issue 166 april 2016
TRANSCRIPT
WORLD ORTHOPAEDIC CONCERN UK NEWSLETTER
www.wocuk.org
WORLD ORTHOPAEDIC CONCERN UK NEWSLETTER
World Orthopaedic Concern UK (WOC-UK) is a
charitable organisation dedicated to improving
the standard of orthopaedic, trauma and
reconstructive surgery in developing countries
We aim:
- To provide orthopaedic education in the developing world
and about the developing world.
- To give help and advice to those setting up orthopaedic
training and service programmes in the developing world.
- To act as a pressure group in the UK to the NHS and to our
colleagues, regarding orthopaedics in the developing world.
- To offer practical help and support to those practicing
orthopaedics and training in orthopaedics in the developing
world
This newsletter aims to update you about WOC-UK
projects and highlight some of the work that is being
undertaken by our members.
There are many opportunities to become involved in
WOC-UK activities. We are looking for volunteers to
support all of our overseas projects. Additionally, if you
would like to be involved in other ways, such as
creating this newsletter, we would love to hear from
you.
Emails:
WOC-UK 3rd ANNUAL CONFERENCE 2016 MOOR HALL HOTEL, SUTTON COLDFIELD
Friday 3rd June: Pre-conference dinner Saturday 4th June: Main Conference
Registration fees (includes lunch): WOC-UK member: £45
Non-member: £55
Please contact [email protected] Visit our website: www.wocuk.org
Provisonal programme:
10.15 – 10.40 : Registration and coffee
10.40 – 10.45 : Welcome & housekeeping
10.45 – 12.00 : Country reports: Malawi
Cambodia
Ghana
Ethiopia
Mbeya, Tanzania
Palawan
Bangladesh
12.00 – 12.30 : Keynote speech: James Fernandes: “The Unit of Hope”
12.30 – 13.00: WOC (UK) AGM
13.00 – 14.00: Lunch
14.00 – 14.20: Tim Beacon: The challenges of orthopaedics in the developing
world: the MedAid International perspective
14.20 – 14.40: Jon Warner: The experience of a company representative in
Nepal
14.40 – 15.00: Faith Muchemwa: Plastic & Reconstructive Surgery training in
Zimbabwe: a trailblazer’s experience
15.00 – 15.30: Coffee
15.30 – 16.00: Trainee Fellowships : James Berwin
Ashish Kalraiya
Ross Coomber
16.00: Thank you and closing remarks
WOC-UK annual conference registration form
Saturday 4th June 2016, MOOR HALL HOTEL, SUTTON COLDFIELD
Name:
Grade: Trainee [ ] Consultant [ ] Retired [ ] Other [ ]
WOC-UK member: Yes [ ] No [ ]
Address:
Contact telephone:
Email address:
Dietary requirements:
Conference prices:
WOC-UK member £45 [ ] Non-member £55 [ ]
Become a WOC-UK member by completing a separate membership form (found at
www.wocuk.org)
I will also be attending the pre-conference evening meal on Friday 3RD June 2016 [ ]
(a payment will be required separately to this registration nearer the time, and a menu will be
sent prior to the date)
Payment options:
Cheques payable to ‘World Orthopaedic Concern UK’ can be sent with completed registration
forms to: WOC-UK conference, 146 Knighton Lane, Leicester LE2 8BF
Alternatively, send completed forms electronically to [email protected] and make an
on-line payment to:
WOC Conference Account (or abbreviated to: WOC conf.ac.)
Account No. 82419468, Sort Code 30-99-90
Lloyds Bank plc, Branch Address: PO Box 1000, Andover, BX1 1LT
IMPORTANT – include payment reference: WOC conf.
[ ] I enclose a cheque for £.....
Or
[ ] I have made a bank transfer for £....
ETHIOPIA
Steve Mannion has visited Ethiopia twice in recent months and writes:
‘From a strategic point of view, I see WOC(UK)’s main link being with the Ethiopian
Orthopaedic Association and with the Black Lion Hospital. The Black Lion is the premier
orthopaedic training establishment in Ethiopia, has a huge numbers of trainees but is
desperately short of trainers. It would be great to see a virtually seamless presence of
either an Australian or UK orthopaedic visitor to assist in service delivery and the training of
residents. Whilst expert sub-specialist visitors are welcome, the main need is for generic
trauma skills & general orthopaedic teaching.
The orthopaedic needs of Ethiopia are not confined to the Black Lion and training
institutions are now being established in other regional centres. In my view the best method
of supporting the development of orthopaedic training in such centres would be
“Institutional Links” such as that already pioneered by Laurence Wicks with the Leicester -
Gondar link and that which Tony is proposing in Hawassa. Whilst not being directly
controlled by WOC I would be grateful if these were to continue to be at least affiliated to
the WOC (UK) banner as representing elements of what is becoming a considerable
contribution from the UK to the development of orthopaedic services in the country.’
Links with the Black Lion Hospital’s orthopaedic unit in
Addis Ababa have been strengthened tremendously over
recent years through the presence in Ethiopia’s capital of
WOC-UK member Rick Gardner.
Rick works as a consultant for the CURE hospital in Addis
but has dedicated time and effort into building the UK’s
support of orthopaedic training at the Black Lion.
WOC-UK aims to support a minimum of 6 visits per year
from the UK. Ideally each trip would consist of two visitors
for a minimum of two weeks at a time. Financial support
for this has been generously provided by the Bone and
Joint Journal council, along with funds allocated from
WOC-UK’s own accounts.
In addition, projects are being established to help develop
orthopaedic services and training in other parts of the
country.
Look out for reports on recent WOC-UK member visitis to
Ethiopia in future copies of the BJJ news.
We are looking for more volunteers to participate in this
link project over the coming year. Anyone who is
interested in becoming involved should get in contact
through any of the emails provided at the start of this
newsletter
ETHIOPIA - Geoffrey Walker visited Addis Ababa in
November 2015, and reflects on how things have changed
since he first arrived in the country in 1990
When I first arrived in Ethiopia the population was 45
million. It is now about 100 million. In the same period
Addis has grown from 2.1 million to about 3.4 million.
The growth of the economy of Ethiopia is thought locally
to be about 12% per annum, although it is probably
nearer to 6% pa.
There are a vast number of new buildings in Addis and
on my recent arrival I had difficulty in recognising the
Airport Road.
The ‘middle class’ continues to expand. There are now
two private orthopaedic hospitals each with about 50
beds.
The Black Lion University Hospital’s main buildings are undergoing restoration and
development, mainly in Radiology, which has some new and sophisticated apparatus.
The Main Operating Theatres are still not functioning which means that some general and
other surgery is undertaken in the new theatres of the Orthopaedics/Physiotherapy block,
the building of which was generously supported by Australian Doctors for Africa – ADFA –
under he direction of Graham Forward).
A major enlargement of the current grossly inadequate Accident and Emergency
Department has recently started.
The Orthopaedic Department and its 21 bed children’s ward have been supplied with
relatively sophisticated beds all with electric controls! These have replaced the ‘special’
orthopaedic beds’ which were obtained some years ago.
However, there are still problems with the water and electricity supply and this seems to be
more severe in the orthopaedic/physio building than in the main part of the Hospital.
The Orthopaedic Training Project currently has a total of 77 trainees –
while there are only a total of 72 orthopaedic beds in the BLH! However
our trainees also spend time and gain invaluable experience in four
other hospitals: Cure Children’s Hospital, Soddo Christian Hospital, St
Paul’s and a new department of Plastics and Accident and Emergency
at Alert.
General surgical trainees also spend time in our department, usually in
three separate visits of one, two and three months. There are usually
about 10-15 of these trainees in our department at any one time. Sadly
our Orthopaedic Trainees do not spend any time in general surgery.
ETHIOPIA - Geoffrey Walker visited Addis Ababa in
November 2015, and reflects on how things have changed
since he first arrived in the country in 1990
Dr Geletaw Tessema who is a recent graduate from our training project is the current
Department Head. He is a very impressive young orthopaedic surgeon who is striving hard
to improve the workings of the training project and is worthy of all the help that he can
receive – he will welcome all appropriate assistance that is offered.
At present Dr Geletaw has three specific requests:
Fellowships (presumably out of Ethiopia) for members of the training staff.
GW recalls the success of sending an Assistant Professor to the training project in Dhaka,
Bangladesh .
I am sad to report that since the inception of the Orthopaedic Training Project virtually no
orthopaedic instruments or other materials (apart from plaster) have been supplied by the
‘Hospital/Government’. All have been donated from many different sources. Private and
Mission hospitals make their own arrangements but there can be problems with ‘Customs’.
Dr Geletaw told me that currently individual departments/units in the Faculty/Hospital are
no longer allowed themselves to raise funds or to look after money. All requests for
materials, or indeed for ‘anything’ have to be made to the Faculty. Thus the orthopaedic
department has no means of purchasing small but necessary items, paying for small
services or indeed for anything or any activity.
Visits by Orthopaedic Surgeons from
other Countries: I believe that these need
to be by those of us with experience in the
use of simple/conservative management,
i.e. Plaster and traction and who will make
visits of at least two to four weeks.
Whenever possible visitors should bring
implants and other orthopaedic materials
for the department. Dr Geletaw is able to
overcome any ‘Custom’s Problems’.
GW believes that when possible potential
donors should first check with Dr Geletaw
the suitability of any materials that they
may be able to bring.
What and how to teach? While sophisticated orthopaedic surgery is now being practised at
the BLH, in private hospitals and in a few but important hospitals outside Addis the vast
majority of the 100 million Ethiopians receive care for orthopaedic problems from General
Surgeons, General Practitioners and Traditional Healers. It is therefore important that
visiting teachers keep this in mind and stress the importance of conservative management,
i.e. plaster and traction as well as discussing more sophisticated techniques’. Unfortunately
injured limbs are often treated (outside major hospitals) with circumferential plasters or
traditional splints both of which may result in gangrene or Volkman’s contractures. It is best
to emphasise the use of padded plaster gutters, i.e. a plaster back splint with side pieces.
Teaching needs to be ‘inter-active’ as formal lectures do not seem to be readily absorbed
To enable the resident surgeons to take on these cases, they are
taught a range of corrective procedures for Club Foot that require basic
equipment, a basic knowledge of anatomy and surgical skills. They
include open Achilles and Posterior Tibial tendon releases, Tibialis
Anterior tendon transfers, and Triple Arthrodesis without screw fixation.
The focus now is to objectively measure outcomes via a combination of
validated Quality of Life questionnaires and a basic biomechanical
study pre- and post-operatively.
Many thanks to the surgical team at CMR for hosting Steve and I, to
the Christian Blind Mission (CBM) for organising the trip, and to Steve
for bringing me along.
The week before Christmas 2015, I joined Steve Mannion
on one of his trips to the Centre for Medical Rehabilitation
(CMR) in Vientiane, Laos, which is regarded nationally as a
Centre of Excellence. Beyond the throng of our welcome
party, I caught a glimpse of the patients waiting to be seen
and I suddenly felt a million miles away from the familiarity
of an NHS Ponseti Clinic.
The clinic on our first day was attended by
surgeons from CMR, and also the 5 satellite
Provincial Rehabilitation Centres (PRCs) around
Laos, and also physiotherapists and P&O
technicians. Laos has established a successful
Ponseti programme but there is a need for
capacity building, education and mentoring in the
surgical sector. To meet this need Steve typically
visits the country 3 times per year, operating,
mentoring and teaching at CMR and PRCs.
The CMR’s operating theatre is basic and small but they have had a modern anaesthetic
machine recently donated. The orthopaedic ‘kit’ consists of the bare essentials: scalpel,
forceps, mallet, one osteotome and a bone nibbler. Yet despite the austere surgical
environment, Steve’s mantra for Club Foot surgery in the developing world is to do one
operation that provides definitive correction. “After an operation like this, they are unlikely
to ever come back for follow up, so it means doing the right surgery and doing it well.”
We saw a spectrum of cases including several
neglected club feet, arthrogryposis, and patients
with chronic polio. After only a few hours, we
had amassed enough patients for three full-day
operating lists.
Not such a Laos-y Christmas By James Berwin (MRCS), London Core Surgical Trainee.
WOC(UK) assists in COSECSA examinations in Malawi by Steve Mannion
The College of Surgeons of East, Central and Southern Africa
(COSECSA, www.cosecsa.org) was founded in 2000 with a remit to promote
postgraduate training and accreditation in surgery in sub-Saharan Africa. 10 countries are
currently members; Burundi, Ethiopia, Kenya, Malawi, Mozambique, Rwanda, Tanzania,
Uganda, Zambia and Zimbabwe. COSECSA now has 87 accredited training hospitals and
169 certified surgical trainers in the region, with 126 specialist surgeons having graduated
via COSECSA training programmes since 2004. Exams are held at two levels,
the Membership of the College, an examination of “surgery in general” and a
specialist Fellowshipexamination, typically taken after a further 3 years specialist training.
WOC(UK) Chairman, Steve Mannion and Hon Secretary, Deepa Bose were joined by
BOA and WOC veteran David Jones as examiners at both the membership and
fellowship levels of the recent diet of the COSECSA examinations held in advance of
the Annual COSECSA Scientific Conference which was held in Blantyre, Malawi, in the
first week of December 2015. Over 50 candidates were successful in the MCS
examination and 9 in the FCS(Tr & Orth) specialist qualification, representing a very
significant increase in the number of orthopaedic specialists in the COSECSA region.
WOC(UK) now has an established link with COSECSA, contributing volunteer UK
examiners to each diet of the annual examinations, and a similar arrangement also exists
with the West African College of Surgeons (WACS).
The three WOC(Uk) representatives in Blantyre also attended the
COSECSA Annual Scientific Conference, with Chairman Steve
Mannion giving a plenary presentation entitled “ Meeting the
unmet need for musculoskeletal disability surgery in Sub-
Saharan Africa”. The conference also saw the launch of the G4
Alliance ( www.theg4alliance.org), a global initiative hoping to
build political priority for Surgical, Obstretrics, Trauma and
Anaesthesia in the development agenda. Also launched at the
COSECSA conference was Women in Surgery
Africa ( www.womeninsurgeryafrica.org), an organisation
determined to address the “gender imbalance" in African surgical
practitioners.
Hand Surgery Work Shop, Boadzulu Mangochi, Malawi by Bo Povlsen (Hand surgeon)
It was the brain child of Linda Chokotho,
who has recently completed her
orthopaedic training, and is the first and
only hand surgeon in the entire country.
Earlier in 2015 WOC(UK) and BSSH had
sponsored Linda to attend a BSSH training
course and undertake a hand surgery
clinical observation in the UK.
Focussing on hand trauma diagnosis and
management, including burns, the lectures
and practical sessions were led by myself,
Linda and Jonathan Jones (orthopaedic
hand surgeon from Peterborough).
Feedback was positive from the 25
participants, all clinical orthopaedic officers
working in the state or government medical
sector.
There are over 100 clinical orthopaedic officers in Malawi and the
Hand Work Shop was oversubscribed. There should be scope for
running it times to provide all clinical orthopaedic officers with an
opportunity to participate at some stage.
The British Society for Surgery of the Hand generously supported the
travel costs for Mr. Jones and myself; Feet First assisted with
organising logistics from and to Lilongwe where we flew to from the
UK via Nairobi.
Sponsored by WOC (UK) and the British Society for Surgery of the Hand (BSSH), the first Hand Surgery Workshop in Malawi took place on the 24th September 2015, the day before the 25th Malawi Orthopaedic Association
Annual meeting.
WOC(UK) linkman to the West African College of Surgeons (WACS)
is Mr Paul Offori-Attah. WOC(UK) members interested in contributing
to our projects in West Africa are encouraged to contact Paul through
Steve Mannion and Rick Brown went on to do some
clinical work on complex foot and ankle cases with Dr
Henry Ndasi, consultant orthopaedic surgeon at
Mutengene Baptist Hospital. Dr Ndasi is head of the
Cameroon Clubfoot Care Project which began in 2013,
with an initial Ponseti method training course given by
Steve Mannion after which 4 pilot treatment centres
were established. There are now 20 clinics covering
approximately 40% of the country, with a plan to expand
to cover the entire country over the next 3 years. The Ponseti method has proved
extremely successful in treating
patients in Cameroon
presenting at under 2 years of
age. Challenges have included
lack of compliance due to
travelling distance, brace
provision and older children for
whom Ponseti treatment alone
has been successful only in a
proportion of cases.. In future it
is hoped to develop referral
centres, such as Dr Ndasi in
Mutengene, for the treatment of
older children with clubfoot.
WOC(UK) has a tradition of hosting
instructional workshops at the annual
WACS Congress, with past themes
including hand surgery (Ivory Coast 2015)
, compound tibial fractures (Ghana, 2014)
and clubfoot treatment (Togo, 2013).
WOC(UK) also contributes two examiners
to each diet of the FCS(WACS)(Orth)
examination which is held twice per year.
Steve Mannion, Chairman of WOC(UK) was
joined by the Rick Brown, President of the
British Foot & Ankle Surgery Society
(BOFASS) and WOC(UK) member, in
hosting a foot and ankle surgery instructional
session at the Annual Congress of the West
African College in Yaounde, Cameroon on
the 17th of February 2016. They were joined
as faculty by WOC(UK) member Mr
Aloysius, consultant orthopaedic surgeon at
Wrexham Hospital who is of Cameroonian
origin. Course content included the
treatment of ankle fractures, by both
conservative & operative means, as well as
the treatment of tibial pilon fractures and
Lisfranc injuries.
West Africa- Cameroon by Steve Mannion
An Orthopaedic Trainee Abroad: Giving and Taking In Malawi Ashish Kalraiya - ST3 Orthopaedics (London)
Prior to starting my Orthopaedic ST3 job in London, I had a fantastic out-of-training
opportunity to work in Malawi. I am grateful to Dr Leonard Banza and his Orthopaedic
team for warmly welcoming me at Kamuzu (Lilongwe) Central Hospital.
Volunteering in Malawi was a
long-term ambition after my
best friend travelled there for
a medical elective. I was
struck by his anecdotes of
using resourcefulness and
lateral thinking to improve
health care. I wanted to
witness complex trauma and
test my surgical skills in this
austere environment.
After an induction week, I took a senior role in the firm. I ran two full-day operating lists,
clinics, ward rounds and lectured medical students. Challenges included no available
antibiotics despite many patients with acute osteomyelitis, the only x-ray machine breaking
and an overall lack of staff. I also attended the 2015 COSECSA Conference, Blantyre, and
heard several insightful lectures.
I would hugely recommend working in Malawi to my peers for I
gathered a wealth of experience that will benefit my practise and
there was a benefit to the hospital too. My previous experience of
working in South Africa certainly helped my adjustment to the
environment. Other challenges included accommodation and car
rental costs being fairly steep, and getting registered with the
Malawi Medical Council taking several months. A proposal for a
formalised programme sending clinicians at intervals to Malawi may
well provide a good solution to such issues.
For a junior Registrar, whilst
initially daunting, this was a
fantastic experience. Making
challenging decisions was
great for my development.
Furthermore, performing
operations that were a
necessity, yet within the realm
of my capabilities, gave me
huge confidence.
Visiting Trainee Surgeon’s Charter: travelling to a less developed country
We believe that the decision to organize a fellowship or placement or ‘surgical camp’ in a less developed
country is primarily out of an altruistic drive. Most volunteers feel they have a skill or resources which are
lacking in other parts of the world and their visit is a way of sharing these. There are countless benefits that
the visiting surgeon will most certainly gain from the experience, but these should not take precedence over
the humanitarian goal of the mission. Thus we discourage trips motivated purely by “cutting experience”,
“exposure to tropical pathology and surgery” or “a sense of adventure”. To approach global health on these
grounds alone is essentially unethical and risks being seen simply as human experimentation. It is necessary
to apply the highest ethical standards in your practice abroad, probably even more so than in the UK, since
safeguards for patients often are not as stringent there as they are here and also since you are often going to
be working under much less scrutiny, if only as a result of the staff shortages typical of these placements.
Intention to treat approach
Ensure that all that you do is primarily for the benefit of the recipient country
Ensure supervision from a trusted senior is available in your placement
Do not tackle cases which you think are beyond your capabilities
Do not compete with local doctors, students and clinicians for operating time- form partnerships instead
Accept if no actual benefit has been achieved in terms of training from your visit- use the experience to better
plan future visits
Pre-trip preparation
Make prior contact with destination hospital, including head of department, hospital director etc, especially if
travelling with an agency/NGO which arranges everything for you. It is customary in the UK to go through
these formalities, so it should be common courtesy to do the same abroad.
Have a plan of what you will do and come prepared to your placement
Read up about the health care system and common pathology you will encounter in your placement
Look for courses that will equip you with some of the knowledge and skills useful to work in these different and
often challenging environments
Research what materials/drugs etc will be useful for you to bring
General cultural advice
Respect local culture
Make an effort to learn basic language skills
Try and learn a little about the history and traditions of the country
You can read up about wider issues affecting less developed countries- aid, trade, history, colonialism,
slavery etc. This will often make you more sensitive about subtle issues and help you with connecting with
local people
Be polite, patient, courteous, punctual, appropriately dressed etc as per local culture, just as you would expect
of visitors in the UK
Work attitude (to understand all is to forgive all)
Work ethics will invariably be different from the one you consider normal or appropriate. Remember work ethic
is determined by many factors, including pay, promotion, job security, and other incentives which we pretty
much take for granted here, let alone stringent managerial pressures. This can be very different abroad and
one should take extreme care when criticizing people. You might want to criticize the system instead but again
with care and tact. The appropriate thing is to enquire politely and try and understand the other point of view,
while sharing with them your own work ethic. You can demonstrate the value of it through your own good
example and through convincing accounts of it working from your own past experience.
Be aware of the gap in wealth between you and your colleagues potentially. Revealing your expensive
equipment might not be appropriate, especially if you do not intend to leave them behind for the benefit of the
hospital.
Planning what you bring should also reflect that and indeed you might find yourself carrying equipment that is
not compatible with the health care setting you discover once out there.
Question the relevance of applying “western” standards of healthcare to the recipient country. It might not be
applicable for a number of logistical and cultural reasons.
Be generous, but be careful not to create a culture of dependence. The latter can be frustrating to yourself and
indeed end up being counter-productive to your mission. Giving to local projects and grassroots initiatives
which you find attractive while abroad might be a more sustainable way of sharing your money with the
community.
The Kadoorie Senior Orthopaedic Fellowship Children’s Surgical Centre (CSC), Phnom Penh, Cambodia
Established in 1998 by Dr Jim Gollogly,
CSC is a Non-Government-Organisation
hospital in Cambodia’s capital, Phnom
Penh. The city has a population of 2
million and is undergoing major
redevelopment. The hospital provides free
care for the poor of Cambodia, with an
emphasis on children, but also treats
adults. 20,000 patients are seen each
year, and 5000 procedures performed.
The orthopaedic/plastics department is
staffed by 7 senior Khmer surgeons and 3
surgeons in training (SHO equivalent).
The pathology is varied and presentation
is often delayed. Lower limb long bone
infection and fractures present late with
non and mal-union requiring surgical
reconstruction. CSC is the only hospital
that routinely accepts referrals for
sarcomas and as the pathology is
generally advanced at the time of
presentation, amputation or innovative
limb-sparing surgery is often required.
The hospital has recently acquired
funding to assist with the provision of
adjuvant chemotherapy.
Although limited in comparison to the
developed world the surgical inventory is
sufficient to support the majority of
orthopaedic surgical procedures,
including limb deformity correction with
circular frames, hip arthroplasty and
limited spinal surgery. Record keeping is
electronic.
The aim of the Fellowship is to improve the
quality of care provided by the local Khmer
staff. The fellow will therefore assist with the
surgical workload and training,
independently and under the direct
supervision of Dr Gollogly. The complexity
of cases will depend on the level of his/her
ability and experience, and is suitable for a
senior UK surgeon with an interest in
paediatric orthopaedics, trauma and limb
reconstruction either individually or in
combination. Candidates should ideally
have had experience in, or are able to adapt
to, working in low resource environments.
The successful candidate is expected to
work from 0800 -1700, Monday to Friday,
with no on call commitments. It is expected
that the period of tenure is at least 6
months, and ideally 1 year. The successful
candidate is expected to supervise between
2 and 6 international medical students, who
are involved in the clinical activity as well as
working on research/audit projects aimed at
regional publication.
The fellowship is funded through the
University of Oxford by the Kadoorie Family
and provides a monthly stipend with an
additional allowance for flights,
accommodation and insurance. The hospital
also provides a 4x4 vehicle, for
discretionary use. The funding allows for a
very reasonable quality of life in an exotic
and interesting location.
Applications are welcome from senior (post FRCS) trainees and also from Orthopaedic
surgeons approaching the end of their career. You are encouraged to submit a curriculum
vitae to Dr Gollogly and invited to contact any of the following for further information:
Dr Jim Gollogly - [email protected]
Mr Rob Handley - [email protected]
Professor Keith Willett [email protected]
Mr Andrew Wainwright - [email protected]
Mr Fergal Monsell [email protected]