UCSF-Bedford Orthopedic Center in Umtata, South Africa

UCSF began incorporating overseas missions into its orthopaedic resident training in 1992. From 1992 through 1998, fifteen of thirty-six graduating orthopaedic residents went on overseas volunteer missions. Of those fifteen residents, six (40%) have gone on additional volunteer missions after graduation; and three of these graduates have since led other volunteer missions that included UCSF residents.

In 1998, the Orthopaedic Research and Education Foundation earmarked funds to sponsor a pilot program for a resident rotation at an Orthopaedics Overseas site. Dr. Holly Brown (UCSF Class of 1999) was the first American resident to be selected. She spent two and a half weeks at the Bedford Orthopaedic Center in Umtata, South Africa, a former homeland under apartheid. The caseload consisted of a variety of general orthopaedic problems with an emphasis on fracture management. At the Bedford Orthopaedic Center, a considerable amount of the trauma is sub acute in nature due to the delay in initial presentation to the hospital. The patient load is quite heavy. In addition to trauma, there are many tuberculosis infections and pediatric cases, with only one orthopaedic center to care for over three million people.

From 1996 to the present, a formal overseas elective rotation was developed as an opportunity for all fourth year UCSF residents. Residents may do this elective while rotating at the San Francisco General Hospital. This is the first and only such elective officially offered through an orthopaedic surgery program in the country. Residents are given a specific set of goals and objectives for the rotation. They keep a journal of all of their operative cases, listing the diagnosis, treatment and level of supervision provided by the Program Director. In addition, residents record the patients they see in consultation in outpatient, inpatient and emergency department settings. Residents teach the local staff of health care providers, and document the audience, setting and topic of all lectures and formal education they provide. The residents learn valuable lessons, both clinical and philosophical, during their rotation. Historically, three-quarters of all residents who have done the elective, engage in future volunteerism missions, well above the national average. Funding for this elective comes directly from faculty support and philanthropic donations from individuals and industry.

Through the overseas rotation, residents gain a unique learning opportunity that complements and consolidates their orthopaedic residency training. UCSF’s commitment is to foster the lifelong spirit of volunteerism in our orthopaedic residents, and to promote like behavior in other orthopaedic training programs across the United States. By decreasing barriers to volunteerism and encouraging early participation in volunteer activities, UCSF hopes to nurture a culture of physician involvement within the United States orthopaedic community.