Due to delay of our flight from Nairobi our arrival was unfortunately a bit  later at Mwanzay, but Dirk  was our representative  on behalf of the welcoming committee.

Patients were already waiting In Sumve. A total of more than 50 patients presented till eight pm. Some of them without obvious orthopedic problems, but the majority had an abnormality of the musculoskeletal system. Unfortunately, we couldn’t offer treatment in a few patients because of the limited surgical options such as absence of fluoroscopy or specific instruments.

The remaining patients were eligible for a (surgical) treatment. Patients with (old) clubfeet, crooked legs due to malnutrition and old fractures were enlisted for OR.  All patients are treated the next  two days in 2 Operating Rooms with the help of a local team and two Nijmegen interns Kevin and Jose. The children received a cuddle toy for comfort  after surgery. See photo

The organization of hospital has been changed. Dr. Wilhelima is the new head, just graduated and direct responsible for the entire hospital!

Dirk and Tineke are volunteers and  (re) settled in Sumve and are therefore an excellent contact for us. In the future they will be able to organize our missions. Meanwhile there are several grant applications running for various hospital projects ensuring development of the Sumve hospital. However Njokuti contribution will be essential in the future.

On the next, very early Sunday morning we flown back over beautiful Serengeti to Arusha Luthern Medical Center for the second period.

Monday was outpatient clinic day, but unfortunately there were less outreach patients than last year. Perhaps due to the fact that Paula returned to Britain in combination with the pregnancy of Sarah what could result in less time can be spent for  the outreach program. Another cause could be that the local orthopedic team consisted of  dr Kibira and Dr Peter are able to treat clubfeet and crooked legs . A obviously very good development!

We encountered  children with (old) fractures and crooked legs during this consultation, but remarkably few clubfeet.  We were able to use  2 operating rooms, but it was not really necessary because of the amount of patients. This time-leftover was in favor for training and education. The equipment and instrumentation was pretty good, although it could still be organized better. We have not ventured arthroscopic surgery, but this could be done in the future, only when maintenance of the equipment can be guaranteed.

Although there is hardly any other treatment option available, we couldn’t offer surgical treatment for a young patient suffering from an extensive bone tumor of the upper arm. This after extensive consultations with the staff and facing high risk of complications. Also one case of pathological fracture due to bone infection could not be operated on due to pulmonary problems and anemia. The remaining patients were enlisted for surgical treatment.

On our last day we have visited the old Selian hospital. This hospital has significantly fewer facilities, but could certainly be on the program as part of Arusha visit.

In summary, as in 2011, a very  efficient program. We could  expand in Sumve , as Dirk and Tineke provide a good base and contact for our missions. Lack of tools and operating instruments are a serious problem. We could consider using a volume sea-container to transport equipment. Contact address is located in Zeeland, the Netherlands.  Tools and financial contribution will be further discussed and elaborated. In addition, aftercare of post-operated patients is not always well organized and is a concern.

ALMC is  under its way and will probably need less orthopedic help in the future. Also plastic surgery care is taken care, mainly short-term, by physicians from the U.S. However good training to local doctors is more important for structural care. Offered  orthopedic problems mainly consist of complex problems what not always can be treated because of limited possibilities. However, opportunities for expansion of both plastic and orthopedic care are available at Selian Hospital and need to be developed in near future.

 

October 2012
Writen by: Peer Poelmann and Ron Onstenk (orthopaedic surgeons)