10 minute read
BOA members visit and support East Africa
Adil Ajuied, Mark Bowditch, Pranai Buddhdev and Nick Bowman
Adil Ajuied is a Consultant knee surgeon at Guy’s & St Thomas’ London. While on fellowship in South Africa, Adil had the opportunity to deliver charitable medical care alongside his fellowship. It was this time that inspired him to seek out new opportunities to support developing word orthopaedics in Tanzania.
Mark Bowditch is a Consultant Orthopaedic Surgeon East Suffolk North Essex NHS FT Trust and is the BOA Vice President.
Pranai Buddhdev is a Consultant paediatric orthopaedic surgeon at Mid & South Essex NHS Trust and a member of the BSCOS Education Committee. Pranai is on the Executive board of the Hip Hope Network, an international organisation promoting paediatric hip health worldwide and has a keen interest in promoting global paediatric orthopaedics and improving health infrastructure in Tanzania.
Nick Bowman is a Consultant knee surgeon and works in Tunbridge Wells in Kent. He has a passion for delivering medical care and teaching in developing counties and has worked in Ghana, Malawi and most recently Tanzania.
During their visitation, the team spent most of their time at the Muhimbili Orthopaedic Institute (MOI) in Dar es Salaam, Tanzania, in addition to visiting the Mnazi Mmoja Referral (MMR) hospital in Zanzibar and an orphanage for blind children during their stay.
MOI is the national reference centre for orthopaedics for both Tanzania and East Africa performing 30-40 major cases per day receiving consultant-fellows for advanced training internationally from much of East Africa, including South Sudan, Kenya, Uganda, Zambia, Malawi, and Rwanda. The institute is a Sign Nail training centre, as well as representing the only Multi Trauma Centre in the country. MOI also delivers elective services, in addition to being a tertiary centre for subspecialties such as paediatrics, arthroplasty, sarcoma, neurosurgery and sports medicine.
What was the goal of the project?
The aim of the group was to deliver specialist clinical care, not usually available, via a local tertiary hospital through direct surgical care, education and training, as well as making a substantial donation of implants and equipment. Simultaneously, and most critically, the group aimed to leave a legacy of enhanced care and ongoing clinical and educational engagement.
The group were aware that within the space of orthopaedics and trauma, there is significant need throughout East Africa, and while much of this need is trauma, the area less frequently focused upon is elective orthopaedics. Furthermore, it is well established that the regions demand far out strips the resources available.
In an attempt to match the clinical strength of the group to the local needs, and therefore maximise clinical impact MOI was identified as the ideal host institution. While being the national tertiary reference centre, clinical demand out striped the available resources and equipment. Furthermore, it was very clear early on during their engagement and interaction, that there were outstanding and highly talented local consultants surgeons with the potential to be up skilled.
In preparation for the group visitation, two members of the group conducted a pre-visitation site assessment in 2022. It was during this visit that the team first had the opportunity to assess the clinical needs of the local population, the key resources requiring donation, and critically began the process of building the friendships and relationships with local clinicians and hospital management that would allow for the surgical visitation in late 2023.
We in the UK, and wider western medicine, are accustomed to exhaustive educational and training opportunities through conferences, instructional, dry bone and cadaveric courses. These resources are not available through East Africa, and the cost of travelling abroad to access this education training is prohibitively expensive.
Who went?
The group was comprised of eight BOA-Home Fellow Consultant orthopaedic surgeons and two members of senior Smith & Nephew staff who made an invaluable contribution by way of project management and technical support.
The consultant surgeons (St Roch Society) were drawn from across the UK, six of whom primarily specialised in knee surgery, and, two paediatric orthopaedic surgeons. The group have been established approximately 10 years earlier, focusing primarily on education and training. It was during one of these educational meetings that a member of the group, Nick Bowman, presented on his personal experience of having worked in Malawi. It was this presentation and subsequent discussions that planted the seed for the Tanzania visitation.
The surgical team identified very early on that given the nature of the clinical care and education they hoped to deliver, project management and technical support was going to prove essential. The group turned to their primary industry partner, Smith & Nephew, and saw Elizabeth Turp, and Stephen Dugmore join the team. It was noted by the surgical team that the contributions of Elizabeth and Stephen were invaluable both in the pre-departure planning and equipment donation phase, as well as on the ground during the visitation.
What did they do?
Once the team had completed their assessment of the equipment and implant needs, donations were sought in the UK, collected and inventoried before being shipped to Dar Es Salaam. Donations were gratefully received from industry, hospitals, and charitable sources (Table 2).
Smith & Nephew
Hospital Innovations
OSSUR
Orthopediatrics
Fortius Clinic
Guy’s & St Thomas’ hospital NHS trust
Broomfield hospital NHS trust
Royal Tunbridge Wells NHS trust
Vista
Orthocycle
These donations included, but were certainly not limited to; three fully equipped arthroscopy stacks, shaver systems, fluid pumps, surgical instrument sets, trauma and sports implants, simple and advanced negative pressure dressings, knee braces, ankle boots, TLSOs, clutches and personal protective equipment. The volume of goods required an entire shipping container for dispatch, and were valued at approximately £1.5-2 million. The shipment received all the requisite UK and Tanzanian regulatory clearances and exemptions prior to dispatch.
Prior to departing for Tanzania, the group arranged multiple remote Zoom calls with the local clinical team at MOI, which allowed the teams to review cases and discuss clinical workload as well as planning daily schedules of activities etc. This also gave the respective teams an opportunity to establish and build relationships.
Upon arriving at MOI and following a short orientation and induction, the UK team quickly established a daily routine and programme. These would begin at 7am with a Trauma meeting, followed by a daily orthopaedic grand round seminar where two to three lectures were delivered and lively Q&A Sessions were enjoyed by all.
The teams would then divide into pairs and proceeded to theatres, ward rounds, or clinic. The teams would deliver two to three operating lists per day, completing approximately six to nine procedures per day. Every day ended with a round-table debrief of both the successes, as well as any challenges faced and strategies were put in place to enhance the next day’s activities.
The highlight of the trip?
The group report that they found the entire trip spectacularly rewarding and fulfilling and that it is so difficult to pick out any one particular highlight. However, one day does standout for the group members, which interestingly occurred away from the hospital.
Over their first weekend, they had the opportunity to go and visit and support a local orphanage for blind children and those with disabilities, (The Sathya Sai School and Orphanage). During this visit, the group members made a charitable donation and distributed toys kindly donated by one of their benefactors. Since returning to the UK the team have maintained links with the orphanage, and continue to support their amazing work.
What where some of the takeaways?
Andrew said, “Tanzania is very under-resourced in terms of healthcare. It’s a desperately poor country and they have no funds for medical equipment and implants. In all my years as a surgeon, I’ve never had to use domestic equipment in an operating theatre setting, however this is routine at MOI. MOI is a specialist orthopaedic hospital and treats people from across the entire country and neighbouring countries. They are amazing people and it was rewarding and humbling to be able to make a contribution.”
Giles commented, “The gratitude of the patients they treated and the doctors they trained and collaborated with was overwhelming. They have so little and yet achieve so much. Everything is reused including such simple things as scalpel blades. We take for granted the abundance of resource that we have here. I sincerely hope that as well as treating some patients our education and training contribution will lead to the better treatment of many more. And note to self – ‘I will endeavour to never again complain about lack of equipment’. We do not appreciate how fortunate we are! Many thanks to all those that supported this trip.”
Martin said, “The challenges the group encountered were immense but the resilience and determination of the local clinicians inspired him every step of the way. The gratitude and relief on the faces of our patients, young and old, were immeasurable. It was a humbling experience to witness the transformative power of healthcare, as we saw hope being restored and lives being changed for those less fortunate.”
What are plans for the future?
Since their return to the UK, the group has held almost monthly virtual MDT meetings with their Tanzania colleagues, and continue to be in regular dialogue. The group has also been able to secure donations to fly in three of the consultants from MOI, for a UK visitation, during which they will attend multiple cadaveric mini-lab courses, and will have the opportunity to visit multiple UK orthopaedic centres where members of the St Roch Society work. This will be a unique educational and training opportunity for these Tanzanian colleagues and will be their first trip to Europe.
Members of the group will be returning for a further visit in July 2024, and the group will also be contributing faculty to the second East African Arthroscopy Course in July 2024. n
