What can we Expect from the ORTOJ?

Samir Shaheen MD, JMHPE, Associate Professor, Head of Paediatric Orthopaedics ,Head of Orthopaedic, Board Director of Educational Development Centre for Health Professions, Faculty of Medicine University of Khartoum Khartoum, Sudan, E-mail: drsshaheen@hotmail.com

The ORTOJ is being launched at a time when many of the existing journals publish articles relevant either to the developed world or the developing world. Thus a journal that addresses both worlds is much needed.

Indeed ORTOJ, with its wide vision, will be able to address all aspects of orthopedics and trauma, satisfying the interest of readers around the globe. We are aware that, different areas of the globe differ in their disease makeup, health care levels and systems. Although these differences apply for health disciplines in general, they are more obvious in orthopedics and trauma in particular. For instance in many areas in the developing world, Sudan as an example, seeing and managing neglected late presenting cases or cases seen by bone setters first is the rule. Even children disabilities are taken care of soon after birth by untrained personnel. Compared to other developed areas with good health system and people awareness were even tertiary care is available in a location accessible for almost all population. Thus researches addressing neglected cases although of little value at some parts of the developed world, is highly appreciated in the developing world. Indeed this difference in levels of the first care will affect publications and research topics. In most of European, American and other developed countries, a trained orthopedic and trauma surgeon will see the patient first, whereas a pediatric orthopedic unit will be usually the second if not the first level of health care, compared to developing countries where either a native bone setter or a general medical assistant is the first level of health care. Thus our training in such setup should be directed towards health personnel (paramedical staff), so that people will opt going to health centers and not to native bone setters if better service is offered by the available health personnel. In a study previously conducted in Sudan,¹ it was shown that clubfoot can be scored to comparable results when it is done by a pediatric orthopedic surgeon or an assistant physiotherapist (a nurse who had only on job training in physiotherapy). So we can trust these health personnel to deliver an acceptable quality service, because it will not be possible for the health system to make a trained orthopedic or pediatric orthopedic surgeon as it is in the developed part of the world. In such underdeveloped areas, even patient’s follow up is a challenge due to lack of awareness and cultural issues related to how disability is looked at in such communities and poor health system setups, leave alone financial constraints.

Another point is that, surgery in general and orthopedic surgery in particular differs according to geography. For example Mycetoma is a health issue in many countries. It is particularly endemic between the latitudes of 15° South and 30° North in an area of vast forests and savannah, the so called Mycetoma Belt. These include Sudan, Somalia, Senegal, India, Yemen, Mexico and South America.² In Sudan for instance, Mycetoma has been found to be the third commonest cause of amputation.³Thus an article on Mycetoma can be welcomed in such a journal with global concerns heading towards being of international impact and observing principles of “Health for all”.

Similarly, tuberculosis is of high concern in many areas of the world. In a recent study tuberculous adenitis was found in over 30% of patients examined for enlarged lymph nodes in the neck.⁴ Indeed this would not be the case in Europe and Northern America. Many of the high impact journals that are concerned with western issues will find little interest in publishing articles looking at Mycetoma and Tuberculosis, two diseases that affect areas of the globe with the highest population rates.

In conclusion, the ORTOJ is a promising journal, with high expectations and will carry that balance between the needs of these large underprivileged populations while having a strong impact on the fast developing art and science of Orthopedics and trauma taking care of the needs of readers all over the world.

1. Shaheen S, Jaiballa H, Pirani S. Interobserver reliability in Pirani clubfoot severity scoring between a paediatric orthopaedic surgeon and a physiotherapy assistant. J Pediatr Orthop B. 2012; 21(4): 366-368. doi: 10.1097/BPB.0b013e3283514183

2. Shaheen S. Patients with lower limb amputations for mycetoma in the National Center for Prosthetics and Orthotics in the Sudan. Khartoum Medical Journal. 2008; 1: 27-29.

3. Fahal AH, Shaheen S, Jones DHA. The Orthopaedic aspects of mycetoma. Bone Joint J. 2014; 96-B(3): 420-425. doi: 10.1302/0301-620X.96B3.31421

4. AgabEldour AA, Salih ENM, Ahmed HG. Incidence of Tuberculosis and Amyloidosis among Sudanese Patients Presented with Enlarged Nodes. Journal of Tropical Medicine. 2014. doi: 10.1155/2014/832029