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sorry. Hello. Good morning. Good morning, everyone. Um, thank you. Making up so early? Uh, my name is Dan on the current, uh, world orthopedic concern Links person with Botha. Um, and it's an absolute pleasure to introduce today. What is a fantastic array of speakers who'd been doing some fantastic work all across the world? Um, I'm going to spend the first two or three minutes. Just recap the opportunities available to trainees. And what Botha can do for you guys if you are interested in pursuing work and low middle income countries. So what do we do? We've got We've got a WhatsApp group of all interested trainees, which is open to all. It's a sort of pretty easy group, people just posting opportunities, things that they're doing. Any ideas? Most recent, we've had a walk. Ikea, Gastaut Journal Club organized bialys here at the front that went down really, really well. Bursaries. This year was the first year that we ran the walk. Botha bursaries. So the next slide shows the five winners of them and the projects that they're going to do with their their short. So it's 500 lbs, and that's really to promote short visits as part of a bigger, sustainable link. And I know there are many, many more links in the country that what I don't know about that are doing really good work across the world. More recently, there's a chapter called Professor Chris Larvae, who works in Oxford, and he has started a global Reps meeting collaboration. And that's between the trainee and subspecialty leads of all the surgical societies. So the global surgery reps from, uh, TSH both as, uh, the neurosurgeons E N T u K now all going to meet up on an annual basis, restart the global surgical frontiers. Uh, conference that really took a hit from covid. Never really got back up, up started again. If you're If you're wanting to spend time away, there's now a letter endorsed by world orthopedic concern that you can give to your T P D for study leave for such visits and that is also endorsed by the S. A C. And finally, this conference itself is being broadcast free of charge to any trainees or consultants in low middle income countries. And as I said before, I think it's 24 different countries across the world that can all zoom in for free. So this next side is just the winners of the bursaries you may recognize from the names that they have trainees in your local regions. We'll hear from she'll put a little bit later on about her work in Malawi with feet first, but as you can see, it's a really widespread. I'm really pleased that Rose, uh, we wanted to do something virtually so she all she all she's gonna spend the money on is is fees for Zoom and virtual teaching aids that she can support the Guyanese training program with, um and otherwise, I think that's it. So the first speaker is Matthew are nutty. He's a C T two in London, and he has done lots of work with the University of Harvard, and we're going to hear about his talk now, so thank you very much. Okay. Hi, everyone I'm at Thanks for the introduction, Dan. Um, I apologize in advance. I don't have any notes, as there's no, uh, we just see the same slides you guys. So I've got my notes on a very small screen in front of me, so hopefully we will not have any issues? Um, good, that's good stuff. So why am I giving this talk? So the burden of trauma globally is enormous. As you can see, um, that there's about 14,000 deaths per day. Do too traumatic injury, which accounts for about 4 to 5 million per year, depending on where you get your figures from. The vast majority of these are in low and middle income countries where there is a distinct lack of access to healthcare, with 20% of the world's surgeons serving 50% of the poorest people on the planet. So it's a, you know, a silent epidemic. I think it's fair to argue, Um, so why should we be engaged in this sort of work? So the primary benefits are obviously to the patient's health professionals and health systems of the host of the partner nations that this work is being undertaken with. However, this doesn't mean that there aren't additional secondary benefits that we can, uh, look at, um, and you can see here sort of the benefits to individual trainees, um, as well as the wider NHS. And this demonstrates another set of sort of driving forces that, uh should compel us to engage in this line of work. Um, so if we're, you know, going to be committed to being involved in international development work from, uh, orthopedic standpoint, we need to be aware of the potential pitfalls that exist so that we can engage effectively and ethically. Um, so just, you know, some examples of poor practice that we should be aware of. Um, and you know, these if they're coupled with things like insufficient regulation can lead to poor coordination of initiatives. Um, depletion of resources in the partner nations. Uh, neocolonialism is something that we really need to be aware of. A rising, um, and generally it can just, you know, it can have a detrimental impact on the nation that is intended to be assisted. So moving forward, we should focus on coordinating efforts. Efforts? Sorry. Um, adhering to a minimum set of standards, uh, to which we, you know, adhere to, um, when engaging with this line of work and depart from voluntarism, which can be a problem. Um, occasionally, um and this can be achieved through sort of international consensus, strong governance and accountability, and also, you know, sustainable development initiatives which will come onto now. So why sustainability? It's a bit of a buzzword at the moment, but it really, really is important in this line of work in particular. Um, so the 2030 United Nations sustainable development goals have been around for a little while now S d G three is explicitly focused on health and well being. So obviously it relates to health care and surgical, you know, initiatives globally. Um, and there are a number of other, um, development goals that also cannot be achieved without addressing health. And, you know, particularly surgical care. Um, an improvement in global surgical care are recognized as prerequisites for achieving these STDs. Um, so we really need to prioritize this when we're engaging in this line of work so barriers to sustainability, um, to be aware of again so that we can take steps to mitigate and prevent any of these arising. So these are just a few lacking explicit objectives, not having robust follow up in place for, uh, any initiatives that exist. Poor managerial practice, insufficient capacity for change. So it's it's good for initiatives to be malleable and to be able to respond to the needs of the population that they're attempting to help and solitary interventions that occur, you know, in isolations, without any further subsequent follow up or as part of a long term plan. They're also quite problematic. So, facilitators, so some key principles, as I mentioned, they need to be sort of. This line of work needs to be driven by the needs of the local population and the local health system and not influenced by sort of goals of funders and things like that, which can cause issues. Um, and they need to align with sort of the national goals of the health institutions in the host nation's um, and it's good to focus on things like organized long term strategies, which can incorporate short term surgical missions. Um, but they you know, they have to be appropriately staffed and include sort of highly trained professionals who have specific skills that can help in particular scenarios. It's otherwise they can be ineffective. And yeah, and there are some other things to consider. Um, so, in the sort of post covid environment in which we all live now, there have been some lessons that we can, uh, learn so virtual conferences. As I understand, we're virtual right now. And I I hope there are some colleagues from low middle income countries who are able to join us. Today is it's really excellent that that, you know, has opened up access for our colleagues over in low middle income countries who often are excluded. Unfortunately from these sorts of conversations, um, collaborative opportunities. So it's a massive thing that's happening with research. The minutes I'm sure people are aware there's a really, you know, opportunity for everyone to, and it collaborate is the only word. I can really find that with our colleagues over overseas and produce a really meaningful research and have everyone involved and engaged in producing that. And we hear a lot about well being at the minute. And we we know that we're in a workforce crisis in the NHS, and we're very worried about retention and, you know, maintaining the workforce as we saw back on the slide earlier. Um, there are really benefits to trainees engaging this in this line of work, and it improves staff morale. It reduces sick leave, and you know it has all of these benefits for with the potential to address the workforce issues that we are facing. So it's something for trusts to consider. Um, So what can we do as trainees? I know it seems quite daunting. I went to my first What conference is an F one and had absolutely no idea what I could do to get involved or how I could appropriately be involved. And that's I think is a really good place to start. I mean, not not throwing shade on both or anything but what is always my favorite conference and has been for many years now. And I always enjoy going. This is a really great place to meet. Um, you know, professionals doing, you know, seniors doing this sort of work. And other trainees who have had experiences that you can you can learn from, Um and there are level appropriate opportunities so you can get involved as, uh, down mentioned what the fellowships that have been awarded. Um, there are people, you know, various levels of training, able to engage with trips and work that's being done overseas in an appropriate manner. I've mentioned collaborative research ready. So I went to talk to you much more on that, Um, as surgical trainees are very lucky we have access to a whole host of postgraduate education, and that's something that I've really enjoyed doing after my medical degree. So I definitely encourage others to do the same. And the last point, which I think is probably one of the most important is advocacy. And that's something that we can as trainees get involved in and, you know, talk about what? What we need to see happen. Uh, and I think particularly our own education is a good is a good place to start. Surgical training has a woeful, you know, amount of focus on global surgery and global health, and I think that's something that we as trainees, should recognize and push to see change throughout our training. So the end goal, I think we, in summary, can say that trauma is a principal global health issue. And as trauma orthopedic surgeons and trainees and people working in the speciality, we have a really, really potential to contribute effectively to this, especially through being involved in our nation wide regional trauma systems. That gives us quite a unique set of transferrable knowledge that we can, you know, discuss with our colleagues and try and help develop globally. Um, we need to, you know, maintain a sustainable and ethical approach if we're going to have a equitable and successful, um, set of programs and see that see global surgery and orthopaedics in particular improve on a global standing. Um, and training engagement is possible and essential. We recognize the importance of a diverse workforce and being representative of population. But I think we should expand this to include a diversity of experience and training. Should really empower trainees to be engaged in this line of work and gain experiences globally that we can, you know, bring back myriad benefits to the NHS and our patient's in the UK as well. And there are my references, any questions and there's a link to an S. I don't know if this is any use to anyone, but the essay that I produced this talk from if people want to read it, is there. Thank you very much. Any questions