Over the past decade and a half, the problem of musculoskeletal trauma has been identified as impacting more individuals in developing countries than HIV, drug-resistant tuberculosis, and other infectious diseases that are commonly recognized as public health crises. The need for access to surgical treatment for patients who sustain traumatic injuries has recently garnered more attention. Yet funding from nongovernmental organizations and other national/international foundations has not reached the levels necessary to appropriately address this important public health issue.
In the May 15, 2019 issue of The Journal, Agarwal-Harding et al. document the issue of patients experiencing delayed access to musculoskeletal trauma care in the sub-Saharan country of Malawi. Thanks to the development of a trauma-care registry serving both rural and urban health centers in Malawi, the authors were able to clarify the factors associated with delayed presentation for care.
Not surprisingly, those factors included distance from treatment centers and sustaining an injury during a weekend. These issues are likely widespread throughout Africa and in many other developing countries, where EMS services are sparse at best and treatment facilities are generally under-resourced. Although an increasing number of people in developing countries are being injured in road/vehicle-related accidents, many of the patients evaluated in this study did not experience high-energy trauma, but were instead injured from falls and during sporting activities. In short, they experienced the types of injuries that are likely to occur to everyday people doing everyday activities anywhere in the world.
The issue of delayed access to care is addressable if we continue to acknowledge the incredible public health burden that musculoskeletal trauma places on individuals and society within the developing world. These injuries not only affect patient quality of life, but they also have large impacts on families and communities due to a loss of income or disability-imposed restrictions on community engagement. Addressing this issue is of great interest to the readers of JBJS, who are volunteering to serve the orthopaedic needs of the developing world in ever-increasing numbers.
Marc Swiontkowski, MD