Orthopaedics Resident, Dr. David Stockton, is a BISC Project Travel Award recipient who has been involved with Engineers in Scrubs. Read on to learn more about his career in global surgical care and research projects in orthopaedic surgery.
This story was originally shared by the UBC Branch for International Surgical Care – click HERE to read the original post.
Tell us a bit about yourself and your interest in global surgical care:
I grew up here in Vancouver and went over to Victoria for my undergrad, then to Toronto for medical school. I played a lot of sports growing up, and I did my undergraduate degree in Kinesiology. My interest in biomechanics and the musculoskeletal system naturally led me towards pursuing residency and orthopaedic surgery. In my first year of residency, I worked with Dr. Peter O’Brien, and I learned about his involvement in the Uganda Sustainable Trauma Orthopaedics Program (USTOP). I talked to some senior residents that had gone on USTOP trips to Uganda before and it seemed like really interesting work they were doing. In my second year, I had a chance to go on one of those trips, and it was really educational, and I found it really worthwhile.
I also met some engineers that were also on the trip, and they were testing out low cost, sustainable orthopaedic surgery devices for under-resourced healthcare environments. It was that exposure that really triggered my interest in biomedical engineering. Since I was also at the time looking for an area to pursue a graduate degree in, that put biomedical engineering front and centre on my radar.
You applied for and received a BISC Research Award in 2016. Can you tell us about that project and how it went? Is it still ongoing?
That’s a project that I helped get off the ground when I first travelled to Uganda with the USTOP team. At the time, Dr. Peter O’Brien and Dr. Piotr Blachut were interested in looking into the feasibility of intramedullary (IM) nailing, which is a treatment for open fractures of the tibia. IM nailing is the gold standard operation for these fractures in high income countries like Canada. But for low and middle income countries like Uganda, the standard of care is treatment with external fixation devices. What I helped do was to create a randomized clinical trial with the goal to compare the outcomes of these two treatment methods.
Over the years, I’ve learned a lot about research trying to coordinate a randomized trial in a sub-Saharan African country and trying to do this remotely from the West Coast of Canada. It’s been great working with the principal investigator in Uganda, Dr. Daniel K. Kisitu. He’s really invested in the project, and he’s really been working tirelessly to recruit patients and randomize them and follow them up. In orthopaedic research, I think one of our big challenge is that 90% of the severe fractures in the world occur in low and middle income countries. But only 7% of orthopaedic research is specific to these under resourced areas.
With this project, we’re attempting to help facilitate the generation of some evidence that might be directly applicable to patients and surgeons working in these under resourced areas like Uganda. The project that I’m working on has been going on for a number of years. It is supposed to be wrapping up this year, and our aim is to publish the findings in 2021.
You also worked on a project developing a traction table for a low resource setting through Engineers in Scrubs. Can you tell us about that?
That was a separate project, and I worked on that with some other engineering students. We did that during the Master’s degree program that I did in biomedical engineering. Essentially, the problem that we were looking at involved the issue of the high incidence of femur fractures in under-resourced countries and their treatment.
In countries like Uganda, they don’t have access to expensive traction tables that we would normally use in a country like Canada in surgery to help reduce and fix the fracture. What we tried to do was to develop a low cost device that could work with any generic operating table and provide traction. It would help pull on the leg and help realign it so that a surgeon would be able to better fix the fracture.
We developed a prototype device during the Master’s program and we were able to test it on another trip to Uganda in 2018. The surgeons there told us that they really like the device. They have been able to continue using it, and it was really gratifying to help see an immediate impact on patient care by helping to develop this prototype device. One of the unfortunate realities is that it’s a device that’s not massively scalable.
For example, for a large hospital like Mulago Hospital in the capital city of Kampala, a hospital like that only needs one device. For that reason, I think we’ve had some trouble getting buy-in and investment from device companies. But we are still trying to see if we can get some traction with a company that is specifically interested in healthcare in low and middle income countries.
If you were to fast forward 5 years or 10 years to your ideal practice, what would it look like?
My goal is to pursue a job as an academic orthopaedic trauma surgeon. After I finished residency next year, I’ll be traveling to a hospital called Shock Trauma in Baltimore, Maryland where I will train further as an orthopaedic traumatologist. My passion is helping people that have suffered high energy fractures helping to fix them and get back to full function or close to full function as possible after their accident.
I’m also interested in clinical research, and secondarily biomedical and basic biomechanic research. In a future job in five to ten years’ time, I hope to continue these research interests. I hope to help to continue to advance our ability as surgeons to help people recover from their musculoskeletal injuries. It would be ideal if I could continue being involved in projects in Canada and North America, but also in other regions of the world, like Uganda, because orthopaedic trauma is a global problem. I think each country has different abilities and strengths and weaknesses in their ability to deliver care. Each country has specific challenges and strengths in how we can help patients get better, get back to work, get back to their families and back to activities that that we like to do.
I think something I’d really like to ideally do in my future career is to help to generate research that addresses the breadth of orthopaedic trauma problems and issues worldwide, that helps patients not just in Vancouver but also in rural areas of Uganda.
If you were speaking to other trainees or those interested in global surgical care, what advice would you give them?
I think my main advice would be just to get involved. I’ve found it massively rewarding. I’ve met some great people along the way and had experiences that that I’ll never forget. I think it’s helped me develop a broader perspective. I think hopefully that can only help to improve my ability to help patients in the future. One thing that I’ve learned is that there’s really very little difference between a Canadian orthopaedic resident and a Ugandan orthopaedic resident in terms of our passion for the specialty, our work ethic, and desire to help patients get better.
One thing I would say to trainees, I think that comes from being fortunate in having been involved with USTOP, is the importance of trying to be involved with sustainable global surgical projects. The one thing that the USTOP program does which I think is greatly beneficial is it focuses on education first and foremost and in empowering and building local solutions that are sustainable. I think focusing on projects that empower local surgeons are probably the ones that can have the most impact. It’s really important that local surgeons have a sense of ownership and feel empowered by any kind of involvement that that you have with them because we’re really very fortunate in high income countries to have some of the health care resources that we do.
I don’t think we ever can fully appreciate what it’s like, for example, to try to administer care and treat orthopaedic trauma patients in a place that we don’t live in. We can try to be helpful with some of the knowledge and techniques, processes and strategies that work for us. It’s been helpful for me to see that. We’re really just offering help to these other surgeons and offering a helping hand to help them develop their own methods and strategies for treating patients and also for training future surgeons in in their own country.
Trauma programs that are homegrown and are really invested most significantly in by surgeons in their home country probably have the best chance of success rather than programs that are really only there for one or two weeks per year. That’s where this recommendation, I guess I would say comes from. I think I’ve been very lucky to see that type of approach in action with the USTOP program. I’ll hopefully, take that type of approach forward with whatever global surgical project I get involved with in the future.
Is there anything else you would like to share?
I’d just like to thank the Branch for International Surgical Care for their support over the years. I don’t think our research project over there would be as successful as it has been without the Branch’s help. I really hope to continue to be involved in the future.