dr Dines was a great host and is an excellent shoulder surgeon. We visited him at the Long Island Jewish Medical Center. We watched him performed rotator cuff repair arthroscopically and a shoulder arthroplasty. We also took the opportunity to visit Dr Handellesman in the affiliated Schneider Children’s Hospital and had a lively discussion with him on pediatric foot disorders.

On the 14 May 2002, we visited Boas-Marks Biomedical Science Research Center. Many of the young orthopedic surgeons would spend some time doing research at this center. It is a large complex with facilities for clean room management of tissue, laboratory for gene transfection, operating rooms for animal surgery and holding facility. Most interesting was the DNA repository where tissue and blood samples of patients are stored and can be pooled for studies. After the tour, we attended a presentation of some of their research work pertaining to tissue engineering and had a lively discussion on that topic.

On the morning of 15 May 2002 we were brought to Long Island Jewish Medical Hospital and sat in for their grand rounds. We presented Dr Dines a plaque as a token of our appreciation for hosting our visit. We then went back to the hotel to prepare for the trip to New Jersey.
In New Jersey, we had dinner with our host Dr Fred Behrens. We attended the hospital monthly meeting the next morning. Dr Canete presented his paper on bone marrow injection for non union. Dr Tasnavites presented his paper on congenital hip dislocation and Dr Chooi presented his paper on congenital club foot. We also had case presentations were we gave our input regarding the management of difficult trauma cases that they had. In the afternoon we went to view their operating rooms. The hospital being a level one hospital had many trauma cases requiring orthopedic management. Thus, trauma cases is thir major priority for the hospital. Dr Behrens had planned not only much academic activity but had also generously taken us to the a watch AIDA, a Broadway musical.

19 May marked the forth leg of our journey. We took a van to Albany, the capital city of New York. The journey was 160miles long and it took us 3 hours to get there. Dr Richard Uhl our host met us at the hotel. The next morning, we were taken to the Capital Group of doctors. This private group of orthopedic surgeons were located in a recently built building. The rooms were cabled and laboratory results and radiology tests could be access from the computer terminals. The surgical suite had video cameras that would allow real time videoconferencing and on table surgery. They also had an in house occupational therapy and prosthetics department. In addition, they had also set up a sports performance centre not just for rehabilitative purposes but with physical trainers and input from sports surgeons to improve performances of athletes.

Four days of activity passed quickly. It was time to move to the next stop in Jacksonville Florida. Dr William Jackson, our host, was so kind to meet us at the airport. He took us to the Radisson River Walk Hotel.

The next morning, we were taken to an outpatient orthopedic clinic. The outpatient clinic served as an alternate locale for the hospital outpatient clinic. It was closer to the patients’ homes and had lower operating cost than those within the main hospital campus. Next we had a tour of the hospital campus. This was followed by a hearty discussion with Dr Jackson and some of his fellow colleagues.

On the morning of the 24 May, we went to St Luke’s hospital of the Mayo group for their morning presentations and case discussions. After that, we were brought to the Shands University of Florida. We gave our presentations and again I made an invitation for them to come to our 2002 combined orthopedic meeting in Singapore. This was followed by grand rounds and an x ray discussion.

On Saturday morning, we went to St Augustine. This is a place with quaint streets that have been retrofitted and made into a tourist attraction. There was also a sixteenth century fort. It was fortified with cannons and surrounded by a moat. We also visited the Fountain of youth. It was a spring that was used to commemorate the landing site of the first Spaniard in La Florida.

Proceeding on from Jacksonville, we went to Chicago for 2 days. We were there on Sunday. Monday was Memorial Day, a public holiday. After that, we went to Warsaw, Indiana to visit the Zimmer plant. It was fascinating to look at the production process of making both implants and the surgical tools. We were shown the design stages and the production steps before finally looking at the end product.

Our final leg of the journey was in Victoria, British Columbia. This was the locality of the first combined AOA-COA meeting. On our first evening there, we went to Victoria Golf club for an acknowledgement reception. The view of Olympic Mountains across the Wonkafooka straits was magnificent. The golf club was one of the oldest in Victoria and was extremely well maintained. We met up with Dr Clive Duncan (COA president) and Dr Michal Simon (AOA president). I also met Dr Bernard Moorey (AOA president elect).

The next four days were filled with interesting presentations and posters. We met with many orthopedic surgeons from all round the world. It was very rewarding experience learning how different countries practice orthopedics.

Finally on the 5th of June 2002, it was time to bid farewell to my traveling companions. Looking back, it was a rewarding and fulfilling trip that broadened my horizons in both in friendship, knowledge and experience.

In addition to the daily report, I would also like to add a few points that future groups may benefit from.

  1. Preparations for the trip should start about 2 months before departure. Contact both the host centers and your fellow traveling companions.
  2. If possible, the sequence of visits to these centers should be arranged to minimize traveling. For example, we managed to arrange the centers such as Long Island, New Jersey and Albany together. The initial plan involved flying to and from New York thrice. This would reduce duplication of flights to the same city and more valuable time could be spent at the centers.
  3. Once the dates for visiting the centers have been confirmed, booking of the flight, hotel and then ground transport would follow in sequence.
  4. All participants should also prepare their talks in advance. In addition to the research topics, it would be beneficial to give a slide show about your country and its health care system. These presentations are both entertaining and interesting to the host centre.
  5. Some ground rules should also be set by the traveling group, such as how to allocate the gift presentation to the host.

Finally, I am happy to add that we had minimal hiccups during our trip and that my group of traveling companions was extremely supportive and cooperative.