What does it take to open hearts & minds to diversity in orthopaedics? As a trainee I was posted to a rural town for six months. Several months ahead of this posting, I was made aware that the orthopaedic surgeons I was to work with were very anxious about having their first female trainee, fearing they would be called in often to assist with trauma and need to work much harder. Contrary to their original expectations, at the end of the rotation both these surgeons asked if they could have another female trainee. Colombian LGBTQI+ surgeon, Tatiana Quiñonez Yepes, recently spoke about her experiences at the AAOS 2021 Meeting. Contrary to preconceptions that orthopaedics would be a difficult pathway, Tatiana’s warm and vibrant personality, along with her skills and passion for music won over her colleagues and paved a way for those following in her footsteps. Operating theatre staff also spoke of how her leadership allowed them to “be themselves” at work by creating an inclusive workplace environment. This is not only a “feel good” story. Diverse and inclusive organisations attract the top talent, are more innovative and make better decisions. Read more: McKinsey.

Our implicit biases are not changed by data or knowledge alone, they are challenged and changed by personal stories and interactions. Tunku Sara Ahmad is a petite Malaysian surgeon I met when she visited a Sydney orthopaedic unit more than 20 years ago. In 2006 she became the first female President of the Malaysian Orthopaedic Association (MOA), long before any English-speaking nation considered a woman for this role. Global timeline of women in orthopaedics. Malaysia, a largely Islamic democracy has had 4 female MOA Presidents, more than any other nation in the world, including the current President, Sharifah Roohi Ahmad. Kuala Lumpur’s major teaching hospital also boasts excellent breast-feeding facilities in the operating theatre that are accessible to all surgeons and operating theatre nursing staff. Such facilities would be the envy of female surgeons in most western nations. Not long ago, an Australian trainee described breast pumping in a bathroom stall between cases whilst simultaneously writing the operation notes, taking a call from the emergency department, and trying to eat lunch between cases! 

Dalal Bubshait was the second female orthopaedic surgeon in Saudi Arabia. Questioned recently about the absence of female mentors, she was effusive about the incredible support she received from the male Professor of Orthopaedics whose encouragement “gave me wings” to pursue a career in orthopaedics. It may surprise you that Saudi Arabia has a higher percentage of women in orthopaedics than the US, the UK and Australia and almost 100 female trainees. Heat Map of the Percentage of Women in Orthopaedics by Nation.

It is with great sadness that we acknowledge the passing of Professor Freddie Fu, Chair of Orthopaedics at UPMC in a separate article in this edition. Although I never met Freddie Fu in person, he has been a constant personal source of encouragement and mentorship in the development of IODA. Never have I cried over the loss of someone I have never met before. Such was his warmth and empathy. Over the past 3 years, rarely a fortnight passed without inspiring emails from Freddie. He chaired the most diverse orthopaedic department in the US for two decades and has past fellows all over the world mourning his loss and celebrating his amazing life. We were fortunate to have Freddie Fu participate in the IODA Mentorship Webinar which is a wonderful record of his legacy. (Sign up to Orthohub is free to view this webinar). 

While the pandemic has brought enormous upheaval across the world, the increased digital engagement has resulted in some positives with the establishment of several diversity initiatives. The Asia Pacific Orthopaedic Association (APOA) has recently established a women’s advocacy group. APOA represents more than 40 nations and has ~60,000 members. The success of this initiative can be attributed to the strong advocacy of IODA member, Annette Holian (First Vice President, Australian Orthopaedic Association) with the support of  Jamal Ashraf (Second Vice President, APOA & IODA Member), and Ted Mah (President, APOA Hand & Upper Limb Section, Past President APOA).  Congratulations to Tanya Burgess who is the new chair of this initiative. We look forward to further updates.

IODA is pleased to support SpeakUpOrtho, a US initiative advocating for a more accountable reporting system for bullying & harassment in orthopaedics which includes several IODA members. This group is now extending globally & sharing stories in multiple languages across social media as a call for culture change in orthopaedics. Arianna Gianakos, a member of SpeakUpOrtho, recently spoke at the AAOS. Here is a brief video of her introduction to SpeakUpOrtho. On a similar subject, IODA Board Member, Simon Fleming, a long-term advocate & TED speaker for the prevention of bullying & harassment in health, has recently co-authored this article Sexual Assault in Surgery: a painful truth. It is a difficult conversation that we need to have if we are to improve healthcare. 
An exciting event for many women in orthopaedics was the First Global Symposium of Women in Orthopaedics at the AAOS. It was an honour to co-chair this world-first symposium with Camila De Mattos (Brazilian Orthopaedic Women’s Society, President) & Dawn La Porte (Ruth Jackson Orthopaedic Society, Past President). Thank you to the many IODA members who participated. It was a huge collaboration bringing together women in in orthopaedics from many nations.

 

IODA has recently co-convened a Symposium at the British Orthopaedic Association (BOA). This was a collaboration with the BOA and Women in Orthopaedics Worldwide (WOW). The topic was “Career Breaks & How to Bounce Back”. The session was chaired by Kristy Weber, IODA President (Immediate Past President AAOS) and Camila De Mattos (Co-Chair, Women in Orthopaedics Worldwide & IODA Member). Incoming BOA Vice President-Elect Deborah Eastwood gave an excellent keynote address to open the webinar. Don’t miss it –thought provoking and insightful! 

 

It is very encouraging to see many national orthopaedic associations developing diversity strategies. The AAOS Diversity Advisory Board has been active for several years. The Australia Orthopaedic Association launched the AOA Diversity Strategy in 2018,  the British Orthopaedic Association launched the BOA Diversity Strategy in 2020 and the New Zealand Orthopaedic Association is commencing work on its own Diversity Strategy. As a contributor to the AOA Diversity Strategy, I have been impressed with the cultural change that has occurred in the past 3 years due to the excellent leadership of the AOA Board. Yes, there are hurdles, detractors and still a long way to go but great progress is being made around the globe. We are stronger together!