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We are deeply involved in teaching and training in Africa, to strengthen delivery capacity of trauma care in the region.

We have partnered with COSECSA (the College of Surgeons of East Central and Southern Africa) in a three year project. Funded by the Department for International Development, we have set up the COSECSA Oxford Orthopaedic Link (COOL) to deliver trauma and orthopaedic training, and research into aspects of tropical orthopaedics. The project is directed by Chris Lavy and Hemant Pandit and managed by Grace Le.

Its work comprises:

Trauma training

With help from over 70 NHS consultant volunteers, we have taken the Primary Trauma Care course to the 10 countries making up COSECSA. These are Ethiopia, Kenya, Uganda, Tanzania, Rwanda, Burundi, Malawi Mozambique, Zimbabwe and Zambia. In each country we work with local clinicians in delivering the course to doctors, nurses and paramedics, stressing the importance of training new local instructors to continue the work.

Orthopaedic Courses

Teams from the Nuffield Orthopaedic Centre have gone to the COSECSA region to run week long courses for trainees in Paediatric Orthopaedics, Hip and Knee Replacement, and Spine Surgery. The demand for places is overwhelming demonstrating the need and desire of the local trainees for an understanding of modern orthopaedics and constructive links with colleagues in the UK.

Orthopaedic Fellowships

We have arranged and funded 18 x 6 month fellowships in selected orthopaedic hospitals in Malawi, Zambia, Kenya and Ethiopia. Again the demand for these by local trainees has been enormous, and several of the fellowships have been divided so that the training can be shared by more than one person. This is less than ideal but again shows the demand for quality teaching and hands on training.

Research

Over the last two years we have worked with colleagues at the London School of Hygiene and Tropical Medicine to run an epidemiological survey of the musculoskeletal needs of children in a population of 1 million in Central Malawi. Orthopaedics was our interest but we shared the project with the London School as there were researchers there who had interest in children's hearing, vision and intellectual impairment, and the survey was an appropriate vehicle to cover all these disciplines. 

We have also surveyed the volume of trauma that presents in Malawian hospitals over a year, which is published in Injury, and we have surveyed the capacity to manage trauma in the 990 hospitals that cover the COSECSA countries. This work was presented at the Launch of the Lancet Commission on Global Surgery in April 2015 ahead of publication.

Links to the research outlined above are available here.

The future

The global need for orthopaedic surgery is enormous. Research into defining and detailing this need is important, but it has to proceed hand in hand with training, improving resources and capacity building. We are trying to be involved in all these areas and to continue to work closely with colleagues in COSECSA. Over the next two years we have further grants to develop a pan Africa clubfoot training package, an Africa spine trauma management course, and to deliver more training courses and fellowships for local trainees.

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