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Chapter 8 The Regional Associations
Chapter 8
The Regional Associations
To facilitate communication and organization, the IAOMS decided to invite six geographical regions to represent their particular nations at the executive committee. This chapter contains the reports of these six regional associations, with an emphasis on their particular development and impact on the development of the specialty in the region they represent as well as globally.
Africa
African Association of Oral and Maxillofacial Surgeons
Development of oral and maxillofacial surgery on the continent of Africa has been rather slow and uneven among the various nations in the continent. The northern and southern parts of the continent are far ahead of west, east and central Africa in terms of the development of oral and maxillofacial surgery. While South Africa and Egypt can boast of fairly large numbers of oral and maxillofacial surgeons (OMS), Nigeria has just a little above 100 and the East African countries of Kenya, Tanzania and Uganda have less than 30 and Ghana has about 12. Figures in Francophone African countries are not easily available but are not significantly higher than in the other nations.
As far back as 1992, South Africa, with a thriving national association and a mandate from the International Association of Oral and Maxillofacial Surgeons, attempted to bring the continent’s OMFS specialists together in preparation for the hosting of the 11th ICOMS. Conrad Masureik made spirited efforts to achieve this. This effort failed to produce the desired result but probably was an ‘eye-opener’ and the necessary stimulus for a country like Nigeria to consider establishment of a national association, which came to be in 1993.
In 2003, Paul Stoelinga, as the president of the IAOMS, stressed the need for African oral and maxillofacial surgeons to come together at a meeting in Athens. This call became a reality in August 2005, when Pino Ferreria, then president of the IAOMS, assembled key colleagues from Egypt, Ghana, Kenya, Nigeria, Tanzania and South Africa in Nairobi, Kenya. At this meeting, extensive deliberation took place on the constitution, funding and structure of an African maxillofacial association. Discussion at this meeting gave birth
to the African Association of Oral and Maxillofacial Surgeons (AfAOMS) and election of its officers. The elected executives consisted of the president, Ademola Abayomi Olaitan (Nigeria); vice president, Symon Guthua (Kenya); secretary general, Ashraf Ayoub (Glasgow) and treasurer, Grace Parkins (Ghana). The executives agreed to have a biennial scientific meeting to alternate with that of the ICOMS to synchronize and ensure continuity. Egypt agreed to host the association in the year 2006 and Nigeria was to hold the 2008 conference, followed by Kenya in 2010. The president was given the responsibility of principal organizer of the association and as regional representative on the executive committee of the IAOMS but at the meeting held in Nigeria, the executives decided to vest the responsibility of organization of the association and representation on the executive committee of the IAOMS in the secretary general. At the same time, Symon Guthua was elected the president of the association while Ademola Olaitan was elected as the secretary general.
As a young association, the activities of AfAOMS are anchored on the vigor, drive and enthusiasm of the executives. While some members of the executive committee have shown keen interest in the association’s affairs, the large size of the continent, relative communication handicaps and the non-availability of funds retarded the momentum at takeoff. The inability of nominated Kenya to raise funds for the hosting of the 2010 biennial scientific meeting is a typical case of the hindrance that the lack of funds can cause.
Eligibility for membership of the African Association of Oral and Maxillofacial Surgeons (AfAOMS) is based on membership of the national OMFS association in countries with such bodies. Individuals practicing in countries without national societies or associations are free to join the continental body. At the moment, members are drawn mainly from Anglophone countries. Francophone and Lusophone countries are yet to be fully involved in the activities of the association. Apart from Egypt, which is a founding member and Libya, which has shown keen interest in membership, other Arab-speaking nations have not.
Although there are African OMFS who are doubly qualified, dental qualification is the basic prerequisite for the practice of the specialty in most of the African countries. Two pathways are taken to qualify as an OMFS on the continent. One pathway is a university-based Master’s program, which lasts from three to four years. Training of
this type is mainly in the East, South and Central Africa and Egypt. The other pathway is fellowship diploma, which is hospital-based and may last between four to six years. This is the pathway in the West African sub-region for both Anglo and Francophone countries. Individuals with qualifications from the U.K., continental Europe, the U.S.A., Canada, Australia or other regions of the world are found all over the African continent. At the time of the AfAOMS’ affiliation with the International Association of Oral and Maxillofacial Surgeons, the IAOMS had individual national associations and societies as its affiliated national associations, with councilors representing each particular nation. The current arrangement recognizes regional representatives as members of the executive committee. AfAOMS is the 6th and the last region to place a regional representative on the IAOMS Ademola Olaitan executive committee. Despite the fact that AfAOMS is a very young regional association with its unique challenges of inadequate communication and lack of funds, it can boast of modest achievements. The first is the realization of the importance and benefits of coming together. Ghana inaugurated its national association in 2008 and formally became a full member of the IAOMS at the 19th ICOMS in Shanghai. Libya is in the process of establishing its national association. An ongoing IAOMS Foundation sponsored educational program in East Africa, initiated by John Williams and Paul Stoelinga has been of large benefit to the regional association. Communications and the exchange of ideas have commenced between Kurt Butow of South Africa, Vincent Ugboko and Ambrose Emeka Obiechina of Nigeria regarding the possibility of reciprocity and collaboration in the examinations and Fellowship Diplomas of the South African College of Oral and Maxillofacial Surgeons, West African College of Surgeons, Ghana College of Physicians and Surgeons and the National Postgraduate Medical College of Nigeria.
Establishment of the African Association, Kenya, 2005. Front row from left to right: Elison Simon (Tanzania); Sherif El-Mofty (Egypt); Ademola Olaitan (Nigeria); Symon Guthua (Kenya); Gilmie Kariem (South Africa); Grace Parkins (Ghana). Standing from left to right: José Luis “Pino” Ferreria, Ashraf Ayoub.
The African Association of Oral and Maxillofacial Surgeons is a fairly young association with challenges, modest achievements but with capability and potential to a great horizon. These capabilities and potentials can be reached with visionary leaders and recognition and with serious attention paid to challenges and sincere support, in all ramifications, from the established regional associations. Ademola Abayomi Olaitan
Asia
Asian Association of Oral and Maxillofacial Surgeons
The Asian Association (AsianAOMS) was formed in Manila on March 16th, 1989. At the first congress, the founding president was E.M. Nazarino (Philippines), the chairman was Y. Uchida (Japan), the secretary general was Kanichi Seto (Japan), the publicity/social secretary was N. Ravindranathan and the chief editor was S. Enomoto (Japan). The first issue of the Asian Journal of Oral and Maxillofacial Surgery was published in October 1989. The next congress was held in Taipei in 1993 with the congress chairman being Professor Chao, the organizing secretary Professor Chang and N. Ravindranathan was elected as the second president.
At the third congress, Professor Kim was elected president for the period 1997–2000. During the fourth congress in Korea, Jatinder Nath Khanna was elected president.
The next congress was held in conjunction with the 28th congress of the Association of Oral and Maxillofacial Surgeons of India (AOMSI), when the president also became the congress chairman. Khanna, therefore, became the chairman as well as president and Rajesh Dhirawani the organizing secretary. Hiroyasu Noma was elected as the next president and Kenichi Kurita became secretary general.
Four issues of the Asian JOMS were published in the period until 2002.
At the 6th congress in Tokyo, 2004, the Asian guidelines for training and education in the specialty were endorsed by the council and general assembly. However, at the next congress in Hong Kong, 2006, under the presidency of Nabil Samman, the constitution was revised to adopt the IAOMS’ recommendations. At this meeting, the Japanese association announced its
intention of joining the AsianAOMS, resulting in some 1,600 Japanese oral and maxillofacial surgeons forming a vertical type of agreement with the Asian Association. Vacharee Changsirivatanathamrong was elected as the seventh president. The first educational program of the Asian Association, on the subject of orthognathic surgery, was held in Manila, Philippines in 2007 and included both lectures and live demonstrations. The Asian Association found itself in a position in 2008 to donate $5,000 to the IAOMS Foundation and has continued to do so annually. The Japanese Society of Oral and Maxillofacial Surgeons (JSOMS) also decided that they would support the travel expenses of their members who were chosen to present papers at IAOMS and AsianAOMS congresses. The 7th congress was held in Bangkok, 2008, at which Sharifah Fauziah Alhabshi was elected as the eighth president. A second educational program was organized jointly by the Asian, Japanese and Malaysian associations in conjunction with the Oral Health Division, Ministry of Health, Malaysia in 2009. This three-day course on craniofacial distraction, headed by Lim Cheung, was attended by 69 participants and all 25 seats at the Hospital Selayang, Malaysia allocated for hands-on lectures were taken. Asian Journal of OMS To facilitate education and training, the Asian Association established a Foundation in 2009 and utilizes up to $10,000 annually for up to two years for one trainee from each of two developing countries. A total of up to $40,000 is spent over each two-year period. So far, the Korean association has funded a Mongolian trainee on a two-year program and the Japanese association has funded a trainee from Bhutan on a one-year program. The budget for one year was spent in Taiwan where the association accepted a trainee from a developing Asian country.
Presidential medallion of the Asian Association
1st Asian Congress of OMFS Manila, 1989.
Executive Committee of the Asian Association at the 8th Congress in Bangkok, Thailand. From left to right: Benny Latief (Indonesia); Kanichi Seto (Japan); Lim Cheung (Hong Kong); Theeralaksna Suddhasthira (Thailand); Vacharee Changsirivatanathamrong (Thailand); Nabil Samman (Hong Kong); Sharifah Fauziah Alhabshi (Malaysia); Kenichi Kurita (Japan); Masaaki Goto (Japan); Tetsu Takahashi (Japan).
The number of papers submitted to the Asian JOMS has increased annually: 83 in 2007, 92 in 2008 and 114 in 2009. Acceptance rates were 37.3 percent in 2007, 48.9 percent in 2008 and in 2009, 23.7 percent. Delays in publication were caused by collapse of its publisher in 2010, which was resolved by Elsevier taking on the publishing.
As of March 2010, the total membership for the AsianAOMS was 2,116. Vertical membership arrangements exist for all accredited members of the JSOMS and those from Taiwan. Kenichi Kurita
Europe
European Association of Cranio-Maxillofacial Surgery
Established in 1970, the European Association of Maxillofacial Surgery was the brainchild of Hugo Obwegeser of Zurich. In the late 1960s, believing that the emerging specialty needed the support of a strong, professional body, he proposed the establishment of a European association to the German association, who rejected the idea. However, with the support of several like-minded individuals, in March 1970, he invited a group of 59 participants to a clinical meeting in Zurich and informed them of his resolve to establish a European association. The group, most of whom were qualified in medicine and dentistry, supported this move, as well as the suggestion that the requirements for membership should be a dual qualification and at least three years training in maxillofacial surgery. The suggestion that each person’s membership be based on their qualifications and not the membership of a national association was made by Hans Freihofer, a past president of the FDI. At the time, this was intended as a strong educational statement but changes in Europe, coupled with a history of diverse development of the specialty, resulted in this statement being appropriated by politicians and used for their own purposes.
It has to be remembered that Europe is a widely differing collection of nations and, as far as our specialty was concerned, was divided north-south and east-west in terms of its origins. In the north, the origins were from dentistry, while in the south they were medically based. In Eastern Europe, stomatology existed and was considered to be a medical specialty with little dentistry, a course which also was found in France, although here a true specialty existed on top of a medical degree. Only in Germany, Austria and Switzerland did the specialty develop from dual medical and dental training. Several countries, including the U.K. and the Netherlands, were to develop a training program that was similar to one developed by the Germans and others followed in the course of time. Just to complicate matters further, until 1989, the whole of Eastern Europe was isolated from the west by the Iron Curtain, created by the Soviet Union, which for 40 years prevented contact between surgeons on either side of it.
In 1957, the European Economic Community (EEC) was established and gradually expanded; as other countries joined later, it was renamed the European Union (EU). There was a need to take on this huge political force, since it would have a great influence on the specialty as harmonization was introduced as part of the process necessary to permit freedom of movement and freedom to work in any of the affiliated nations. It was against this background that the European association was established and the structure of the initial council reflected the divisions. The president was also the person responsible for the next conference and the other officers were the secretary general, treasurer and editor-in-chief.
The first president was Franc Celesnik of Yugoslavia and the first congress was held in Ljubljana in 1972. Eligibility for membership was a constant issue from the very outset, which bedeviled membership. An enormously successful congress was held in Zurich in 1974 under the presidency of Hugo Obwegeser, at the end of which Norman Rowe was installed as president and the third congress was scheduled for London in 1976. An unforgettable opening ceremony was held at the Royal College of Surgeons where the scientific program was also conducted. More than 550 delegates from 32 countries attended. It was at this meeting that Obwegeser was to be elected an Honorary Member of the association, which received unanimous support from the attendees. He would stay on council as editor-in-chief.
The 1978 congress in Venice, with Camillo Curioni as president, was followed by the first president from Eastern Europe: Stefan Knapik (1980). With the election of Gerhard Peiffer from Hamburg, the association demonstrated how attempts were made to rotate the presidency throughout Europe in order to encourage interest and further the
association’s membership. There were further changes among the officers after the first decade when Hermann Sailer became treasurer (1982) and Jacques Levignac was elected to the new post of education officer (1984), while Hans Peter Freihofer became editor-in-chief (1980). It was at the Paris conference in 1984, with Jean Delaire as president that the first moves were made to change the name of the association. The move was proposed to recognize the full scope of clinical practice in the specialty which was feasible in some countries. The decision on the name change was deferred until the 1986 conference in Madrid, under the presidency of José Alonso del Hoyo. At that point, the association’s name became the “European Association for Cranio-Maxillofacial Surgery,” and with it came a name change to the Journal, to “The Journal of CranioMaxillofacial Surgery.” This meeting also saw Wolfgang Koberg forced to resign as secretary general due to ill health. John Sowray took his place and John Williams was elected as assistant secretary. Finally, the decision was made to hold the 1994 congress in The Hague with Paul Stoelinga as president, he, too, was elected to council.
Two years later in Athens (1988), the Bermuda and Tenerife meetings had taken place, and as a result, a proposal was made by council to make provision for senior singly qualified members to become eligible for full membership in the association. Following a heated debate in the general assembly, this was defeated by a single vote. However, the ballot had not been conducted under ideal circumstances, as the simultaneous translators had walked out at a critical moment in the proceedings. The vote was so unsettling for two senior members of the executive committee that they spent the evening pacing the streets of Athens, seeking a way forwards.
The next six years saw presidents with significant roles in other international bodies and the influence of these positions affected the thinking of the EACMFS council. Under the presidency of Robert Pfeiffer, several pressing issues needed to be addressed: 1) trainee membership was introduced (Brussels, 1990); and 2) a forum of European leaders was necessary, in particular to provide advice on Herman Sailer
the specialty to the European Community on political and training issues. With this emphasis, it was important ideally to involve the presidents of all the European national OMFS associations. There also was an equal need for a European postgraduate educational college. Over the next few years, these issues were discussed and implemented in different ways. Additionally, for financial reasons, the publication of the journal was transferred from Thieme to Churchill-Livingstone.
By March 1991, the former East European association had been dissolved and as part of this, the EACMFS invited 44 European representatives to a meeting in Linz (December 1991) to examine a draft constitution for a Confederation of European National Associations, a body which was deemed necessary until such time as Europe could move forwards as a common front, ideally within the EACMFS. For the Bermuda/Tenerife proposals to work, this common approach was required. Almost at the same time, the section of stomatology and oral and maxillofacial surgery of the European Union of Medical Specialists (UEMS) decided to establish a European Board. The president, wearing his UEMS hat, found himself desperately in need of advice on the educational program from within Europe and council agreed that he should be supported in the formation of such a group by invitation.
Founding members of the European Association in Ljubljana, 1972. From left to right: L. Merville, France; M. Perko, Switzerland; G. Rossi, Italy; S. Knapic, Poland; J. Toman, Czechoslovakia; H. Obwegeser, Switzerland; F. Celesnik, Yugoslavia; M. Glahn, Denmark; C. Freidel, France; A. Rehrmann, Germany; W. Koberg, Germany.
The EACMFS was being consulted regarding political and educational issues for which it was inadequately prepared and the consequence was discord among its most senior members who still believed that the association was an entirely scientific one, without any other function. There was a clear need to strengthen the specialty’s links through the Confederation, thereby strengthening the association’s negotiating position. It was highly desirable that a common European response be prepared to counter any American attempts at downgrading the proposals which were on the table. As part of this process, council proposed changes to its constitution at its meeting in March 1992. A smaller, more flexible executive committee of five or six individuals would form the nucleus of the association and the council would be composed of representatives, ideally the presidents of all the national OMFS associations of the new, enlarged Europe.
A very successful congress was held in Innsbruck in 1992. At his final meeting as president, Rudi Fries announced, sadly, the deaths of two of the honorary members who had played large roles in the establishment of the association, Norman Rowe and Wolfgang Koberg. He also reported on the adoption of the IAOMS Guidelines on education and training, which would later serve as the blueprint for the EACMFS Guidelines. He proposed the need for the association to widen its membership while still complying with the standards that were already set, i.e., applicants for full membership should a) come from a country with a national OMFS association and b) such associations must have declared agreement with the EACMFS training principles and the IAOMS guidelines. Additionally, Emil Steinhauser would take over as editor-in-chief.
In his inaugural presidential address (1994), Paul Stoelinga announced that his prime objective was to follow up the many contacts and conduct a recruitment drive among East Europeans. Further, he was anxious to follow up on the association’s initial meetings with AAOMS by establishing a liaison committee to, hopefully, prevent any new misunderstandings, particularly over education and training. While the conference at The Hague succeeded in bringing a significant number of East Europeans, their presence also produced problems, some of which required the president to have to deal with immigration police in the middle of the night! A large number of late registrations for the social events was an unexpected issue, as was the presence of a film company which took a lot of money from delegates and then absconded with the proceeds. Despite all this, the conference made a profit.
The confederation was attended by 57 representatives of 27 nations, providing a much better representation of regional opinion than had been previously available. As a result of the changes voted in at the last general assembly regarding the constitution of council, this representation was also reflected in the EACMFS council, so the confederation had achieved its purpose and could now be disbanded.
The presidency now moved to Hermann Sailer and the conference to Zurich to celebrate the 25th anniversary of the founding of the association (1996). For the jubilee
meeting, a significant effort was made to support Eastern Europeans who wished to attend the meeting, particularly by providing financial support. The first European board assessments were held in conjunction with the conference and the new education officer, Bernard Devauchelle, was officially invited to take part in the business of the Board. The executive committee held their first meeting in Midhurst (U.K.), combining this with an inspection of the office facilities which had become the organizational hub of the association (1995).
Christian Lindqvist was now the president (1998) and undertook the difficult task of taking the Scandinavian countries into the agreed common training program. It was at this time that the issue of representation on the IAOMS executive committee was raised. The difference in structure, particularly the fact that EACMFS members were there as individuals, plus the fact that the EACMFS did not have a mechanism for a national association to have membership, made the European association’s structure different from the established structure of IAOMS. However, in response to an invitation to send a representative to the executive committee, Hermann Sailer agreed to serve.
Also at this time, the journal’s editor-in-chief was facing an intolerable increase in workload. This provoked
a wide ranging discussion with the end result being a suggestion that sectional editors be appointed.
In his initial address to the executive committee as president, John Williams (2000) listed topics which he felt needed to be resolved by the association: • harmonization of training; • revalidation or reaccreditation of trained surgeons, which would be difficult to achieve in some of the major
European countries, notably France and Germany; • the increased demand for accreditation of services, particularly from vociferous patient groups, but fueled by politicians across the EC; and • the trainee membership and increasing difficulties in organizing any form of educational exchanges. In addition, the financial state of the association had become critical as expenditure was exceeding income. Subscription rates had remained unchanged since formation of the association some 25 years earlier even as commitments continued to increase. During its period collecting membership dues, Churchill Livingstone had exposed a huge disparity between what was thought to be the membership (over 1,000) and what it really was in terms of who paid their dues (about 760). A new fees structure was approved at the Edinburgh meeting.
Increasing tension between the EACMFS, the IAOMS and AAOMS over the educational guidelines necessitated a second “summit” meeting which successfully resolved the differences once and for all (see chapter 4). The congress in Edinburgh was attended by more than 1,000 delegates and included a colorful opening ceremony where the dignitaries were led in by a piper in full regalia. The scientific meeting introduced early morning workshops aimed specifically at trainees. This emphasis on trainees was continued by Ulrich Joos, the next president (2002), at his congress in Munster. The association was still in a quandary over educational guidelines, together with the thoughts of UEMS, the forthcoming IAOMS meeting in Durban and the need to present a position statement of European opinion on the issue. The lack of any increase in membership and the friction between the scientific role of the EACMFS and the political responsibilities also being asked of it resulted in further questions.
Following another successful congress, Bernard Devauchelle became president (2004) and was to organize a conference in Tours. Irrespective of the ongoing financial situation, it was considered essential to support the development of an educational program in Iasi, Romania. The website, another financial priority, was now functional and provided enormous help to the educational program. The work that had been done John Lowry
over several years to establish a “Foundation” within EACMFS that would be particularly focused on education and training, was eventually brought to fruition in 2005. Despite being established as a scientific association, the political needs of Europe had been imposed on the membership and the latest was the “European Working Time Directive.” As it stood, it was unacceptable and interfered severely with training. This issue extended far beyond surgery and would take some years to resolve. Guillermo Raspall became the new president in 2005 and as part of the process of resolution of the financial difficulties, was able to address the issue of the secretariat taking over collection of the membership dues. Political changes in the EU/UEMS workings were likely to have a significant effect on training because of a recently introduced “Bologna Agreement.” Just how this would affect OMFS training remained to be seen but a risk of the development of the specialty of oral surgery was concerning council. The executive committee, having worked on modification of the constitution, was supported by the general assembly who adopted all the amendments. This was an attempt at providing a mechanism of inclusiveness for all people in the specialty, irrespective of their qualifications. Taking over the presidency in 2008, Luigi Clauser saw a desperate need to work closely with the European Commission on Harmonisation of Education and Training, which was chaired by Wolfgang Busch and covered Ulrich Joos extensively the evolving aspects of the specialty. The autumn of 2008 saw the sad and untimely death of John Lowry who had served the association both as assistant secretary and secretary general for ten years. Only the fourth person to hold this post since the inception of the association, he had been involved in many of its developments and was an absolute font of knowledge. Following the Bologna congress, the presidency moved north again to Belgium and Maurice Mommaerts with Henri Thuau, acting as secretary general, before
Miso Virag
being formally elected to the post. A résumé of training requirements across Europe demonstrated persisting great variation between nations, despite the attempts of the UEMS at achieving harmonization. The EACMFS was now working regularly with the UEMS through a series of joint committees. The meeting in charming Bruges was again a great success attended by a record number of colleagues. The presidency then moved to Mišo Virag, who will hold the next congress in 2012 in Dubrovnik, Croatia. John Williams
Latin America
Latin American Association of Oral and Maxillofacial Surgeons
Asociacion Latino Americana de Cirugia y Traumatologia Buco Maxilo Facial ALACIBU was established in 1962, in Bogota, Colombia, when an international group of Latin American oral surgeons and dentists with an interest in oral surgery met. It was decided that international congresses were to be held every three years and the location of the congress would alternate between the north and south of the Latin American continent in the following countries: Argentina, Bolivia, Brazil, Colombia, Costa Rica, Cuba, Chile, Ecuador, El Salvador, Guatemala, Haiti, Honduras, Mexico, Nicaragua, Panama, Paraguay, Peru, Dominican Republic, Uruguay and Venezuela.
The second meeting was held in Venezuela, in 1967, under the presidency of José Barros San Pasteur and the third in Buenos Aires, in 1970. The Buenos Aires congress was the first meeting attended by North American colleagues, among them Fred Henny, at that time a past president of the International Association of Oral Surgeons.
Subsequent meetings took place every three years in, respectively, Mexico (1973), Chile (1976), Honduras (1979), Brazil (1982) and Ecuador (1985). At these meetings, several well-known speakers from overseas and North America were invited to present the latest developments in oral and maxillofacial surgery.
A milestone in the history of ALACIBU occurred in 1985 when a formal document was signed between ALACIBU and AAOMS, together with CAOMS to promote cooperation in education and research in both North and South America. In this year, ALACIBU was also appointed as a member of the Latin American Dental Federation and it was decided to hold simultaneous scientific meetings. It is also of interest to note that at the general assembly in Ecuador, it was decided to improve the communication systems between the national associations so as to promote the professional exchange of ideas.
During the period 1985 and 1988, ALACIBU became involved in the infamous Tenerife and Bermuda conferences during which international guidelines on education and training were prepared. Several of Latin America’s most prominent members were invited to participate in this endeavor. These events had an enormous impact on the development of the specialty in this continent. One result was a seminar held in 1988 after the 9th scientific meeting in Uruguay, on the education and training of OMFS in Latin America. This seminar was held in Punta del Este and was preceded by a survey that was sent to all Latin American OMFS associations with the aim of learning each country’s current practice with regard to education and training. These preliminary discussions created a positive ambiance in which specialty leaders over the next 12 years were able to come up with a Latin American document on education and training.
At the meeting in Uruguay, it was also decided to establish a Latin American journal on oral and maxillofacial surgery. The first issue was published in 1989 with support from the Spanish society. Unfortunately, any further publications ceased due to a lack of funding.
At the next congress in Chile in 1991, the second seminar on education and training took place, at which the results about the scope of OMFS in Latin America were presented. It was agreed that the training in all Latin American countries would take a minimum of three full years. There were many European and North American colleagues present who gave their opinion under the leadership of former IAOMS president Robert Walker.
An important event for the specialty in Latin America took place in 1992 in Buenos Aires, the 11th ICOMS, held under the chairmanship of José Luis Ferreria. The conference was a huge success, not only because of the quality of the meeting but above all because it showed the involvement of South America in international affairs. The event also resulted in a boost for closer cooperation among Latin American associations, which was borne out at the next meeting in Cartagena, Columbia, in 1997, where new
From left to right: José Luis “Pino” Ferreria chair of the 11th ICOMS in Buenos Aires, Argentina; Danial Laskin (U.S.A.) then IAOMS secretary general.
regulations transformed ALACIBU from a society which organized scientific meetings every three years, to a true continental association with an executive committee.
As a result of those regulations, ALACIBU now has an executive committee, a council formed by all the national presidents and a general assembly. The president is now elected for a two-year period and each national association now pays a fee to ALACIBU for all their members. This means every OMFS, who is a member of his/her national association, is also a member of ALACIBU.
In 2000, in La Paz, Bolivia, a document on training and education for oral and maxillofacial surgeons in Latin America was finally approved by the general assembly. This document, based on the IAOMS education and training guidelines, was prepared in cooperation with AAOMS and CAOMS. At this meeting, a list of all registered oral and maxillofacial surgeons in Latin America was also presented. Former ALACIBU presidents Cesar Guerrero, Luis Quevedo and Eduardo Rey had all stressed education and training as their main objectives as president and this focus was borne out by the accomplishments of the 2000 general assembly.
The emphasis on education and training continued during the presidency of Edela Puricelli with a 2008 analysis of OMFS practice in Latin America and the proposal of a “core curriculum” in Foz de Iguazú in 2009.
In the period 2001–2011, further steps were taken to enhance professional standards in Latin America. These steps included the first IAOMS-sponsored educational course in Lima, Peru, which received generous assistance from AAOMS and SECOM and a second IAOMS educational program in Paraguay in 2009, the result of the successful course in Lima.
During the years 2003–2006, in addition to further improvements in the governance of ALACIBU, which required changes in the bylaws of the association, two important meetings took place in 2008 and 2009. The first “Latin American Forum on Professional Practice in OMF Surgery and Traumatology” occurred in 2008, under the auspices of the IAOMS and with the attendance of IAOMS president Nabil Samman and IAOMS educational committee chair, Julio Acero. The main purpose of this Forum was the selection of methodologies that would encourage the establishment of “Centers of Excellence” in Latin America and to enhance the training and education guidelines proposed by ALACIBU and the IAOMS.
At the second “Forum,” the focus was on a plan of action for the development of accreditation systems for OMFS training programs in Latin America, the adoption of common surgical protocols and favorable conditions for the establishment of guidelines that could be adopted as minimal curricular references in most Latin American specialist training programs. Both meetings were attended by representatives of all of the Latin American national associations. At the second meeting, several invited guests from AAOMS shared their experiences in North America. As of this book’s publishing date, ALACIBU had approved a Latin American Board to manage OMFS accreditation and certification policies.
In summary, ALACIBU has undergone a spectacular development in the last two decades and has progressed into a true professional organization in line with those on other continents. Mario Scarrone and Edwin Valencia
North America
American Association of Oral and Maxillofacial Surgeons/ Canadian Association of Oral and Maxillofacial Surgeons
Oral and maxillofacial surgeons in the United States and Canada have always had a close collegial relationship. The training is virtually identical, as is the scope of practice. A large number of Canadian surgeons are members of the AAOMS and a significant number are American Board certified. Two joint association meetings have been held in Toronto. Therefore, when it was rumored that the IAOMS was going to regionalize, it was natural for the two associations to meet and discuss the formation of a North American association.
On September 19, 1996, a joint meeting was held at the Fontainebleau Hotel in Miami, Florida. Attending for the American association were John Helfrick, Daniel Laskin, and AAOMS staff member Barb Moles. The Canadian association was represented by Victor Moncarz and David Precious, with Moncarz serving as chair. Although invited, Dan Lew, Sam Kucey and Alva Swanson were unable to attend. The purpose of the meeting was to discuss the formation of an alliance between the AAOMS and CAOMS in order to form a regional affiliate of the IAOMS.
It was decided that all members of the AAOMS and CAOMS would comprise the membership of the North American Association. It was envisaged that there would be a board comprised of three members from each association and that the representative to the IAOMS executive committee would serve as chair of the board. The board would meet every other year, in the year in which there wasn’t an international conference (ICOMS). Because of the difference in size between the two associations, it was determined that the AAOMS would have a representative to the IAOMS for eight years and the CAOMS for two years in a ten-year cycle. Daniel Lew was appointed chair of the North American Association.
At the 1997 IAOMS meeting in Kyoto, the council approved the concept of regionalization of the association. Shortly after the meeting, Dan Lew stepped down from his position as North American Association chair and Kent Cohenour was appointed as the North American representative to the IAOMS executive committee. Kent Cohenour served in that position from 1998–2001. Don Booth was appointed as the representative in 2002 and served in that position until 2007.
In May 2007, it was mutually agreed by the AAOMS and CAOMS that the regional representative would routinely be appointed by the AAOMS board of trustees. It was also determined that the representative would serve three two-year terms (from international conference to international conference). Upon conclusion of Don Booth’s term of service in 2007, Boyd Tomasetti was appointed as the Boyd Tomasetti North American representative and continues to serve at this time.
Although the original concept of a “North American Board,” which would meet on a regular basis, was never implemented and the North American Association is more virtual than real, the concept has proved to be of value. The North America region has direct input into IAOMS activities and international communication and cooperation has been facilitated by the regionalization. The AAOMS and CAOMS continue to support the concept of a North American regional association and of regional representation on the IAOMS executive committee. John F. Helfrick and Dan Lew
Oceania
Australia and New Zealand Association of Oral and Maxillofacial Surgeons
Oral and maxillofacial surgery as it is known today did not exist in Australia and New Zealand in the first half of the 20th century. There were, however, several distinguished individuals working in isolation in their regional centers, either from a base in dentistry or from general surgery.
In both the first and second world wars, surgeons from Australasia made important contributions to the wartime reconstruction services in the United Kingdom. These include Percy Pickerill, Harold Gillies and Archibold McIndoe.
The first move to establish an Australian Society of Oral Surgeons occurred in Adelaide, concurrent with the Australian Dental Congress in 1957. Key individuals from all states of Australia met and the society was conceived. Plans were put in place to develop a constitution, and it was agreed to meet in Perth in 1959, again concurrent with the next Australian Dental Congress. By then, New Zealand had joined and the first formal meeting was held under the presidency of Dr. Henderson. The executive consisted of the president, honorary secretary, treasurer and local councilor to run the association, with a broader council representing all states of Australia and New Zealand. The executive held office for two years and at the end of their term, a biennial scientific meeting was held and then affairs were passed on to the next executive.
The honorary secretary was the key organizer for the association. The records were kept in cardboard boxes and one early secretary still vividly recalls receiving 20 cardboard boxes which were not marked or classified, at the start of his period of responsibility. The association’s affairs very much depended on the drive and enthusiasm, or sometimes lack of these skills, of the executive. Review of the records from those days show that there were recurrent themes: the membership and who was eligible; negotiation with state and federal governments in Australia and the national government in New Zealand as they all had different rules and regulations; the constitution and bylaws; helping members who got into professional difficulty and at times, prickly relations between dentistry and related medical specialties. The executive also had to arrange the scientific meetings and often more importantly, the social functions which went with the scientific meeting.
Membership decisions were always difficult in the early days as there was no agreed standard of training. Each dental school had its own master’s degree program which varied in length between one and three years. These were largely outpatient related and had variable research and coursework requirements. Graduates then commonly went to the United Kingdom for one or two years to obtain hospital experience and a United Kingdom fellowship. Some individuals went directly to the United Kingdom and bypassed any formal training and others obtained a medical degree. It was all very haphazard. In the early 1970s, an analysis of 23 consecutive successful applicants for membership showed that they had followed 22 different pathways of training which had taken between 1 and 22 years to complete and they ended up with one to six postgraduate qualifications!
Arising from this, the Australian and New Zealand Society of Oral Surgeons established an education committee of two young academicians, who subsequently became full professors, Frank Monsour of Brisbane and Alastair Goss of Adelaide. They presented a document entitled “Oral Surgery Training, A Plan for the 80s” to the 1979 ANZAOMS meeting in Sydney. The key steps
identified were a bi-national standardized curriculum, accreditation of training institutions and trainees, minimum requirements for the full scope as documented by log books and a national exit fellowship examination. A medical degree was not mandatory but considered desirable. The meeting presentation was fairly stormy and some dental school heads, who had not otherwise attended the national oral surgery conference, came in just for the afternoon to protect the independence of their school’s programs.
ANZAOMS supported the education committee’s initiatives and through the 1980s, the key steps were progressively put in place. Important educational courses besides the bi-annual scientific meetings were run under the chairmanship of Henk Tideman in Adelaide. He invited his European colleagues to update the profession in current maxillofacial surgery. These meetings were attended by about three quarters of the Australian and New Zealand membership and greatly broadened the horizons of members of the specialty.
At the end of the 1980s, the Australian and New Zealand Association of Oral and Maxillofacial Surgeons (ANZAOMS), as it became known, decided that the education and the examination components of the association would be better separated and put in the hands of the Royal Australasian College of Dental Surgeons. The College had established a diploma in oral surgery with the first examination held in 1973. Presentation to sit the exam was voluntary but many of the key leaders of the specialty presented for the searching examination, conducted under the chairmanship of John De Burg Norman.
In 1979 a section board in oral and maxillofacial surgery was established as part of the College under the chairmanship of Marsden Bell of New Zealand. The committee was largely comprised of heads of training units. This was supported by College representatives. This group had the drive, experience and authority to fully implement the training plans. Lateral entry into medical school for dental graduates training in oral and maxillofacial surgery was initiated in 1988 and lateral entry into dentistry for medical graduates was initiated in 1994. The academic teaching units, which are well embedded in each center’s major hospitals, covered the full scope of the specialty, including trauma, oncology and maxillofacial reconstruction.
Today, there is a fully functioning Board of Oral and Maxillofacial Surgery which sets the course and curriculum, accredits training units, selects advanced trainees and monitors their progress.
ANZAOMS has developed parallel to the College Board for all other aspects of oral and maxillofacial surgery. It has its own chief executive officer and a secretariat, thus the post of honorary secretary is no longer required. The executive does not rotate through Australia and New Zealand but meets centrally and the officers are elected on merit. The research arm of the specialty was established in 1990 as the Australian and New Zealand Association of Oral and Maxillofacial Surgery Research and Education Foundation. This Foundation has established substantial funds from the membership and trade.
One of its first investments was to finance a series of workforce studies. The detailed information from this has greatly aided planning of the Board of Oral and Maxillofacial Surgery of the College and ANZAOMS. It has been an invaluable factual base to negotiate with government’s educational and funding bodies. Oral and maxillofacial surgery services are provided mainly in a private practice setting in which dentoalveolar surgery predominates but they also cover trauma, pathology, orthognathic surgery and implantology. Thus, in Australia and New Zealand today there is a strong specialty of oral and maxillofacial surgery which is well organized and comfortably meets as an equal with related surgical specialties and the medical and dental professions.
The Australian and New Zealand Association of Oral and Maxillofacial Surgeons were founding members of the international association. Marsden Bell of New Zealand was at the first meeting in London in 1962 and then attended every meeting of the international association until the Vienna meeting in 2003. He also served on the board of the IAOMS Foundation from 2000 until 2005, being chairman from 2001 until 2005.
Passing on the ANZAOMS presidency. From left to right: Ann Collins and Paul Sambrook.
7th Clinical meeting of ANZAOMS. Front row from left to right: Cliff Black, Jan Donaldsen, Bill MacKenzie, Sandy MacAlister (IAOMS president), Bruce Lindsay (ANZAOMS president), Paul Bramley (BAOMS president), Frank Helmore, Bob Cook, Berry Fitzpatrick, Paul Swinburn.
Australia and New Zealand has had two IAOMS presidents, Alton “Sandy” MacAlister of New Zealand and Robert Cook of Melbourne. David Poswillo, a New Zealander sometimes based in Australia but mainly in the United Kingdom, was the secretary general of the IAOMS in the days when the secretary was the key organizer. Alastair Goss was a long-serving member and chair of the education committee, as well as the first Oceania regional representative on the executive committee. He was followed by John Curtin and then Paul Sambrook.
In the mid-1990s representatives of regional associations were invited to join the executive committee of the IAOMS. These were North and South America, Europe and Asia. Australia and New Zealand were considered part of Asia, but as Oceania is a recognized continental grouping, it was later recognized as the 5th region. It is the second largest by area but the least populated. The dominant, well developed countries are Australia and New Zealand with the remaining over 40 countries being spread throughout the Pacific. These nations are all small, developing countries. Dental training can be achieved in some instances either in Australia or New Zealand or at the more recently developed regional dental schools at the University of the South Pacific in Fiji and at the University of Papua New Guinea in Port Moresby.
Australia and New Zealand have long been involved in providing aid at all levels within Oceania. The first formal major commitment of Australia and New Zealand to the development of health services was outside its region in Bangladesh. A full course in oral and maxillofacial surgery was set up under Australian mentorship and a number of senior Bangladeshi trainees spent time furthering their training on rotation through Australian schools.
Numerous education missions have been made to the Philippines, Indonesia, Fiji, Tonga, Samoa, East Timor and the Solomon Islands. Two courses for the Pacific region surgeons have been conducted under the auspices of the IAOMS and the leadership of John Curtin.
There remains much work to be done but the commitment of Australia and New Zealand to this important work in Oceania is in place and will continue.
The progress of the specialty has been based on the work of many but a few whose names are featured in this report were often stimulated by external competition from related surgical specialties and made giant steps. It’s in the hands of the new well trained young surgeons to take things further. Alastair Goss
