AADO Asian Fellowship Program
A Report from Dr. Manish Kumar Varshney
26 August - 19 September 2008

It is a report from Dr. Manish Kumar Varshney, a candidate in AADO Asian Fellowship Program, who had a visit to Hong Kong on 26 August - 19 September 2008.

Overview and general annotations: Before putting any observations I would like to benevolently thank the AADO and the considerate and generous trauma team at the Queen Elizabeth Hospital (QEH) to provide me with the much required training in the trauma specialty of Orthopaedics, the need of which has grown world over. The instructions and specific tips gained during training are cherished and would help me in improving services in future. The thoughtful organization and considerate attitude made the start so suave to ally all my fears and reservations. At every difficulty, I remember to have been helped by the trauma team even at the grim times of personal difficulties back home. The training at QEH has reformulated some of my ideals and seriously questioned few practices that are topics of heavy controversy in the specialty. Pre-operative patient management, planning of treatment, treatment execution and decisive outcome criteria practiced here have taught the legacies of each in instance. Especially the planning part has appealed me much as I find this to be the most important ‘turning point’ which drastically affects the ‘results’ of surgeon and ‘expected outcome’ for patient. Meticulous planning by some ingenious and indigenous methods by the specialists of team paves the path for a successful outcome here I think. Putting attention to detail the challenging cases are critically discussed before-hand and the resourceful and nifty execution during surgery is impressive and worth learning. Some personal and remarkable tips that I have learnt from Dr. Shen WY in nailing techniques for distal tibia, proximal femur and humerus are worth treasure. His ideology in screw fixation of neck femur fractures, open fractures, elbow fractures and tension band principles besides others are beyond elucidation. The list is countless and the short morning discussion forum and supplied study material by him pushes the thinking to best – for his real craftsmanship. The smooth and speedy execution of a well-planned operation by Dr. Li KB has apparently questioned my perspective that most trauma procedures (especially nailing) are time-taking surgery. Completion of most procedures in times incomparable to world literature was no less than a mystery. There was hardly any topic I could find to criticize after quenching my thirst of yearning for overseas training in trauma sub-specialty of orthopaedics, but as I have been specifically asked for the same – I may put the following without malice towards any. Constructive criticism (specifics):

At the outright I would again like to reiterate the fact that these are only my views and should not confer any botheration to the current or future practice at any organization or contemporary. The program is highly organized with a wonderful flow of knowledge from hosts to the fellow and all things so perfectly placed.

1. The ‘welcome pack’ is an excellent guide; however, I would like to add one possibility. Transportation by bus no. 22A from airport direct to Jordan can also be mentioned in the same, helping people that may not like to change transport in between.

2. I felt that there is concentration of particular type of cases at one center (non-modifiable variable). However limited in experience but may I put it forward to the organizers to rotate the fellows (trainees) between centers (say two designated ones, 2 weeks each or so) so that sort of ‘more global’ case seeing and training is done.

3. The schedule of surgeons is really tight here; considering this fact although, may I request for some exchange of information between the fellows and the host in terms of practices and ‘possibilities’. This may be done by say organizing a ‘presentation’ or a seminar on a specific topic by the fellow during training.

4. There is a good flux of patients with hip fractures especially in geriatric population. Just thinking aloud this is an excellent platform to convene well organized (by protocols) randomized and case control trials for this patient group (geriatric hip). Most, if not all; would agree that elementary guidelines are missing from literature in this regard. With the much cherished experience we may publish the same also sometimes in connivance with the fellow’s parent institute to provide a possible ‘Asian’ perspective (sort of multicenter study). The fellow may help in doing or performing part-research if though appropriate.

Not just to put an end to it or for the sake of saying thanks, I would like to express gratitude to the continuing efforts of all the team members including but not limited to Dr. Ivan, Dr. Daniel, Dr. Yip and all those whose ‘names’ (I mean names ‘only’) I could not mention due to lack of clear memorization (please forgive), for making me as comfortable and homely as possible. For sure I will remember “all” for the kindness and consideration especially also Dr. Edmond Wong for all the help right from the time I didn’t even leave India. He extended all possible help from his side to ally my concerns. Lastly I would like to also thank Kellan Cheung for administrative and otherwise help. I wish if I could have stayed more for the possible improvements in skills and leisure such a rare company ……………!

Dr. Manish Kumar Varshney
September 2008