The gastro-orthopaedic tour of Kuala Lumpur continues....

We have been very fortunate to have been given this opportunity. We have met many great people and have learned how different things may be, but moreso, how similar things are halfway around the world. The Malaysians deal with many of the same issues in healthcare and delivery of orthopaedic surgery as we do in the United States. While many of the injuries and pathology they see is similar to ours, I don’t think I have ever seen 4 people on a moped on a highway with a 5 year old child in front and 2 other school age children behind their father.

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We started our day by being picked up by one of the house officers (resident) and being brought to the University Malaya Medical Centre (UMMC) for Friday educational day. Justin and I have now shed our ties as we have learned that the 80+ degree weather with 80% humidity is unsuitable for the formalities of the U.S. Medical students here even have short-sleeved white coats, as many of the wards and other areas of the hospital are not air-conditioned.

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Justin started us off with an excellent lecture on the approach & management of pediatric ACL injuries. The house officers listened in amazement as no one had previously seen an ACL injury in any child under the age of 16 years. Jenn followed this up with her perspective on mentoring in orthopaedic surgery (spoiler alert…this wasn’t the only mentoring we heard about today). I discussed pediatric femur fractures with treatment options and management. While Malaysia lacks lateral entry nails specific to pediatric patients, I was enlightened by their LLRS workshop where Ilizarov frames are pre-made by the residents prior to surgery to be sterilized and modifications were made to spica casting tables to facility cast care.

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After completion of our morning educational session, we were taken on a tour of the hospital including the clinic, the biomechanics lab, and the LLRS lab accompanied by Dr. Roshan Gunalan. We then met up with Professor Saw Aik at lunch. Dr. Wilson Wang was visiting from Singapore to administer the oral examination to the orthopaedic trainees, which is comprised of actual patients with real pathology, not just standardized patients.

We returned to the hospital to discuss Professor Saw’s Silent Mentor program (www.silentmentor.org). Designed at Tzu-Chi University in Taiwan (and in existence since 2012 at UMMC) this program allows physicians, residents, and students to learn surgical approaches and anatomy on fresh frozen cadavers through directed donation by patients. Medical students interview the “Mentors” during their hospice. Upon initiation of the educational program, the “Mentors” teach their trainees through their ultimate sacrifice. 4 workshops are held throughout the year. Over 4 different 1 week sessions, 25 Mentors provided education of almost 700 medical professional! Different from other programs, it is encouraged for the learners to know the identity of the mentor, see the patient being interviewed, and respect the patient as if they were a live patient. After completion of each week, a ceremony is held to honor the Mentors and their families and accompany them to their final resting place. What a humbling experience.

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We regrouped in the evening when we met up with the pediatric orthopaedic faculty from all 3 institutions in KL (Universiti Kebangsaan Malaysia-UKM, Maternal & Children’s Hospital Kuala Lumpur & University Malaya Medical Center-UMMC) for a wonderful traditional Malaysian dinner. We have learned that the Malaysians are extremely proud of their multi-cultural country and even more proud of their cuisine.

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We have been extremely impressed by the quality of care provided, the training programs at each of the institutions, and the friendships that we have gained during our time in KL. We are sad to leave behind an amazing city, but tomorrow we will explore the area surrounding Kuala Lumpur, then head to Seoul, South Korea. We have immensely enjoyed our stay, particularly our local host, Dr. Lynn Azura. We are not leaving a city behind, but rather gaining friendships as we leave.
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