30 years of the ASEAN Orthopaedic Association

Ellewellyn G. Pasion, Peter Lee, Saranatra Waikakul

The ASEAN Community was established in 1967 from the consensus of 5 countries in South-East Asia: Indonesia, Malaysia, Philippines, Singapore and Thailand. Three pillars have been erected to support these agreements by the ASEAN Orthopaedic Association: 1) the ASEAN politic security community (APSC), 2) the ASEAN economic community (AEC), and 3) the ASEAN socio-cultural community (ASLC). These concepts have been developed into the ASEAN orthopaedic community for orthopaedic surgeons in these countries.

In 1978, Professor Soelarto Reksoprodjo invited Professor P. Balasubramanian from Malaysia, Dr. Jose M. Pujalte from Philippines, Professor Robert W.H. Pho, Dr. Ong Leong Boon from Singapore and Professor Thamrongrat Keokarn from Thailand to attend a special orthopaedic surgery educational meeting in Bandung, Indonesia. During the meeting, Professor Soelarto presented his idea about formation of a core group of orthopaedic surgeons in the ASEAN region to work together to promote orthopaedic education, training and social activities.

In 1981, Dr. Jose M. Pujalte from the National Orthopaedic Hospital, Philippines, invited the delegates from ASEAN countries to attend the 1st ASEAN Orthopaedic Association (AOA) meeting in Manila; these attendees were later invited to be the founders of the association (Figure 1. Table I). With the consensus of these founder members, Dr. Pujalte was honoured to be the first President of the AOA, and Dr. Ong Leng Boon was the honorary secretary general. The term of the AOA President one year, and the Presidency was rotated from one country to the next host country for the AOA annual meeting (Table II). The logo for the ASEAN OA was a round world map (outlined by a blue ribbon) focused on Southeast Asia, and deep blue colouring was used to identify our member countries. At the foot of the map, 1981, the year that our association was established, is noted (Figure 2).

The rotation of the host countries for the AOA annual meeting was arranged alphabetically, i.e.. Indonesia, Philippines, Malaysia, Singapore and Thailand. According to the Associations constitution, Council members of the AOA consist of two delegates from each country. The Senior VicePresident is the in-coming President of the AOA, who also hosts the subsequent annual meeting.

In 2005, the Vietnam Orthopaedic Association was included as a member of our AOA. Professor Vo Van Thanh was the first Vietnamese Council member of our association, and Vietnam hosted the AOA annual meeting in 2007 in conjunction with its Associations’ celebrations. In 2011, the Myanmar Orthopaedic Society also applied to be included in the AOA as the seventh member of the association. The existing members of AOA are currently in the process of processing Myanmar’s application for inclusion in the AOA. Dr. Ong Leong Boon was the Secretary General of the AOA from its inception, and contributed immensely to development of the AOA until he stepped down in 2007. He initiated and carried out many fruitful academic activities and collaboration among members of the ASEAN orthopaedic community, and between the AOA and other orthopaedic communities around the world including the American Orthopaedic Association, the European Federation of National Associations of Orthopaedics and Traumatology (EFORT) and the British Orthopaedic Association. Dr. Ellewellyn G. Pasion took over the post thereafter, and is
now our second honorary permanent Secretary General. He had continued to oversee the activities of AOA, and has also created many new missions for our orthopaedic community.

Programs

Our founder councils initiated many fruitful activities to promote education and friendship among the orthopaedic communities in the ASEAN Countries. Such activities include: 1) advising the organizing committees of the combined annual meeting of AOA, 2) promoting direct collaboration among our members by serving as an information centre for academic activities, resource personnel, orthopaedic education and training, 3) operating the yearly fellowship programmes, 4) publishing the Journal of the ASEAN OA, and 5) organizing orthopaedic outreach programs in the region.

A. Travelling fellowships

The first junior traveling fellowship, awarded yearly, was started in 1983, and has been active since that time. Each national orthopaedic association nominates a young orthopaedic surgeon, below 35 years of age, to participate in the program. These fellows travel together to visit key orthopaedic training centers in each host country in the ASEAN region. The fellows present their research projects, exchanging their knowledge and experiences at these orthopaedic centres. Host countries promote interactions of these fellows with the local orthopaedic community through social activities. The fellows are also exposed to local culture and practices, and brought to local areas of interest to enhance socio-cultural understanding amongst the fellows. At its inception, spent 2 weeks in each country. The conclusion of the program was in the country hosting AOA Annual Meeting for that year. In 1986, the programme was shortened to five weeks – one week in each country, as fellows typically had heavy workloads, which did not allow for longer programme participation periods. After the Vietnam Orthopaedic Association became a member of the AOA in 2005 and hosted our Annual Meeting in Ho Chi Min City in 2007, the number of junior traveling fellows increased to 6 and the traveling fellowship programme was extended to 6 weeks. In 2010, the administrative committees of AOA adapted the programme to be a 5 day program in each country, so that the entire traveling time is now about 5 weeks. To date, more than 30 orthopaedic surgeons from each member country have served as junior traveling fellows and most still have close connections to their colleagues in orthopaedics in other member countries, thus improving collegiality among our ASEAN Orthopaedic Communities.

The senior traveling fellowship programme was started in 1985. This programme is similar to the junior traveling fellowship, except that the nominated fellows were senior consultants or professors of orthopaedic surgery in training centres in their home country. These senior fellows travel together to visit orthopaedic training centres in the ASEAN member countries, spending 3 to 4 days in each country. The programme lasts approximately 2 to 3 weeks. The fellows deliver lectures and participate in academic activities of the host countries. After the Vietnam Orthopaedic Association became an AOA member in 2005, the number of senior traveling fellows increased to 6. To date, more than 20 orthopaedic surgeons in each country have served as senior traveling fellows and most continue their connections with each other in both academic and social activities. The first American Orthopaedic Association – AOA Traveling Fellowship was awarded in 1994. Dr. Ong Leong Boon and Professor Stuart Weinstein were coordinators of the program and the ‘godfathers’ of the traveling fellows. The Zimmer Company had supported the expenses of these fellows. Every year, one outstanding young orthopaedic surgeon from each country who is an active member of their national association, ranging in age from 35- to 45-years-old are awarded a fellowship. These fellows travel together to visit 6 to 7 outstanding orthopaedic training centres in the United State of America (USA). They spend about 5 weeks traveling and attend the annual meeting of American Orthopaedic Association at the end of the fellowship. The fellows present their research work, visiting both clinics and laboratories at the orthopaedic centres. Host centres also have special academic activities for the fellows. This programme has been very beneficial to our members wishing to pursue further education in particular fields in the USA. In 1993, the AOA was an international guest of American Orthopaedic Association with a special combined meeting
between these two associations at White Sulphur Springs, West Virginia, USA. Many members of the AOA presented their research in oral presentation or poster presentation. However, with the recent funding limitations, this traveling fellowship is now awarded every 2 years.

The first EFORT and AOA Exchange Traveling Fellowship was awarded in 1996. Dr. Ong Leong Boon was instrumental in establishment of this traveling fellowship. Every year each national orthopaedic association of the AOA nominates a young outstanding orthopaedic surgeon to be a fellow. Prerequisites were similar to the American Orthopaedic Association – AOA Traveling Fellowship. These 5 ASEAN fellows travelled together and visited 3 to 4 outstanding orthopaedic centres in Europe in a trip lasting approximately 2 weeks. Fellows had a chance to broaden their knowledge about both clinical practice and basic research. Most fellows reported that the fellowship was very beneficial. All orthopaedic centres in Europe visited by the fellows were very advanced and comparable to the orthopaedic centres in North America. However, as not all European hosts were English speaking, some ASEAN fellows had difficulty communicating and gaining knowledge from travel to these European countries because of the language obstacle. After the traveling programme, all fellows attended the annual meeting of EFORT. This program was very beneficial to our members wishing to pursue higher education in particular fields in Europe. Reciprocally, 2 senior orthopaedic surgeons from EFORT travelled to 3 of 6 countries in ASEAN region
each year with the next year’s fellows visiting the remainder of member countries so that each country was visited every two years. The fellows presented lectures on their fields of interest. The programme also lasted approximately 10 days. Unfortunately, the program was discontinued in 2003.

In 2004, Dr. Ong Leong Boon negotiated successfully with the British Orthopaedic Association to set up an exchange traveling fellowship with the ASEAN OA. Instead of traveling to several European Countries, the 6 traveling fellows from the ASEAN region travelled to the United Kingdom and visited 3 to 4 outstanding orthopaedic training centres in the UK. Reciprocally, every year, 2 outstanding members of British Orthopaedic Association travelled to 3 of 6 ASEAN countries and participated in academic activities in ASEAN, as had the Fellows from EFFORT. This program had to be discontinued in 2007 due to financial constraints.

In 2003, the AOA established a new cooperative programme with American Academy of Orthopaedic Surgeons (AAOS). Every year, three outstanding orthopaedic surgeons from the USA travel to Thailand two days before the annual meeting of the Royal College of Orthopaedic Surgeons of Thailand (RCOST) to present an instructional lecture for ASEAN Orthopaedic communities. The programme aims are to transfer, exchange and update knowledge in orthopaedic surgery between the AAOS and AOA. Every year, many orthopaedic surgeons from the ASEAN region attend the AAOS Annual Meeting. This instructional course
programme lessen the financial burden of ASEAN orthopaedic surgeons who would otherwise have to travel to the USA for these lectures. The programme took place in Thailand for two years before it was presented in other ASEAN countries. Professor Stuart Weinstein of the American Academy of Orthopaedic Surgeons (AAOS) and Professor Thanrongrat Keokarn, Professor Chaithavat Ngarm-U-kos and Dr. Suthorn Bovonratanavech of the RCOST and AOA are the pioneers who established this programme.

The first Australian Orthopaedic Association – AOA Exchange Traveling Fellowship was awarded in 2011. The aim of the programme is to enhance the relationship between the Australian Orthopaedic Association and AOA in terms of education and social exchange. This exchange programme was proposed at the business meetings during the AOA annual scientific meeting in 2009 and 2010. Due to the efforts of Dr. John C. Batten, Dr. Ian Dickinson and Dr. John Bartlett representing the Australian Orthopaedic Association, and Dr. Bricx Pujalte, Dr. Peter Lee and Dr. Ellewellyn G. Pasion representing the ASEAN OA, the first group of Australian Fellows visited the ASEAN orthopaedic community during October 2011. They spent 2 days in each of Philippines, Vietnam and Thailand, and were our honorary guests in the Combined Annual Meeting of AOA and the RCOST held October, 2011.

B. AOA Journal

The Journal of the AOA was started in 1981with Professor Dato A.K. Abdul Hamid as the first Editor-in-Chief. The Editorial Board consisted of outstanding senior orthopaedic surgeons from every country in our region. The aims of the journal were to promote the publication of research as well as review articles by ASEAN orthopaedic surgeons. There are 3 issues of the journal published every year with about 10 – 15 papers in each. The present Editor-in-Chief is Professor Saw Aik who remains very active in upgrading the journal in terms of quality and consistency. His Editorial Boards had also worked very hard to improve the journal and to have the journal incorporated into international databases. With financial support from the Malaysia Orthopaedic Association, the Editors and peer reviewers are able to
continue their work on our journal. However, we still need a steady supply of submissions from our ASEAN members. We are looking forward to continually improving the journal.

Outreach Programs

In March 2011, the first AOA Outreach programme was conducted in Klaten, Indonesia. Dr. Peter Lee, the immediate past president of AOA was coordinator for the orthopaedic outreach programme. Several orthopaedic surgeons from the ASEAN OA member countries also participated in the programme, for which the theme was arthroplasty. Activities included lectures and discussion, hands-on workshops, outpatient clinics and live surgery demonstrations. The programme was very successful and well received by the local orthopaedic community. The AOA outreach subcommittee has plans for additional programmes in Indonesia, Philippines and Myanmar in 2012.

The Future of the ASEAN OA

With the global changes in orthopaedic clinical practices, the continuing evolution of medical industries, the coming ASEAN Free Trade Agreement (AFTA) amongst ASEAN countries, health reforms and medical-legal issues, the AOA has many new challenges ahead. We also now have more orthopaedic surgeons pursuing subspecialties and academic activities rather than practicing general orthopaedics. This issue could lead to fragmentation of our orthopaedic community into more diverse groups. One of the good
indicators of the relevance of the AOA is the number of international participants in our AOA annual meetings, which has decreased during the past few years. On the other hand, recently there have been more international participants in the subspecialties academic meeting with greater support and funding from the industries.

AFTA may also trigger conflict among AOA Members, as orthopaedic surgeons may begin to practice beyond their national borders. The role of AOA in standardizing and streamlining orthopaedic services in the region must be a focus for the Association. This may lead to the development and provision of new treatments in orthopaedic surgery. In addition, health care reforms may lead to the reduction of both government and private budgets for health care. Registry of various treatments performed by AOA members
along with suitable follow-up may provide us useful information for decision making about allocation of resources with limited government and private funds. According to the AFTA, AOA may have to be involved in the settlement of medical lawsuits. Preparing our members to fully understanding international medical laws may be useful. We also look forward to seeing our journal in most international databases and earning an impact factor.

With mutual trust and understanding, friendship and collegiality among our AOA member countries, and greater support from all AOA members, we hope to see improved collaboration and closer relationships among our ASEAN orthopaedic surgeons to solve future challenges.