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Orthopaedics in the Developing World: Present and Future Concerns

Dr. Dormans is Chief of Orthopaedic Surgery, Children’s Hospital of Philadelphia, Philadelphia, Pa, and Professor of Orthopaedic Surgery, University of Pennsylvania School of Medicine, Philadelphia. Dr. Fisher is Associate Professor, Department of Orthopaedics, University of Colorado, Denver. Mr. Pill is a medical student, University of Pennsylvania School of Medicine, and Research Associate, Children’s Hospital of Philadelphia.

Reprint requests: Dr. Dormans, Children’s Hospital of Philadelphia, 34th and Civic Center Boulevard, Philadelphia, PA 19104-4399.

Half of the world’s population lack access to adequate primary health care, and two thirds lack access to orthopaedic care. Globally, the need for health care outstrips the available resources. This problem is compounded in the developing world by a lack of trained medical personnel, a lack of medical facilities, and, in many regions, an inability to access existing facilities. There is little specific epidemiologic data about the exact burden of musculoskeletal disease in these countries, but most agree that it is reasonable to assume that it will increase. In the least developed and developing nations, problems with access are related to fundamental issues such as infrastructure, physical facilities, equipment, and trained personnel. There are a number of ways in which the orthopaedic community can become involved in ameliorating the burden. Education is the most effective method of providing a sustainable solution. The objective of educational organizations should be to train local health-care workers at all levels in their own environment to provide sustainable and appropriate care so that the programs become self-sufficient and ensure a continued supply of competent medical personnel.