International Federation of Societies for Surgery of the Hand

‘One of the most prominent brachial plexus surgeons, Algimanas Narakas from Switzerland, uttered the following words after a remarkable career. “If I were not desperate to do better, how would I know what hope is?” He constantly sought ways to improve on his results, even though during his time these results were unrivalled. He challenged himself to better his surgical technique, his patient evaluation, his record keeping, and analyzing of his results. This restless dedication influenced and encouraged a whole generation of hand surgeons to be perpetually uneasy with their efforts.

Such an inquisitive mind and a learning spirit is nourished by us coming together, by cross pollination, by teasing the enquiring mind with challenging thoughts; hence the importance of meetings like these congresses.

In 1980, at the 1st IFSSH Congress in Rotterdam, we as youngsters were in awe, meeting with, and learning from, the giants and pioneers of hand surgery. They were the role models who inspired us to also achieve the highest level of knowledge, skill and dedication in hand surgery. Our passion was also to become one of this “elite group of masters”.

However, thirty years later, and having attended all eleven IFSSH Congresses, I have the perception that the impetus of Hand Surgery has shifted away from the so-called “Hand Surgery Specialists”. This shift seeks to empower health professionals in general in the art and science of maintaining the integrity of the hand.

This is what I would call the ‘changing world of hand surgery’. Our aim as the Hand Surgery Family is not to train surgeons to be become “Hand Surgeons” in the first place, but to teach health professionals how to practice basic and good hand surgery.

Although centres of excellence are extremely important to develop and practice better hand surgery, we must not forget that the indigent masses have as much need of medical, surgical and allied health services, as those who can afford the best and most modern techniques available. The dilemma becomes more acute if one realizes that it is the poor masses who rely more on their hands than any other group. Manual labour in its various forms is all they can offer and when injured and diseased they have no income or back-up insurance. Isn’t it ironic that it is mainly these manual workers who are the producers of goods, the manufacturers of merchandise, and the laborers who build structures. These are the people who produce wealth, for the investor and the country. These are the people who get physically hurt and then lose their jobs, who are unfortunately simply replaced and who are often, unfairly, seen as disposable.

Interestingly, the word “surgeon” is derived from the Greek word “cheirourgia”. “Cheir” means hand and “Ergon” means work; therefore hand worker or manual laborer!

Of all time lost due to injuries at the workplace, 70% is attributable to hand and upper limb injuries. It is thus self evident that this fact has serious economic implications for the workman and his country.

The challenge therefore is to bring good quality hand management to these manual workers in an affordable, and accessible way. Hand Surgery should therefore in reality become part of Primary Health Care.

In my travels to various parts of our global village, I have witnessed remarkable ingenuity in meeting local challenges. At one large hospital hand, replantations and micro reattachments were done on a routine basis, and with world standard success rates, using loupes attached to an infusion stand, because of a lack of funds for a microscope. In another country, splinting material made from malleable bark, which is available in abundance from local trees, is used instead of unaffordable, thermo-plastic material. These are just two examples of the resourcefulness that does not hinder our colleagues in disadvantaged areas to practice a relatively high standard of hand surgery and therapy. I have worked in hospitals where the concepts of “disposable” and “once only” materials are non-existent. So-called disposable gloves, swabs and implants are cleaned, sterilized and used again-and-again. The point is that one does not always need the latest technology to produce good quality hand surgery. Or conversely, the newest equipment does not necessary guarantee acceptable surgical practice.

A number of prominent publications have recently shown that donations and hand-outs did not significantly improve the lot and conditions of disadvantaged communities. Some three hundred billion US$ in aid to Africa over the last fifty years has unfortunately not shown much improvement in the standard of living. Redundant high tech equipment “pollute” many countries in Africa. These generous gifts have seldom helped to better the quality of healthcare. In fact, the way aid was given often suppressed initiative and innovation. Similarly, intellectual and academic aid can stifle self development, research and progress. What has made a difference however, is the willingness of locals to improve their own circumstances. Appropriate training and education, workshops and practical seminars, are the most effective tools for community upliftment. The quest to know more is the key to progress.

One of the responsibilities of the President of the IFSSH is to organize the activities of its thirty committees. It has been a dilemma of Past-Presidents to obtain reports from all the committees. In an effort to improve communication amongst all our members and our co-workers, and to disseminate the Committee Reports as state of the art documents, I have obtained permission from the IFSSH ExCo, and which was ratified by the Delegates Council, to launch an electronic magazine. This electronic magazine, or ezine, will be sent quarterly to each member free of charge. This “IFSSH ezine”, as it will be called, will not be, or compete with, any Hand Surgery Journal, but wants to draw the hand surgery family together by enhancing communication via the internet. The IFSSH e-zine contents will feature the following:

A home page with links to the IFSSH web page, contact addresses, event announcements and links to associated Federations.
A section for member news regarding their movements, activities and circumstances, and maybe a photo gallery as well.
Committee reports on specific topics which can be used as the official viewpoint of the IFSSH.
“Letters to the Editor” section.
A question-and-answer chapter for those who have interesting or difficult problems and need advice from members who have more experience.
A list of published articles in peer reviewed journals, with links to these articles.
An interview section with authors and researchers.
Case reports and technique tips section.
An anecdote and tales chapter which could include historical narratives and adventures which are hand related.
An index which would allow one to source previously published topics
And finally product news and announcements.

The ezine will be published by the IFSSH and funded by trade advertisements. It will be edited by the IFSSH President and the President-Elect will be in assistance. The technical aspect will be done by a British company which specializes in electronic page magazines. The aim of the IFSSH ezine is to be an interactive communication medium which will be used by all members and should be available to all members of the IFSSH and related Federations, including the International Federation of Societies for Hand Therapy.

This brings me back to the beginning of my address. The inequality in the management and technical know-how of hand conditions can be harmonized by disseminating information through a medium that can reach all members, even those in the most remote areas. The ezine can become a hub for communication where we can be in continuous interaction with each other.

It should become a tool to spread and share information, as one would expect communication to flow in a family or a well run company. If you want to receive the ezine, please send your email address to ezine@ifssh.info so that we can add your details to the address list. I would also like to urge you to contribute with stories or advice, comment by writing a letter, advertise hand related products or support this exciting venture in any other way you might feel appropriate. Simply send your contribution to this dedicated email address.

In conclusion, I encourage you never to take anything for granted and to be diligent in your efforts to improve your own ability to help your patients.

And secondly, we belong to a family of volunteers. This makes us all equally important. We should encourage each other to interact freely, to communicate and to offer advice to others, thereby strengthening our hand family ties. We should all be leaders and free-thinkers. If this happens, I know that our vision of a vibrant group of mutually, encouraging and supporting members will be realized.’