2021 was a time when I spent some very happy months as the orthopaedic surgeon in residence & interim CMO (Chief Medical Officer) on the isolated British dependancy of St. Helena. The island is one of the most remote places on earth. Napoleon Bonaparte was exiled there after his defeat at the Battle of Waterloo and it is home to the world's oldest terrestrial creature - Jonathan the giant tortoise. St. Helena is also where you will find 'Jacob's Ladder' which is a construct of 699 steps. This is a Grade 1 listed structure & every year there is a timed run up to the top, with competitors coming from around the world to take part. The current record is just under 5 minutes & 17 seconds. Thinking about this is a reminder of something important. The wonderful Jonathan, who I had the privilege of meeting, doesn't let the fact that he is the oldest land-based being on the planet stop him from getting about. To him mobility matters, allowing life to still be enjoyed to the full despite having been born before Queen Victoria's coronation in 1838. Then we have the other extreme of mobility, with those who punish themselves in the attempt to climb 699 demanding steps in record time. Everyone's need for mobility is different, because everyone is unique. When joint replacement began it was essentially a 'pain relief procedure'. Now we are so much better placed to deliver on a broader range of expectations. At the extremes of demand on prosthesis we see sports persons returning to competitive activity. At the other end of the spectrum we see more modest requirements, reflecting the realities of advancing years. Irrespective, loss of mobility impacts hugely on quality of life & the mission of the orthopaedic surgeon is to improve things for patients. It was a great privilege to be able to assist some of the resident's of St Helena with joint replacement procedures while I was there, perhaps the most remote hip & knee replacements in the world. Thinking about such things it's amazing to reflect that Jonathan would have been a "young giant tortoise about town" when Themistocles Glück was proposing joint arthroplasty in the late 1800's. My philosophy is that small & remote communities are deserving of the finest of orthopaedic service & commitment & it was great to see my service to the St. Helena community acknowledged in the reference below. My intention is to bring the same philosophy of care to Forster, Taree, & the surrounding areas of NSW. ![]()
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On 2nd November 2019 my wife, Tanya and I left Palmerston North as I had the honour of representing the NZOA (New Zealand Orthopaedic Association) as the Ambassador Fellow to Hong Kong. We dropped off our daughter who glibly informed us that we would not be missed as she was going to stay with a school friend who had a cool house with lots of animals! Despite gale force winds in Auckland there was no delay thankfully and we arrived in Hong Kong’s spotlessly clean airport, proceeded seamlessly through immigration and were chauffeured to the excellent Hotel next door to the Congress Centre. We were then collected by the HKOA (Hong Kong Orthopaedic Association) Ambassador to NZ, Lewis Chan, whom we had met in Rotorua at the NZOA Annual Scientific Meeting. Lewis, an exemplary host, had made arrangements to show us some of the City and treated Tanya and I to an excellent Dim Sum lunch in a restaurant less frequently visited by tourists. This proved to be the first of several excellent Dim Sum lunches with eminent surgeons from Hong Kong and the Asia Pacific region and we were indeed fortunate that Air New Zealand does not have a policy of weighing its returning passengers! Over lunch Lewis discussed the increasing pressures on the Public hospitals since Hong Kong was returned to Chinese government, the huge clinical workload and the financial realities of living in Hong Kong such as only the privileged elite can afford a house. The tour of Queen Mary’s University hospital, Hong Kong’s most established hospital, made me particularly conscious of how fortunate we are as NZ Orthopaedic surgeons. Trauma and Orthopaedic wards were cramped by comparison (patients could easily shake hands with their neighbour) and the OPD (Out Patients Department) was ostensibly busy. Patient gratitude was very evident however and the standard way of expressing this was bestowing the gift of a wall banner stating “Excellence in compassion: Excellence in skill”. Lewis had received this given his leadership in setting up Enhanced Recovery After Surgery for joint replacements, especially Total Knee Replacements. Interestingly I came to realise that in Hong Kong Total Knee Replacement is far more common than Total Hip Replacement with the key indication for the latter being AVN (Avascular Necrosis). We then had a tour of the University Department of Orthoapedics and educated on “the Hong Kong operation” for spinal TB that put Hong Kong on the global Orthopaedic map. The President’s Welcome Dinner that evening was at the Dragon Room at the Hong Kong Banker’s club on the 45th Floor where I was welcomed formally and fed amazing Cantonese cuisine. There was much mirth and good humour. It was of particular interest to talk with the British Orthopaedic Association (BOA) President, Philip Turner, and discuss perspectives from practicing Orthopaedics in the United Kingdom. Ironically the BOA Ambassador Fellow to Hong Kong and FRCS(Tr&Orth) gold medal winner was a friend and previously my junior Registrar in Wellington in 2011, Chris Mitchell. The theme for the 38th Hong Kong Orthopaedic Association Annual Congress was “Build and Brighten – Child and Adolescent Orthopaedics in the next decade” held at the impressive Hong Kong Convention and Exhibition Centre overlooking Victoria Harbour. There is a vibrant and robust departmental research ethic in HKOA with high quality presentations complementing those of visiting speakers. The first day of the conference focused on Paediatric and Adolescent Hip conditions - a major interest of mine with several excellent talks given. The black-tie Banquet dinner showcased yet more tremendous food and drink whilst in the company of several other dignitaries from the Asian Orthopaedic societies. The following morning in the Arthroplasty session I gave my presentation – ‘A formal systematic review and meta-analysis of Vitamin E Highly-Crosslinked Polyethylene and whether it as yet conveyed advantages in Total Hip Replacement’. I had performed this study, now accepted for journal publication, through my alma mater, Bristol University. This presentation thankfully promoted good discussion and was received well. At the conclusion of the conference Tanya and I then took a ferry to Discovery Bay to experience the city from the water and visited some great friends who are expats from the UK. The Ambassador Fellowship to Hong Kong afforded me the opportunity of many new contacts, renewal of old friendships and establishing collaborative research networks. We enjoyed thoroughly the experience of visiting an amazing city with such a rich history and throughout our visit received excellent hospitality. I wish to thank the New Zealand Orthopaedic Association for the opportunity to attend the Congress, as well the Hong Kong Orthopaedic Association, for their hospitality and organisation. In particular I thank the President of the HKOA Dr Yiu Chug Wong. I believe our future lies in fostering collaborative efforts with Hong Kong, China and the Asia Pacific region, as well as maintaining our more traditional ties with Britain, North America and Australia. I strongly endorse this Fellowship experience and recommend anyone considering this opportunity, to apply.
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