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Um and some of the issues that we've brought up have been, how do we integrate this experience into training programs and program directors, the world over especially orthopedics there, either this or that. And certainly in one point I was told, of course, you can go away, just don't bother coming back. Uh So what we're trying to do is give people the opportunity of learning abroad, teaching abroad, being involved in broad and then taking that with them for the rest of their careers of building these relationships that now you have stood the test of time 40 35 40 years in Ethiopia and Zimbabwe in Zambia. So great pleasure to take uh deeper to come up and give us an overview from the S A seaside. And she's a little bit of the poacher turned gamekeeper. I hope she's are a woman with a mission. Come on up to you. Thank you. Am I doing the right thing? Oh, yeah, yeah. Okay. Thank you. Thanks very much. Um So I guess I'm speaking now more as uh the chair of the S A C as you say. Um But actually I, I hope that I'll show you that it is possible to integrate um uh limit work into your training. Um Many of you here have actually successfully done that. Um And there are ways to do it. So uh the latest voter survey showed that 66% of trainees actually want to get involved in working in low and middle income countries. Um And there are several benefits associated with working in low and middle income countries. I may be speaking to the converted here, you already know what the benefits are but their benefits to both sides. So, first of all, um and this has been said throughout the day, um for us, there's the unusual pathology that we would never see if, if we didn't go to, to uh low and middle income countries. There's the fact that you need when you are in a low resource setting where you don't have access to high tech scans and other investigations, then you need to be that much better at your clinical skills. So your history, taking your clinical examination, your decision making skills have to be that much sharp. Er um So there's that to gain, you get a sense of contribution and purpose, which I think is important to a lot of us. Actually, when you come back, you have a uh an appreciation for what you have in the UK and in the NHS. And it, for those of us who do this kind of work, we find it rejuvenating but for the local surgeons, it's also hugely beneficial, as we've said, um it motivates them when they're, there are people from high resource settings going out there and working with them, it motivates them, it improves the standards of care. Um We teach them about the use of evidence based medicine and research. We provide mentorship and they're also rejuvenated by the contact. So there are clear benefits to be had on both sides. How do you get involved as a trainee? Um There are various strands or various ways that you can do that. So you can work clinically or you can use advocacy or research or education, so we can look at each of those things. So if you want to do clinical work, then uh whilst you're a trainee, it is difficult to go for long periods of time. Although you can, if you arrange it with sufficient notice. Um So really when you're a trainee, you're mostly looking at doing short but focused visits um and have a clear plan of what you want to achieve when you get there. So if you're going for two weeks, you need to understand what you're trying to do. Are you going to see a particular condition or are you going to learn about a particular thing or in fact, are you going to do a Q I project or are you going to get involved in research? What is it that you're going to do? Make sure that you get approval from your TPD well in advance and most T P D s that I've spoken to are actually favorable. Most of them are supportive. If you're going for a short visit, I don't think I've spoken to a single TPD who has said no, I wouldn't allow this. Um When you're there, you can continue your training. So you can complete, for example, case based discussion's when you're there, you can continue to do that. Um And uh for example, Fergal Monsel has a fantastic model whereby for people who are visiting the children's surgical center in Cambodia, he will be your clinical supervisor whilst you're out there and he will do cbds with you. And if you're there, uh for a long period of time, he will meet with you weekly on Zoom and be your supervisor. So there are models that you can use. Um But you just need to have a clear idea of what you're trying to achieve rather than just going and spending time important though that is, and then when you come back, write a report and share your experiences with your T P D and with your fellow trainees, uh so that they can see what you've been doing and it may actually uh encourage some of them to join you. You can go down the route of advocacy. You don't have to travel for that. You can do that from here. Uh So for example, the picture on the right hand side shows child labor in the Cobalt mines. Um And as you probably know, a lot of our orthopedic implants contain Cobalt, don't they? Most of our implants, whether it's trauma implants or arthroplasty implants, most of our implants contain Cobalt. And uh there is widespread use of child labor in Cobalt Mine NG. So if you wanted to go down the route of advocacy, there are several projects that you can get involved in without having to travel. There's research. So research for a UK trainee is almost second nature to you because you it is expected of you, you have to do it, you have to do it, whether you need to do it to get your C C T or because it's expected of you or to gain marks in your self assessment, you need to do research. And so it becomes second nature to you. However, it isn't too many trainees working in low and middle income countries. So there's a lot that you can share and that they can learn from you. And the picture that you can see there is the collaboration between Notah, which is the Northern orthopedic Training program and Ethiopian collaboration. And co heel to the Lady in the Middle is one of the Northern Dina re trainees who set up the collaboration with Ethiopia. And so she runs regular research methodology courses which are online and free and she's running one today, which is why she couldn't be here today. So uh if you wanted to get involved via the root of research, there's lots to do. Um Alex Shad was mentioned earlier in uh in the context of Malawi who is doing a big project on Open to Bill Fractures in Malawi. Uh And he actually has taken time out of his training to do that. He's taken, I think two years out of his training to do that. So there are ways to do it. Um If you're going for short periods, as I've said, you can get approval from your T P D uh if you want to go for a longer period, uh then you have to take an out of program experience which actually several trainees have done. And the one thing I want to say about training collaborative XYZ that they're really, really useful and really, really important. So several exist around the room. I know. Um But you find that you get much more out of it if you can twin your training program in the UK with a training program in, in a lower middle income country. So for example, in Birmingham are training program links up with the Guyanese training program in Guyana. And they have a really um mutually beneficial online teaching program that's really helpful for both sides. Actually, uh you can get involved in teaching as I've mentioned. So this is one of the online teaching sessions between Birmingham and Guyana uh after COVID virtual teaching is something that we're all familiar with. And so it's easier to get involved, although it does have its own challenges, particularly internet connections and not just in low and middle income countries. Sometimes the problem is our internet connection. Um But because we all now know how to use teams and zoom, it makes it easier to do it and it makes it easier to do it across time, time zones as well. Um So that's another thing, another way in which you can get involved. Similarly, Q I project again, Q I projects are second nature to UK trainees because it's expected of you less so in low and middle income countries, but hugely beneficial to them in order to know that what they're doing is uh you know, what, what is the result of, of the things that they're treating? So I mention a few points of etiquette when you go out there um do look after your own health and safety because that is your responsibility and not the responsibility of whoever you're going to visit, make sure that you do your research before you go. So that you understand the environment that you're going into. Obviously, it goes without saying that you, you should be respectful, friendly and have a definite objective because that will make your visit much more productive. You need patience in a good sense of humor. We've mentioned this throughout the day, uh the different environments that you will encounter you go there to, to operate and you find you can't because the water supply is cut off and you have to be prepared. You can't just go away and say, well, the water supply is cut off. I'm going to go and sit by the, by, you know, by this tree and read my book. You have to roll your sleeves up and get out there and find out what's happening and, and why is the water supply cut off? Um And the one thing you absolutely must do is to maintain contact because long term relationships, we've said it before. And it's been a theme throughout the day. Long term relationships are much more beneficial and much more productive than a sort of medical tourism as it were. Obviously, you should try not to compare healthcare systems tempting though it may be. And what you should never do is take training opportunities away from the local trainees. So I always say to people who are going out, remember you're not going out there to operate, you're going out there to see different conditions that you wouldn't see in the UK, you're going out there to practice your clinical examination and your diagnostic skills, you're going out there to perhaps do some research, but you're not going there to take away operating opportunities from local trainees and similarly never data mine. So if you are going to get involved in research or in Q I projects, remember that it isn't your data and don't come back and write a brilliant paper that gets published in the B J J and has your name all over it, but has no mention of the local team. Um because that's probably one of the worst things that we have done over years and years and again, don't lose contact after you leave. So I've mentioned the training collaborative. Um These are some of the examples so noted. The Northwest Orthopedic Trauma Alliance is the one I've mentioned with the Northern Dean Ary. There's the Birmingham program with Guyana, there's Bahadir and the 70 Nery program. Uh So there are many collaborative. Um I know Liz is going to speak about King's Congo in shortly. Um So there are many collaborative is, and if you are on a training program, I would urge you to uh reach out and form a trainee collaborative because that is so beneficial to both sides. And what it means is you will forge those long term relationships that when you become consultants and they become consultants, you will have a firm partnership and that can only be good for their patients' and for our patient's. So really, that's all I have to say. So, you know, working in low and middle income countries is possible. Many of your colleagues across the country are doing it. Most T P D s that I've spoken to are supportive and the S S C is also supportive. So short term visits shouldn't really be a problem as long as you plan them and get approval in advance long term projects you have to do as an out of program experience. But again, many of you I know have done them very successfully. Um And if you do want any help or support in, in speaking to your TPD, then I'm always happy to help out. Thank you. Uh Any questions or anything, but off for a second, I'll just make a very important point to back you up deep on the research issues. I think the B J J would almost consider it fraud now and you would really be barred if it was ever found out that you had not, not acknowledged your co authors, uh particularly the setting.