An appropriate approach to orthopaedics in developing countries

Summary Gifts of high technology and expensive buildings can constitute a disservice to a poor country when not accompanied by funding for the maintenance and running costs, since they will divert limited resources from more essential needs.The orthopaedic surgery that should be practised in many developing countries differs greatly from that in the contemporary Western world because of a different spectrum of disease, the consequences of uncontrolled disease processes and the less satisfactory conditions in which to function. Training in the home country is therefore essential and circumvents frustration and the brain drain from these countries. Poverty in material resources is not matched by poverty of intellect or resourcefulness, and we have much to learn from developing countries. Different cultures result in the needs of patients being quite different. Orthoses and prostheses need to be based on local crafts and resources, and some of these are illustrated.The Western world can best assist by having surgeons working, teaching and learning in the Developing World, using inexpensive means to treat the many and not to pamper the few.

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Résumé Une haute technologie et des bâtiments coûteux peuvent représenter pour un pays pauvre un cadeau empoisonné, s'ils ne sont pas accompagnés du financement de l'entretien et du fonctionnement, car ils peuvent détourner de besoins plus importants des ressources modestes. La chirurgie orthopédique qui peut être pratiquée dans de nombreux pays en voie de développement diffère notablement de celle des nations occidentales, en raison des différences de la pathologie, des conséquences évolutives de maladies non traitées et des conditions moins satisfaisantes dans lesquelles elle est réalisée. La formation dans le pays d'origine est donc essentielle, elle prévient le sentiment de frustration et l'émigration des élites. La pauvreté matérielle ne s'accompagne pas forcément de pauvreté en intelligence et en savoir-faire, et nous avons beaucoup à apprendre des pays en voie de développement. Des cultures différentes font que les besoins des malades sont également différents. Les orthèses et les prothèses doivent correspondre aux ressources et aux possibilités de fabrication locales, on en présente quelques exemples. La meilleure aide que puisse fournir le monde occidental est d'envoyer des chirurgiens travailler, enseigner et apprendre dans les pays en voie de développement, où ils utiliseront des moyens peu dispendieux pour soigner le plus grand nombre et non pour choyer une minorité.

     

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Objective

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