Why does SIGN want to create fracture equality throughout the world?
SIGN supports the trauma surgeons in developing nations who have committed their lives to serving the injured poor. Despite many obstacles, these surgeons often work with limited hospital resources, overcrowded wards, and at times a lack of pay and support from health administrations. Equipping these surgeons with orthopaedic training and instrumentation means that they provide quality fracture care for those who desperately need it but cannot afford it.
Healthcare Funding
Developing countries often face challenges that must receive immediate care and attention from the government. Political unrest, economic instability, and war violence are issues that take priority in legislation and government work. Meanwhile, social services such as healthcare become of secondary importance. As a result, healthcare providers in these countries receive little funding to support services to the poor. Public hospitals and healthcare providers must rely on outside help to serve their poor patients.
Emerging Epidemic of Trauma
Today, much of the Western world is aware of the global health epidemics of HIV/AIDS, tuberculosis, malaria, parasitic infection, and malnutrition. Major funding and great volunteer support goes to these causes. Though deserving of attention and support, these causes shadow the emerging epidemic of trauma and the millions that it kills and injures. Each year nearly 5 million people worldwide die from trauma, approximately the number of deaths caused by HIV/AIDS, malaria and tuberculosis combined.4,5,7 Ninety percent of the world’s trauma occurs in developing countries and that number is growing.
For each death from trauma, 3 to 8 more are permanently disabled.1 Severe fractures that are rare in the US occur on a daily basis in developing countries. Like many healthcare providers in these countries, trauma surgeons are working with few resources and little pay. But unlike many other healthcare fields that receive global support, the issue of trauma is still widely ignored.
Road Traffic Accidents
Road traffic accidents are the greatest cause of trauma in developing nations. As a country’s economy improves, its people are able to earn and save additional money. The first family purchase is generally a motorbike, because it is cheaper than a car and it can still transport the family. On most any street in Asia you can observe an entire family riding on one motorcycle. The purchase of vehicles in these countries occurs at a rapid rate. Motorcycle sales in Asia are ten times that in North America. In Cambodia, the road traffic fatality rate is ten times higher than in developed countries. In 2004, more than 3 people died and 100 were injured every day in Cambodia as a result of road traffic accidents. Motorcyclists accounted for 76% of the casualties.6
The government can scarcely keep up with building and maintaining roads for these vehicles, establish transportation laws and employ adequate personnel to enforce them. Because of the disproportionate rate of vehicles to roads and few to enforce traffic rules, everyone is put in danger, even those on the sidewalk. These roads often contain trucks, car, buses, bicycles, motorcycles, animals and pedestrians. When an accident occurs, resulting injuries are severe, and the victim generally does not have the money to afford an implant necessary to repair their broken limb.
Severity of Fractures
Broken bones in the US are generally less severe and can be treated by cast or splint. But in the developing world, many fractures are broken into multiple pieces which require surgical intervention to heal properly. When these types of fractures occur in the US, patients generally receive immediate surgical treatment with an orthopaedic implant. However, traction and casting are often the only options in the developing world, leaving the patient at risk of a lifelong disability.
Bone Health
Throughout the developing world, the poor do not receive sufficient nutrition to support the growth of healthy bones. Bones are susceptible to a severe fracture due to malnourishment or lack of sun exposure. Although many people may receive adequate calories, staple foods, such as rice, add little nutritional value to facilitate the development of strong bones. In some countries, people are physically covered for cultural practices, minimizing their exposure to sunlight. Vitamin D3, which aids in the absorption of calcium and helps to maintain strong bones, is synthesized by humans skin when the skin is exposed to ultraviolet-B rays from sunlight. Those who receive little sunlight do not synthesize as much Vitamin D for healthy bones.
Bonesetters
In many places, bonesetters are the cultural norm, however they cannot provide adequate treatment for severe fractures. Months after treatment from the bonesetter, patients with severe fractures visit the hospital because their fracture has not healed. By this time, partial healing has taken place or infection has set in, leaving the orthopaedic surgeon with few options for treatment. These options are generally painful or drastic, such as amputation for a bone’s infection that has affected the entire limb.3 This leads to a reputation among the people that surgeons treat trauma patients solely by amputation, continuing the cycle of patients visiting bonesetters.
Implants are Unaffordable
Public hospitals in developing countries primarily serve the poor. Due to inadequate funding, hospitals lack the instrumentation necessary to surgically repair severely broken bones. The patient must purchase their own surgical implant. To an individual living off of $2 a day, this implant can cost well over a year’s worth of income. Patients unable to afford the implant will lie in traction (see photo to right). Traction lasts for months and sometimes years, generally with a poor outcome. Because patients in traction are occupying a bed for a prolonged period of time waiting for their fracture to heal, over-crowding in trauma wards takes place. These trauma victims are typically the breadwinners of their family. During this time in the hospital, the patient’s family must survive on their own. They must also provide food and care each for their injured loved one.
Poor patients may avoid the high cost of a quality implant by purchasing a cheaper implant of lesser quality. For example, patients may buy a plate, which does not supply adequate support for a long bone to heal correctly and can also break.
SIGN’s Mission
SIGN recognizes the impact of trauma on the people living in developing countries. Road traffic accidents, conflicts, falls, and natural disaster often cause injuries such as severe fractures. We support those surgeons who treat the victims of trauma. In addition to coordinating the training of surgeons in poor countries, SIGN develops surgical implants and instruments and donates them to under-resourced hospitals. The equipment has been designed specifically for use in hospitals where real time imaging and power equipment are unavailable. In total, SIGN coordinates 200 programs worldwide, in countries such as Indonesia and Myanmar, as well as in Afghanistan and Iraq, where war has devastated the health care system.
SIGN respects the trauma surgeons of the developing world. They have the talent and ability to serve their patients, but are without instrumentation. SIGN builds local surgical capability in developing countries by providing training and equipment to surgeons for use in treating the poor. SIGN, along with surgeons all over the world, has created equality of fracture care for more than 50,000 patients in 41 countries.
1. Beveridge M, Howard A. The Burden of Orthopaedic Disease in Developing Countries. J Bone Joint Surg Am 2004;86-A-8:1819-22.
2. Honda Motor Co., Ltd . Motorcycle Business Report. Review of Motorcycle Business Operations. 2005.
3. Johnson D. Ogunlusi, Innocent C. Okem & Lawrence M. Oginni: Why Patients Patronize Traditional Bone Setters: The Internet Journal of Orthopedic Surgery. 2007; Volume 4, Number 2.
4. Murray CJ & Lopez AD. Global Burden of Disease: a comprehensive assessment of mortality and disability from diseases, injuries and risk factors in 1990 and projected to 2020. Boston: Harvard University, School of Public Health; 1996. xxxii (Global Burden of Disease and Injury Series Vol. 1).
5. Peden M. Global Collaboration on Road Traffic Injury Prevention. Inj Contr Saf Promot. 2005; 12(2): 85-91.
6. RTAVIS. Annual Report: Executive Summary. Cambodia Road Traffic Accident and Victim Information System. 2004.
7. WHO. Injury: A Leading Cause of the Global Burden of Disease. 2000. Geneva, World Health Organization.
