Harry de Vries and Frank Wijffels had visited Nyabondo rehabilitation center Kenya on behalf of the Njokuti Foundation in August 2009. A team of AMREF had operated 76 children in 5 days time!

In late August of this year, I visit accompanied with fellow surgeon Frank Wijffels from Gouda,  Nyabondo in upper southwest of Kenya at the shores of Lake Victoria. It was a reunion for me to see again this part of Kenya after more than 22 years.

Until 1987, I worked for Memisa in Mumias, about 100 kilometers north of Kisumu. I was looking forward to this reunion, in particular the trip to this part of Kenya. If you are from Nairobi on the plateau, at the edge of the Great Rift Valley, you are able to look miles away in the valley with a lookout at Longonut volcano crater. We drove in the Rift Valley along a winding track and we arrived at Kericho after 300 km what is known for its stretching miles of tea plantations. Unfortunately it was raining and we could not enjoy its real splendor. The first night we spent in Nairobi followed by the second in Kisumu. Unfortunately, our cameras and money were stolen at the hotel in Kisumu resulting in a lot of commotion from police and of course reports. After the necessary ceremonies we could greet Kenyan orthopedist colleague Murillo, who we had already met in Arusha, where he works at the Selian hospital.

Together with Murillo, we went to Nyabondo Rehabilitation Centre. This setting is located about 6 miles south of Kisumu, opposite the Nyabondo hospital. Approximately 100 children were collected; about one third with neglected clubfeet. There were many children with congenital abnormalities, crooked knees, infected bones as well as neglected dislocations and fractures.

We started on Monday. Sunday was lost due to obtaining police report for stolen goods for  our insurance and to find an ATM to collect money, because our money was stolen. Eventually I could buy a small camera with the credit card that I had left.

A begin with obstacles

And then it was Monday. I nervously saw previously that we had to operate 76 children. How should that go?

It was nice to see how the hospital co-operate with the AMREF organization. The surgeon was present on Saturday and had selected the patients. On Monday, two operating  assistants flown in with all the plaster and surgical equipment.

Nevertheless, I was a bit concerned because only one operating room in the rehabilitation center was available. Secondly, the anesthetist was not available until the end of the morning because he had to arrive from Kisumu. In the end we started with the first surgery around 2 PM because the car of our anaesthists had trouble on its way to Kisumu.

Eventually, we had the first child on the operating table at 3 o’clock in the afternoon and  were all prepared to do great deeds. Unfortunately, it failed to bring in a drip and no safe anesthetic could be given. The next child was on the operating table. Initially without any trouble until it appeared that the child had secretly eaten, so it began to vomit. Fortunately the staff prevent the child from vomiting in the lungs by adequate intervention, but everyone was shocked. The children who should undergo surgery, were brought together in a room and a break of 3 hours was added to make sure that the food would be digested with all children who had ate.

Fine example of teamwork, compassion and discipline!

The collaboration with the hospital and AMREF amazed me. There was not much else to do than to operate in Nyabondo. At half past six it is pitch dark and the silence descends. Electricity is only available in the rehabilitation center and in the hospital. In the end, we could resume our surgeries at six o’clock in the evening. And to my surprise, everyone worked the evening until half past eleven. A late dinner, then we went to sleep. Sleep? At 5 o’clock in the morning, before the chickens woke up, we were awakened with breakfast. At half past six in the morning we went to the operating room where the children have been waiting with their big eyes, isolated from anyone who could give them some food … The first child was upstairs and was prepared by the nurses. A discipline I’ve never ever experienced. I couldn’t believe it. And so it went on, a quarter to six in the morning till until half past ten in the evening was surgery time, eat and sleep, and then again at half past six next morning for next day’s program.

A great lot of compassion was shown by so many people for all the children, here in the heart of Africa, and everybody worked so hard in that one week. I was surprised of the disciplined nature and wonderful teamwork. One team was putting the plaster or dressing after surgery, while another team was already busy with washing and preparing the patient for the next operation… On Friday it was promptly finished. Just like that! What a week, what an experience!

What kind of operations did we perform?

Most of the operations were neglected clubfeet with slightly older children, where bone was removed from the foot in order to get them back in a straight position and therefore weight baring again. Less numbered children with clubfeet under three years of age who underwent a so-called soft tissue procedure to provide a nice foot base.

Furthermore, a lot of crooked legs based on probably rickets/malnutrition and a few children with Blount’s disease in what the knee is completely skewed grows by a congenital defect around the growth plate. All bones were put straight by an osteotomy. Blount’s disease must often be after treated with an orthosis to keep the leg straight. This is available at  Nyabondo rehabilitation including a workplace where orthotics and prosthetics manufactured​​.

It is more difficult to treat chronic bone infection or osteomyelitis. We don’t see these kind of infections in Western Europe, but even more we see them in Africa, often due omitting proper treatment in the acute fase  of bone infection. Finally, there was also a number of children with birth defects.

In conclusion we could do and have done a lot in a short time.
See pictures attached which give an impression of the degree of deformity