Bone and Joint Problems – Past, Present and Future Scenario in Nagaland

The Nagaland Orthopaedics Society (NOS) comprising of Orthopaedic Specialist Doctors of Nagaland is a scientific body formed as a state chapter of North-East Orthopaedic Surgeons’ Association (NEROSA), under the umbrella of its parent organisation, the Indian Orthopaedic Association (IOA).

The main objective and activity of NOS is in promotion and dissemination of orthopaedic knowledge among its members and fostering good doctor-patient relationship as well as creating public awareness regarding the scientific and correct way of dealing with bone and joint problems prevailing in the society.

In the past, Nagas like the ancient Indians and Greeks dealt with the problems of fractures, dislocations and other bone and joint problems with common sense and knowledge handed down by our ancestors by way of some gifted persons in the village/range who used to manipulate, massage, splint, apply some special herbs, as well as suction done with stag horns. With this primitive form of treatment, most people who suffered fracture/dislocation may have recovered from their misfortune but then many must have languished in their state of pain and life long-suffering and disability as a result of unreduced dislocations, mal-united fractures, uncorrected birth defects (some of which were treated as a source of future wealth and prosperity e.g. extra fingers/thumbs), etc.

Presently, it is somewhat baffling to the Nagaland Orthopaedic Society that with the rising number of trained orthopaedic surgeons in Nagaland there seem to be equal rise in the number of local bone setters /KOBIRAJ/quacks. Because most of the patients reporting to us, come late and after failed attempts by the kobiraj. By then the patient especially children will have undergone tremendous pain and terror due to the crude methods of treatment employed on them by those untrained popular kobiraj. Many come with unsightly deformities, unattended infection and often brought to the hospital in inhuman ways (Like you carry a butchered pig on all four limbs).

Many educated Nagas settling in places like Kohima and Dimapur also tend to believe in the kobiraj/local healer often unnecessarily undergoing undue pain and later on embarrassment

Some tech and net savvy Nagas also burden themselves with all sorts of internet jargons and suffer undue tensions. It should be noted that medical professionals have their own peer groups in social media as well net-based scientific journals which one can access only after verification of your credentials. Most information freely accessible to everyone is for layman’s consumption and awareness.

It is pertinent to also mention that in Nagaland many non-medical people give their advice to patients without knowing the basic scientific reasons but acting as if they know it. If you are a layman, sometimes your unsolicited advice to a patient during his pain can mislead and incur tremendous pain, expenditure and loss of precious time for him to get the best treatment. Those few patients who report /seek help in time get the most attention and the best treatment available hence the best results.

We orthopaedic surgeons often get patients who are treated by some renowned local healers who will bite a patient on the painful spot with bite marks which are usually infected. Such kind of grotesque treatment is being blindly believed in and propagated in our society.

Another very disturbing form of local healing is being carried out by certain religious persons who even come to the hospital wards, pray for the patient and apply plaster- of- Paris cast on the patients in a very crude and often funny ways to the obvious irritation of the treating orthopaedic doctors.

Hence the present scenario of orthopaedic care in Nagaland is at the crossroads of traditional and quackery versus evidence-based modern medical science each struggling to best the other. However, more and more people from all corners of Nagaland with bone and joint afflictions are turning towards orthopaedic surgeons for advice and treatment as we practice scientifically proven time tested evidence-based peer reviewed replicable methods of treatment.

The future of bone and joint diseases looks grim with increasing road traffic accidents, sports injuries, complex bone and joint injuries from use of machineries, birth defects of bone and joints, and an ever-increasing population of the elderly with their geriatric osteo-articular infirmities such as arthritis, osteoporotic fractures etc.

Half of the orthopedically afflicted patients now comprise of elderly people. This has led to the development of geriatric orthopaedics as a sub-speciality of orthopaedics with many surgeons having interest and skill in this field.

With so many multinational companies and governments investing in the research and development of newer implants, orthotics and robotics, the field of orthopaedic surgery is seeing a sea of change and development almost every day. Light, inert and durable materials such as titanium, cobalt and chromium are going to completely replace stainless steel implants like plates and screws and prostheses. Bio-absorbable screws are now routinely being used on key-hole surgeries in joints. Computer navigation is used in joints and spinal operations for pin-point accuracy and optimum results. Most of the major joints of the body such as the hip, knee, shoulder, ankle and wrist are being replaced routinely and damaged backbones are fixed, straightened or replaced with rods and metallic cages.

New drugs for healing of broken bones and strengthening aged bones have been developed and are extensively been used not only for the relief of pain but for repair of damaged joint surfaces in order to maintain mobility of patients as it is correctly said that “LIFE IS MOVEMENT AND MOVEMENT IS LIFE”

Earlier, a letter from the President of Indian Orthopaedics Association read as follows.

National bone and joint day is being celebrated on 4th of August every year since 2012. Every year week-long activities starting from 1st of August to 7th of August have been organised throughout the country. The theme for bone and joint day every year is assigned by the president of Indian Orthopaedic Association.

For 2019, our President Dr. Rajesh Malhotra of AIIMS Hospital, New Delhi has assigned, “Healthy Aging with Strong Bones” as the theme. We will be conducting various programs pertaining to the theme. We will also be doing free orthopaedic surgeries to deserving people from 1st of August to 7th of August 2019 which will be done by the members of Indian Orthopaedic Association in various hospitals across the country. For this purpose, a free medical camp is organised on 29th of July 2019 to identify the beneficiaries. The camp will be at the clinical establishments of our members. A suitable banner will be displayed at the premises for public awareness. At this juncture, we are happy to mention here that in 2016 Indian Orthopaedic Association created a world record by performing maximum number of free surgeries by any single country.

Healthy aging with strong bones is very relevant for our country as our life expectancy is on the rise. The average life expectancy of an Indian is 68.8 years. This means that our Geriatric population is on the rise and along with that the problems of ageing also will be on the rise. More than 75% of health expenditure in people above 70 years is for orthopaedic disorders. The significant orthopaedic disorders associated with ageing are osteoporosis and arthritis. According to WHO, osteoporosis is a silent killer which can lead to fragility of bones resulting in fractures. The concerned person may not know that she/he is suffering from osteoporosis and surprisingly the fracture may be the first presentation. Similarly, wear and tear arthritis is associated with ageing. Hence it is important to promote “Healthy Aging with Strong Bones” among our people. For this purpose, Indian Orthopaedic Association has requested its members throughout the country to conduct:

a. Free Bone Mineral Density (BMD) test
b. Health Education Programs for General Public, College and School students
c. Distribution of Pamphlets
d. Rallies highlighting healthy ageing with strong bones we request the media to spread the above message.

Thus the future of orthopaedic surgery in our land is bright and we encourage the young upcoming doctors to take up this speciality as their choice considering the vast and perennial scope of this speciality.

Dr. Rokoliebi Khate, President
Nagaland Orthopaedics Association