“A thing that is a necessity here is considered a luxury for much of the world,” says Ashish Shah, MD, an orthopedic surgeon and assistant professor in the Department of Surgery at UAB. He’s referring to the lack of orthopedic expertise in foot and ankle surgery.
About 2,000 foot and ankle surgeons practice in the U.S. “But if you look at the Middle East, Southeast Asia and India, there are just a handful of foot and ankle surgeons in each region,” Shah says.
Shah’s global awareness stems from growing up in India in a city of six million. “I did medical school there, so I’m very aware of the necessity of the local market,” he says.
By the time he left India in 2005, there was not a single foot and ankle surgeon in the entire country of 1.2 billion people. “There are just a handful of surgeons there now,” he says.
In 2010, Shah decided to change those numbers. He had just attended an international orthopedic conference in India and heard orthopedists from various countries talk about the lack of expertise available to them.
The next year, he traveled to India to teach orthopedic surgeons about the intricacies of ankle and foot diagnoses, treatments and surgeries. Over the next four years, Shah took 11 teaching trips to India, Singapore and Oman. This December, he’s heading to the Philippines for the first time.
The first year, his trips were on his own dime. He focused on doing grand rounds at various hospitals, reaching 50 to 75 orthopedic surgeons. Then in 2011, he collaborated with the Parekh Family Foundation to hold more in-depth, multi-day trainings twice a year in India, utilizing large hotel conference rooms and closed-circuit technology.
Those training sessions last 10 to 12 hours a day for two days. “It’s all foot and ankle. There are live lectures, a cadaver workshop, video presentations, and live surgeries,” Shah says. The doctors in the conference room watch Shah on a big screen perform an ankle or foot procedure in a surgical suite somewhere in the city. “We can discuss things and answer questions during the surgery,” he says.
The focus is on teaching about flat foot, arthritic conditions, and sports injuries. “These conditions are considered more neglected in those countries, and surgeons are not aware of how to treat them,” Shah says.
There are so many stories of need in these countries, Shah says, and not just when he walks into a hospital. On his last trip to India, while Shah was out to dinner, the waiter told him he had fallen 20 feet during an earthquake. He had seen 20 orthopedic surgeons who had not been able to diagnose and treat him. “I diagnosed him and gave him a prescription for shoe inserts,” Shah says. “I still get emails from him about how it changed his whole life.
“Orthopedics is the only area where surgeons can make such a difference without performing surgery,” Shah says. "We can use bracing or the support of a shoe, and make a big difference to someone.”
Besides the two foundation courses, Shah travels three or four more times a year completely on his own, working with an orthopedic association in that country to hold shorter, more simplistic seminars that include lectures, live exams, and video presentations. “When I started this, I thought about how I could go overseas and treat 100 patients, but then only 100 patients would benefit,” he says. “But if I taught 100 surgeons, then 100,000 patients would get the benefit.”
His global outreach has led to orthopedic surgeons from those regions now traveling to Birmingham to learn under Shah at UAB. “In the last four years, I have had seven visitors from Egypt, India, Singapore and the Middle East,” Shah says.
Those visits sparked the beginning of the international foot and ankle fellowship this fall at UAB specifically for orthopedic surgeons from overseas. “They can come for a few weeks to a few months for observing and research,” he says, adding that he’s developing a nonprofit to help fund the surgeons’ room and board while they learn. “I’ve already got two fellows from Oman coming next year to spend three to six months with me.”
Next year, Shah will take his teaching program to Jamaica. Right now to spread the knowledge even further, he’s opened his own YouTube channel. “Basically, it’s everything I perform at UAB, plus diseases and pathology, and the access is free,” he says.
Shah plans to use the web for more formalized training starting in November. “I’m working on setting up online education—webinars—to reach different countries. It will be live teaching online.”
On every trip, the need is always obvious, but so are the rewards. “We walk into their hospitals and see so many neglected club feet, flat feet, all these arthritic conditions, and they’re so happy to see us. You see it in their eyes,” Shah says. “It makes you feel real satisfaction that you achieved something in your life.”