The 2009 ABC Travelling Fellowship - Cultures and Health Care

Eric Bohm, B.Eng, M.D., MSc, FRCSC
Winnipeg, MB
Mark Glazebrook, M.D., MSc, PhD, FRCSC
Halifax, NS
The 2009 ABC Travelling Fellows

The American British Canadian (ABC) travelling fellowship, started in 1948 by Prof. R.I. Harris of Toronto during his presidency of the American Orthopaedic Association (AOA), continued its fine tradition this year. Seven North Americans crossed the Atlantic for the tour: Eric Bohm from Winnipeg, Kevin Bozic from San Francisco, Leesa Galatz from St Louis, Mark Glazebrook from Halifax, Rex Haydon from Chicago, William Mihalko from Memphis, and John Sperling from Rochester. The itinerary included eight institutions in England, one in Scotland, one in Ireland, and six in South Africa. The 36 day trip was thoroughly enjoyed by all as new friendships, colleagues and collaborations developed throughout the journey.

From L to R: Kevin Bozic, Rex Haydon, Mark Glazebrook, Leesa Galatz, Eric Bohm, Bill Milhalko, John Sperling

The current atmosphere of heated health care debate sharpened our interests in how orthopaedic care is delivered in other countries. Presentations from both hosts and fellows added to our knowledge of the topic. In Canada, health care insurance is universal, regardless of ability to pay. However, there remain issues with waiting times for elective procedures, cost and sustainability. Recently, alternative models for delivery of elective hip and knee replacement surgeries have been undertaken, which has resulted in reductions in wait times for these procedures. In the US, those with health care insurance appear to have quicker access and more choice, but nearly 50 million Americans are without insurance. Those in the UK have access to both a universal system (the National Health System, or NHS) and private providers, typically paid for by health insurance purchased privately. As part of ongoing effort to reduce waiting times and meet their 18 week benchmark from referral to treatment, the NHS has engaged private providers to provide publicly-funded care. This has resulted in some "competition" between public and private providers (know at "ISTCs" or Independent Surgical Treatment Centres), along with a vigorous debate about the quality of care delivered in these private centres. Our travels south of the equator demonstrated a very different health care system. Faced with significant fiscal constraints, large numbers of immigrants, and huge volumes of trauma, South Africa's publicly-funded hospitals face a constant uphill struggle to provide orthopaedic care to those without private insurance.

Nelson Mandela Square, Johannesburg

The fellows changed seasons with a 12 hour flight south to South Africa and learned of a beautiful country that has its own unique challenges. The orthopaedic community is in a constant struggle to balance the ever increasing demands of public trauma with a desire to advance elective orthopaedic care in the private setting. Tours of the largest public hospital in the Southern Hemisphere (Baragwanath Hospital) left an impression on the fellows that will never be forgotten. The most important lesson learned on the South African tour was that there exists strength in the people that provides a spirit of hope for a bright future. 

Baragwanath Hospital