By: 19 December 2013

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SICOT’s 34th Annual Conference took place in Hyderabad, the Indian capital of Andhra Pradesh, in October, and attracted a large crowd from all the continents. The format was standard; a huge main hall, four large halls and dozens of smaller meeting rooms able to seat the thousand-plus presentations. SICOT is clearly in competition with the great national and regional meetings in Europe and America, but the subtitle of the meeting – Orthopaedics in an Unequal World – retained the practical concern for the huge populations in the countries adjacent to India.

Selection of the programme, like that for the finest journals of Orthopaedics, is probably made on the basis of originality, reliability and relevance; in other words, is a presentation ‘new, true and important’?  The items presented at Hyderabad scored well on these points. But most national associations have come to realise the importance that a substantial part of the meeting should be dedicated to ‘instruction’, which was the case here. We raise the question as to how the profession is to develop, and what SICOT’s place is in that process.

Huge meetings become the showcases of manufacturing industry. It is here that commercial profit cannot (and should not) be excluded, but at the same time manufacturing industry desperately needs the restraining hand of the scrupulous critical appraisal.

Another worrying feature is the expense to the average trainee in orthopaedics of attending such events. The cost of travelling to get to a conference, the price of accommodation and the registration fee are prohibitive. Couple those with the conviction that practical technique has to be demonstrated in practice.

How much is learned, and accurately assessed, at a great conference? Great venues are ideal to find out what is going on and what is being invented. It is not a good place for finding out what has been discarded as obsolete or frankly flawed in its inception, or discarded as dangerous.

The subtitle of the 34th Annual meeting was chosen by the organising Chairman (Professor Ashok Johari) – Orthopaedics in an Unequal World. Has anything been changed by this meeting?  Yes, in that those attending have been made aware of the problems.

The triumph of information technology has made the countries of the world, with a low income in monetary terms, painfully aware as to how enormously better the rest of the world is compared to themselves. The effect is seen daily in the press: desperate emigrants drowning, starving and dying of thirst in the desert, in their struggle to reach ‘the promised land’.

This broad observation is hardly the stuff of world orthopaedics, but it is clearly to be seen as a driving force of ‘medical emigration’. The opportunities for rich rewards from wealthy populations that pay well for expertise are considerable. Small wonder then that the bright young trainee, charitably supported to work for a while in the West, will accept any job with the prospect of having the tools with which to do excellent work. It follows, therefore, that charitably supported migration further damages, not the trainee himself, but the low and middle income countries from which he comes. It behoves us, therefore, to arrange for surgical training to be provided in the country of origin, (to quote TKS) where “the need is desperate, the pathology abundant, but facilities basic.”