Perspective
Nils HANSSON, Giacomo PADRINI, Thorsten HALLING, and Felicitas SÖHNER
Department for the History, Philosophy, and Ethics of Medicine, Centre for Health and Society, Heinrich-Heine-University Duesseldorf, Germany
Citation: Acta Orthopaedica 2022; 93: 767–768. DOI http://dx.doi.org/10.2340/17453674.2022.4588.
Copyright: © 2022 The Author(s). This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (https://creativecommons.org/licenses/by-nc/4.0/), allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material for non-commercial purposes, provided proper attribution to the original work.
Submitted: 2022-09-02. Accepted: 2022-09-07. Published: 2022-09-21.
Correspondence: nils.hansson@hhu.de
NH drafted the paper and was responsible for the study design and the interviews. All authors discussed the interview questions. GP, TH, and FS reviewed the manuscript and contributed with comments on the paper.
Acta thanks Bengt Uvelius for help with peer review of this report.
When the Nordic Orthopaedic Federation (NOF) turned 60 years in 1979, Hans Emnéus (Lund University, Sweden) completed an edited volume on the history of the federation in which orthopedic surgeons published accounts of “Nordic” milestones in Denmark, Finland, Iceland, Norway, and Sweden (1). In the introduction, Emnéus pointed out that if he had waited for another 15 years (until the 75-year jubilee) to gather the articles, few authors would still have had any memories of the “big elephants.” Today the same can be said about the first contacts among orthopedic surgeons in the Baltic Sea region during the immediate aftermath of the Cold War. How did the first contacts across the former Iron Curtain in northern Europe emerge, and what kind of drivers of and barriers to scientific exchange did the physician-scientists face? Drawing on oral history with “bridge-builders” from Sweden and Lithuania, we wish to document some of the first steps in collaboration that subsequently contributed to the NOF membership of Estonia in 2008 and of Lithuania in 2017.
Inspired by recent European oral history projects in medicine (2), this overview reconstructs the first contacts in orthopedic surgery across the Baltic Sea after 1990. The literature concerning Northern European cooperation across the Iron Curtain in the surgical disciplines is still scarce (3,4), and the same is true regarding how the neighboring countries tried to reconnect after turbulent political times. In 2022, the first author, NH, interviewed 5 orthopedic surgeons who played significant roles in building and maintaining a scientific network from the early 1990s onward between Sweden and the Baltic states, predominantly Lithuania (where independence was declared on March 11, 1990): Li Felländer-Tsai, Stockholm, Sweden; Lars Lidgren, Lund, Sweden; Lars Olof Sjöstrand, Karlskrona, Sweden; Šarūnas Tarasevičius, Kaunas, Lithuania; and Hans Wingstrand, Lund, Sweden (5). The questions circled around the biography of the interviewee (university studies, first research experiences, scholarly focus), what the “Baltic” collaboration looked like after 1990, what role the scientific exchange in the Baltic Sea region played in research and in clinical practice, and which factors (barriers and drivers) influenced the scientific exchange.
According to the interviewees, hardly any scientific or clinical collaboration in the field of orthopedic surgery existed between Sweden and the Baltic states during the 1980s. Hans Wingstrand, who had travelled around Eastern Europe as a student on several occasions during the Cold War, mentioned that the Lund professor and Acta Orthopaedica editor Göran Bauer encouraged him to report on new research from conferences in Poland and the Baltic states as an informal science ambassador of Eastern Europe. Wingstrand told the clinic of his experiences regarding promising research projects, although he could not give full pictures as many of the talks were given in national languages. More formal contacts with the Baltic states were established after an initiative by Lars Olof Sjöstrand in 1991, which led to several study trips (sponsored by the Swedish International Development Cooperation Agency) by Lithuanian scholars to Sweden (Örebro, Karlskrona, and Malmö/Lund) and of Swedish colleagues to Lithuania (Klaipeda, Kaunas). Following those initial contacts, Lars Lidgren, Lund, intensified the Swedish–Lithuanian scientific network, enabling further Lithuanian scholars to follow clinical work and do research in Lund. In the interview, Lidgren added that the Lund clinic supported colleagues in Klaipeda with grants for annual meetings, modern textbooks, and slide projectors (6). Thus, the interviewees reflected on the transfers of knowledge on different levels, such as joint scientific publications and grant applications, guest lectures, and the arrangement of study trips to clinics around the Baltic Sea, including the exchange of PhD students. One of the latter was Šarūnas Tarasevičius from Kaunas, who defended his dissertation in Lund in 2009 with Hans Wingstrand as main supervisor (7). According to Tarasevičius, the scientific styles in Lithuania differed greatly from the Swedish standards at the turn of the millennium. First trained in the “Soviet system” (“Soviet science was quite different”), Tarasevičius stressed that it was in Sweden where he first learned how to write scientific papers and conduct clinical trials on an international level. Having said that, Lars Lidgren emphasized that it was 2-way communication from the beginning and that scholars from Lund have learned from Lithuanian colleagues. Lidgren added that recently several advanced clinical pharmacokinetic studies have been performed in Kaunas. Talking about differences between Sweden and Lithuania, Tarasevičius mentioned that it is easier to recruit researchers in Lithuania even before external funding is secured (“we are hungry for science”), and that the research bureaucracy and ethics applications are less time-consuming in Lithuania compared with Sweden.
The orthopedic collaboration between Kaunas/Klaipeda and Lund has so far resulted in more than 40 scientific articles published in international journals, many of them on hip/knee arthroplasty and register studies, 10 of them published in Acta Orthopaedica, owned by the Nordic Orthopedic Federation (8). During the last decade, a few articles from the other Baltic states have been published by the journal. From 2012 to 2020, scholars from Estonia submitted 9 articles to Acta Orthopaedica and 1 of these was published. The corresponding numbers for Finland were 224 (94 accepted), and for Sweden 417 (214) (9).
Finally, the interviewees also discussed strategies regarding how to further strengthen scientific collaboration in Northern Europe. Li Felländer-Tsai, Karolinska Institute, pointed out that most current large projects include collaborators beyond the Baltic Sea region, but that conferences with a prime focus on Northern Europe still have important roles to play, for example to deepen the collaboration particularly regarding joint register studies, to illuminate the special needs of patients in the region, also taking cultural and diversity factors into account, and not least to frame relevant discussions within our specific healthcare systems (10). Thus, the next biannual NOF congress (September 2022) will take place in Vilnius, Lithuania.