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SARS, War and Snow: An ABC Trip around the World Kevin. A. Hildebrand, M.D., FRCSC
University of Calgary Nizar N. Mahomed, M.D., ScD, FRCSC
University Health Network, University of Toronto The 2003 American, British and Canadian (ABC) travelling Fellowship took place April 5 - May 9, 2003. Two Canadians and five Americans travelled to the United Kingdom, Australia and New Zealand, circling the globe along the way. The Canadians were Doctors Kevin Hildebrand from the University of Calgary (elbow and wrist disorders) and Nizar Mahomed from the University of Toronto (arthroplasty). The Americans were Doctors Mark Easley from Duke University (foot and ankle, knee arthroplasty), Sohail Mirza from the University of Washington (spine), Khaled Saleh from the University of Minnesota (arthroplasty), David Skaggs from Los Angeles Children's Hospital (paediatric orthopaedics) and Kristy Weber from MD Anderson (oncology) (Figure 1).
 | | Figure 1: The 2003 ABC Fellows. From left to right: Doctors Nizar Mahomed, Khaled Saleh, Kevin Hildebrand, Kristy Weber, Mark Easley, David Skaggs, Sohail Mirza. | SARS, the Iraq conflict, and snow figured prominently at the beginning of the trip. The trip was in question right up to the final days but six Fellows did manage to meet for departure from Chicago on April 5. Nizar was unable to leave Toronto due to the quarantines declared for health care workers in several hospitals. Kevin left Calgary in a snowstorm - more on snow later.
 | | Figure 2: Nizar and Kevin at the Sydney Opera House. | We arrived in London on April 6 to sunshine. In fact, the three weeks in the United Kingdom were characterized by sun with only a half day of rain in Edinburgh and temperatures in the mid teens to mid 20's degrees Celsius. We traveled to Bristol, Bath, Birmingham, Stoke-on-Trent, Stratford-upon-Avon, Oxford, Edinburgh and London. In London, we visited the Royal National Orthopaedic Hospital in Stanmore and St. Mary's Hospital. Nizar joined us for the final week in England. We were hosted by excellent individuals including Misters Roger Atkins (Bristol/Bath), Rob Grimer (Birmingham), Peter McLardy-Smith (Oxford), Malcolm McNichol (Edinburgh) Professor Nick Maffuli (Stoke-on-Trent), and Ms. Deborah Eastwood (London).
The clinical work highlighted the use of the Ilizarov technique for correction of congenital or acquired shortening or deformity and acute treatment of tibial fractures and treatment of more chronic complications. Arthroplasty was another prominent theme. There were several reports in many centres on the use of the Exeter hip, the Oxford unicondylar knee, and resurfacing hip arthroplasty popularized in Birmingham. Joint registries were also discussed with an example of the Scottish registry used to look at DVT trends. Kevin met Mr. Willie Souter in Edinburgh and had an engaging discussion with him regarding the Souter-Strathclyde total elbow arthroplasty. Two presentations were particularly entertaining; one by Mr. Michael Freeman, who traveled to Bristol to challenge traditional thoughts on knee kinematics, and Mr. Charles Court-Brown gave a lively rendition on a controlled trial comparing external fixation and reamed intramedulary treatment of tibial fractures in Edinburgh.
 | | Figure 3: Mark Easley and an Australian local. | The nonacademic aspect of the British tour was spectacular at every stop. The highlight event was the dinner at Wadham College in Oxford hosted by Mr. Peter McLardy-Smith. Other activities included attending the Taming of the Shrew at the Royal Shakespeare Theatre in Stratford, shooting clay pigeons at Mr. James Christie's farm near Edinburgh and witnessing the history of the British Empire and Orthopaedics. There was so much history that by the end of the British tour, the phrase: "if it ain't over a thousand years old I ain't looking at it," could be heard frequently as we tried to "see everything" in our short time there. Orthopaedic highlights included a walk through the Girdlestone ward at the Nuffield in Oxford and seeing pictures of attending staff such as Mr. Bankart and Sir Watson-Jones at the Royal National Orthopaedic Hospital. The British leg ended with a dinner at the Café Royal with the British Orthopaedic Association. This venue was the site for one of the few pictures taken with all seven Fellows together (Figure 1).
The SARS epidemic forced some changes in the travel plans from London to Sydney, Australia. Originally, we were to travel through Singapore, but due to a travel advisory, we went through Bangkok. Dr. Sohail Mirza returned home and did not accompany us to the Southern Hemisphere due to the SARS epidemic in Asia. After 22 hours in transit (two hours lay over in Bangkok), we arrived in Sydney April 26. Kevin called home to find out he was missing a storm that dropped 80 centimetres of snow on Calgary.
For the nine days we were in Australia, we travelled to Adelaide and Melbourne, in addition to Sydney. Our hosts were Mr. David Little in Sydney, Professor Donald Howie (University of Adelaide) and Professor Jegan Krishnan (Flinders University) in Adelaide, and Mr. Richard de Steiger in Melbourne. We were treated to a wide spectrum of clinical and research presentations. The Centres we visited commented on the liability insurance crisis that is gripping the orthopaedic community. Joint registry work was also being developed in this country. Our travels in Australia also allowed us to see many of the natural and man-made landmarks such as the Sydney Opera House (Figure 2) and Harbor Bridge, the McLaren Valley south of Adelaide and the Melbourne Cricket Grounds (MCG). Friendship was also extended in the form of lovely dinners, memorable lunches at wineries and, of course, golf and go-carts. We were able to take in Cleland Park near Adelaide and relax with the locals (Figure 3).
 | Figure 4: ABC Fellows and their New Zealand hosts.
Back row: Dr. Khaled Saleh, Mr. Haemish Crawford, Mr. Tony Hardy
Middle row: Mr. Michael Barnes, Mr. Ross Nicholson, Dr. Mark Easley, Dr. Kristy Weber, Mr. Khalid Mohammed, Mr. Peter Robertson.
Front row: Dr. David Skaggs, Dr. Kevin Hildebrand, Dr. Nizar Mahomed. | May 4th saw our trip switch from Australia to New Zealand. The final leg of our tour was Remarkable, with our first stop being the resort town of Queenstown in the mountains of the South Island. We were greeted by eight former ABC Fellows from New Zealand (Figure 4). Activities included golf, tours of the Lord of the Ring's film site, bungy jumping (David and Kristy) and Shotover River jet boating. Our other stops were hosted by Mr. Peter Devane in New Zealand and Mr. Haemish Crawford in Auckland. In New Zealand, we learned about methods to monitor wear and loosening, the joint registry (which included data on total shoulder, total elbow and total ankle arthroplasties), mechanisms of ACL injuries in skiers and snowboarders, and the ACC, to name a few of the outstanding presentations. The ACC provides for care of all injuries greater than one week old whether they were work-related or not. Liability insurance is not an issue in New Zealand where a no-fault claims process is in place. Our final formal function in Auckland was a wonderful dinner in the Royal New Zealand Yacht Squadron. The next day (May 9) saw us depart for North America after a morning sail in Auckland on one the America's Cup yachts.
In closing, we would like to express our heartfelt support for the ongoing tradition of the ABC Fellowship. We met many leaders in orthopaedics on the international scene and made new contacts and friends. We learned about the methods used in different areas of the world to treat patients like ours and we were also able to share our methods of treatment. Finally, we want to thank the Canadian Orthopaedic Association, the American Orthopaedic Association, the Universities of Calgary and Toronto, our colleagues at our institutions and most importantly, our families who supported us in this endeavor. |
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