By Dr Tim Nunn, Consultant Orthopaedic Surgeon, CURE Ethiopia Children's Hospital
 
'Some recent articles suggest that 0.4% of research papers come from low and middle income countries. With so much focus on first world orthopaedics in modern journals the scope and possibilities for research in resource poor environments is massive. Conditions present there that are not seen in such frequency or with such delayed presentation the West. Treatment options are limited and existing evidence is often at the level of ‘expert opinion’.
 
My research focus is ‘delayed presenting clubfoot’ - the most common diagnosis in our Children’s Orthopedic Unit. Choosing a common condition to do research on was important to get substantial numbers quickly. We set out to devise a protocol for treatment of this condition up to adulthood. To do this we required funding, a research nurse, links with an interested academic unit in the UK, Institutional Review Board and National Ethics approval. Much thought was given to our research questions for these studies. Our unit is small in consultant number and consensus regarding the way forward was obtained prior to embarking. Administrative support was vital too in getting the research project off the ground.
 
For conditions where treatments and follow-up is required long-term placement in country is needed. For this reason, multicentre studies are difficult to coordinate. In resource poor settings electronic communication difficulties exist and added challenges exist in managing a project remotely.
 
My experience is that clinical research work in Ethiopia is interesting, rewarding and fruitful. Picking the right project is key to success.'
 
Read the peer-reviewed article:
Nunn TR, Etsub M, Tilahun T, et al. Development and validation of a delayed presenting clubfoot score to predict the response to Ponseti casting for children aged 2-10. Strategies Trauma Limb Reconstr. 2018;13(3):171–177. doi:10.1007/s11751-018-0324-z

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