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Uh next one of the great things about being a trainer is you train people. And the Hippocratic Oath said, you know, your trainees, your students should be better than you are. So I thought I hit the jackpot. I had a fantastic trainee who took my job when I retired. And then shortly there afterwards, he pointed out to me, I taught him to, well, I'm back to Africa. So I'd like to just introduce the jab in with a thwack who is going to talk about taking the plunge. He left Sonny Scotland to go to Zimbabwe to work in bull away at the United teaching hospitals and the cure hospital. And to my great pride has become a great teacher, loved and admired by most of the Zimbabwean trainees, except the ones he kicks and says you got to work harder. So, job. Ooh, thank you. Good morning, ladies and gentlemen. My name is Jasmine Tetra consultant, orthopaedic surgeon in Zimbabwe, and former NHS consultant. I'm very honored to share my experience as I took the profile, feel plunge and returned to practice my trade in a low reserve setting. I'm very thankful to Alberta for the invite. I currently work closely with four charities in Zimbabwe. The first three focusing on providing affordable care for pensioners in a country work party over here. Beyond the reach of the majority, many of these unfortunate people who have worked all their lives have seen hyperinflation erode their retirement policies and mentioned benefits. The cure setup is recent in Bulawayo but following a worldwide directive is only providing three point of care to Children Under the age of 18, I was born out of an X of South African Pirated at the time when Zimbabwe was considered the breadbasket of Africa and the safe haven. My upbringing was quite good and with my dad, a teacher and mom and nurse who were never a short in a country which was at the time very functional. I completed my primary and secondary schooling in Bulawayo and within the 1st 18 years of my life had not left the bounds of my city of birth. 1992 I was hospitalized for the best part of three weeks, the osteomyelitis of my right calcaneus experience that no doubt played an integral part in my chosen career path who intend to attend medical school in Harare, obtaining my primary medical qualification in 2005, I was then awarded the prestigious 87 NG scholarship which saw me make my move to the United Kingdom to pursue a higher degree in infection with particular interest in the role of biofilm on orthopedic prosthesis. My foundation program was to follow in Newcastle before fortune see me landed training number in orthopedics in the west of Scotland, Denarii where I spent eight years living up to my C C T in 2017 and subsequently taking up a post at university hospital hemispheres within NHS manner chair. Now I'd only ever heard about Scotland at the time I was offered the training rotation. I recall many of my colleagues ask why I chose basket of all places to live. As you can see, the small town is located accurate distance, both Glasgow and Edinburgh within the aquatic central belt location would afford me the perfect balance between the east and west and prove relatively accessible to the rotations. I was to choose through the eight year training program. Town is small but it's history rich and is the place of birth of Sir James Young Simpson who discover the anesthetic properties of chloroform. Many landmarks including schools, roads and even pop are named in his honor. It started offers a small coal mine in town. It's forming into an industrial hub in the Victorian era. It is now mainly commuting town with the growing population. Now it's just under 25,000. My training would see me spend a number of rotations in central Glasgow where I also went on to complete my fellowship training. The bulk of my training would come out of district general hospitals within NHS Lana Chair is not surprised then that I would settle here and take up my substantive post at University Hospital Hair Myers seen here on the left with a later traumas practice, moving to General Hospital District General Hospital set up was most appropriate for my future endeavours. And it allowed me a more varied training, exposure in practice and exposed me to mentors with a vast experience in working in low and middle income countries. I particularly recall Alberto's experience of Zimbabwe in the late 19 eighties, an experience which I never imagined still existed to this very day which I coined which orthopedics, I desire to provide a modernized service to my country birth. Let me to taking the plunge at the onset of the mentioned pandemic. Now I probably would be hung, drawn and quartered for saying this. But lawyer is arguably the cleanest, most beautiful and most liveable city in Zimbabwe, like around the tree lined avenues and the clear blue sky are the hallmark of this city best appreciated in the spring month. The buildings in the city are a reflection of its colonial past and the city was born in the early 19th century when the then the very king legacy Xscape Waasland battle during the intense phase of what we called explain the forced migration of tribes after the Zulu King Shaka triggered nearly genocide of wars being the largest city in Matabeleland with 1.2 million inhabitants in its metropolitan area. It is to referral public hospitals and off presents with cure. Recently coming in as a third, prior to 2020 this large catchment area was served by only four full time orthopedic surgeons who hated for the greater catchment area of over 16 million inhabitants from the province from a burden. It's massive as a result of poor roads leading to carnage as well as generally poor enforcement of health and safety at the workplace. Prior to my arrival, there was no arthroplasty service within the public sector. Despite a clear need given the burden of high energy trauma and its complications. There was also not also no limit reconstruction service, not just in the city but the entire country. The hospital on the left is larger of the referral hospital below central hospital where underwent by surgery back in 1992 which before independence catered for the Black majority population with United below your hospital. Brown's on the right formally Bolly Essential Hospital which previously stated for the White Minority Cure Children's Hospital is located on the grounds of the United Blah, you hospitals on the side of the previous Robbie Gibson Infectious Disease Hospital which was gutted by fire under a decade ago. As already alluded to this beautiful hospital provides a free point of care, world class pediatric orthopedic service led by the Rick Gardener. The comparison of my two worlds, the geographical catchment area of uh allow a public hospital is more than 50 times that of NHS Land lecture with about 10 times the population but half the number of a public sessions at n thanks to the recent cause exa initiated that has seen a new breed of young orthopedist decisions. Join the current four seniors. Volume of work is enormous based on my personal data, more than three times the number of weekly incantations for both you and follow up patients' and more than four times the number of procedures. What I find quite interesting is a conversion rate to surgery of new patient's roughly a quarter of new consultations within NHS Land. Actual lead to a procedure where is the statistic slept in Zimbabwe? It is in in many cases that people for many reasons but mostly financial delay in presentation, Zimbabwe who want to survive. One has constantly on the the loss of one's ability to unbel eight is just about the only push factors you're seeking up. Yeah, soldier on for years with arthritis, weeks with trauma and what we deal with. He has completely different structures from an orthopedics. What I experienced during my training, my first days on the ground had me questioning my decision to take the plunge. How does one run a service, know, implants or image intensifier, know Sandri's swabs, dressings, switches and even paracetamol are often in short supply. I moved from the relative comfort of the hospital on the left in Lanarkshire to the one on the right at United Gloria hospitals, theatres are poorly equipped and plan B is often not an often if the patient can only afford an eight whole DTs, you have to make it happen. Cutting screws is the order of the day. Have made good friends with the recon plate help. You can also have the fractures, bending the plate into a bed bed configuration for ankle fusion A Y S are the workhorse and they completely just about anything. How do we cope? The truth is a simply get on with it. Take week to an echo from a fracture to of pain. Definitive care for various reasons, not limited to justice pottage. Obsessions still the team is one of driven and skilled colleagues with success of equal sex. A program providing much needed respite dropper is truly a land of haves and have not patience with the financial muscle can afford a world class orthopedic servants, private hospitals like the one shown in the image. But the reality is that more than half the population live below the poverty bait um line and cannot afford such a service being to being dependent on the crypt public hospitals. The team in Bulawayo works against all odds and the less fortunate on the left is a new breed of what sector graduates led by the mentor. Mr column starts saddlery and on the right, the telehealth network team that is working closely with ourselves, provide going replacements maintenance from my end. The key endeavor is one of skills sharing. The workload is a mammoth task beyond the capabilities of a single orthopedic surgeon personnel on the ground are keen and fast learners. The reusable standard still it is out of rings are an affordable workhorse for trauma. We have since introduced a limb reconstruction service. We recently introduced another process surface after a four day camp which culminated locally trained cohort of young surgeons carrying out last two hips of the camp me in the car park. This service in particular has been well received and made front page news with the vast majority of patient's having previously sort services abroad due to the explosion. It cost of throwing replacements in the private sector. I wish to quickly discuss a few cases of interest that is just a sample of what we have to deal with in our setting. Particular case is a common appearance where the unavailability of orthopedic specialist means that anyone with a medical degree can carry out any procedure poorly. Yeah, we have a great three B T B O fluctuate that was sutured and spanned in the configuration shown with pins well within the zone of injury, right? The list viability and we're left with a total a meter defect plus without a plastic surgeon on site, we proceeded to construct an open bifocal bone transmit frame and proceeded with destruction. His a genesis that allowed us to not only cover the bony defect but also to reduce the size of the wound which then required minimal grafting. They won't close at 11 weeks and the patient continued to bite the frame until they docked. They are due for bone graft at the document side in two weeks and re generators now visible on the plain films. Base number two is another patient. 35 year old mine ing engineer who presented with an infected ankle. 10 weeks after an production and intelligence station following a workplace injury, complication had been recommended and the factor was not healed with the foot in about 30 degrees of required us. First brightman led to a large defect. A second look for eight hours later, short bible wound ages and once again without any plastic service resorted to employing our workhorse to close the wound stablize the structure as well as gradually correctly acquired this, they weren't closed in 28 days and the fracture went on to unite allowing for removal or frame with a plantigrade, foot percutaneous kiddies tendon lengthening was carried out and the patient prepared returned to work after four months. Case number three is a neglected segmental typical structure. Histo fracture was undisplaced and healed but the proximal fracture was in significant various in short. By the way, we carry out this a little of cases without an image intensifier. We elected for an acute correction with packaging it called equipments due to the patient being unreliable in residing over 100 and 40 kilometers from Malawi. The patient is expected to not attend follow up but returned seven months later, walking without any walking, eight frame was then removed. That opportunity to be used on other patient case number four is just to show how we improvise to carry out a percutaneous achilles and the uh repair we use Ky as other band and similar infection to the Iceland device used in the NHS. Now case number five is my best so far in Zimbabwe and on, on the floor hazard it gets as to what bone attracted here. This patient is Beatrix and doesn't mind us sharing her identity. Six month old elephant calf rescued from its um visit basin was domesticated at the local wildlife sanctuary battling too many. I was to learn that this injury is almost only seen in elephants in captivity, I guess believes in being that the fallen fracture is almost unsurvivable in the wild. When if that doctor Mark Lumbar, the former patient of mine was called to put it down. He quickly got in touch and I was quick onto the energy span. Actual support because of advice Alberto is expected responded after much pondering, I felt she deserves an Ortho fix data donated by University Hospital Hammers which has now since been framed Asian allergy on that side and pumped up with antibiotics. Actually the most compliant and most grateful of any of my patient's. She went 2019 just four weeks and the data was removed in six weeks, he's gone on to thrive and a very well done job by the team involved in this world. First Zimbabwe is truly beautiful but in time for the kids is never dull. The picture on the left taken after all kind of monkeys came for that daily of a battle harvest on the right, the neighbor's cat was let out at night. A male leopard up a tree. We do live in harmony with animals and it's, it's always a pleasure to share the space with them. So please do visit Zimbabwe. It is a lot more onshore than just the material falls. The need is there as we rebuild a part in any form is always appreciated. Nothing ever needs to go to waste. We put it all too good use as we say, we always make a plan. And once again, very grateful to Alberto for providing me this platform as well as your entire team at world orthopedic are concerned. I am happy to take any questions at this stage about my experience. Thank you. See a bow tech agenda. Jabu. Thank you very much for that. Uh And I hope your online. Yes. Yeah. Can you hear me? Yes, we can. Jab. Ooh, thank you very much. Good to see you. Money room a square. Say uh you're traveling too much. Have any questions for job. Ooh deeper. Um Thank you so much. That was an amazing presentation. Uh I just wanted to ask because you completed your training in the UK. And obviously you're now working in a very different environment. How well do you think the U K training prepared you for your work now? Yeah. So the good thing about U K playing thing that uh General Publix is get principles right then, getting those principles in hand, you should be able to deal with a lot of challenges. The pathology is very different, as I've mentioned. Um, people present meat and afternoon in stage disease. I thought of the cases I've dealt with cases that I've actually not physically dealt with within my UK practice, but applying the same principles that I guess how much in, in our trading. I think it is valuable and I think the local core training is, is actually appreciating. Uh this. Yes. Do you have any other questions and from the chat room? Okay, Jabali. Thank you very, very much indeed. I hope to see you soon. Hopefully from one of the hip camps up in Zambia. Fantastic scene, July. Uh take care. Bye.