Working visit Tanzania

Working visit Tanzania

Harry de Vries and Rene van den Wijngaard went to visit their African colleagues in Haydom and Arusha in April 2011. Harry reports.

On April 7th, Rene and I travelled to Tanzania via Nairobi. It was Rene’s first trip for the Njokuti foundation and the first time we went out together. Always exciting. It eventually became a very hot trip with much work and much fun. Upon arrival at Kilimanjaro International Airport, we stayed in the hotel next to the airport. The next day Pat Patten of the Flying Medical Service picked us up. It’s a strange feeling: On an international airport waiting on a plane specifically for you to pick you up and bring you to Haydom. By land it will take you all day, by plane it will take one hour.

For the first time in three years, the hospital Haydom was enclosed into our program. The last three years a Norwegian colleague called dr. Krogedahl had been working as an orthopedic surgeon. Therefore there was no need for our surgeons to visit Haydom. The reason for Njokuti foundation to include Haydom into our trip was the end of dr. Krogedahl’s stay in the Tanzanian hospital. He had to return to Norway to finish his orthopedic training.

Dr. Krogedahl had collected some patients with complex problems, which needed our attention. An additional problem was the X ray device, which was not working properly. Perioperative routine check with the C arm x ray device was not available. Rene had done additional training in fracture care by doing a fellowship in Australia for 2 years, which came in handy for treatment of some complex fractures. The non-functioning X-ray machine required a lot of our frustration tolerance…

In between operations outpatient clinics were preformed. We met with a motley collection of patients with congenital and acquired defects. Unfortunately not all abnormalities were operable. A good advice or a good explanation of a diagnosis will also be very helpful for a patient in his way to acceptance of his disability. Sometimes the treatment plane is hard for a given patient: as in the patient with the Madura Foot, which we had to recommend a lower leg amputation …. the only chance for this guy to obtain a functional usable leg in combination with a prosthesis. His religion decided otherwise. Amputation was not an option.


Clearly, this image shows the abnormal position of the head of the radius in relation to distal humerus.

For another child our presence was more of a success: an unrecognized fracture of the elbow had not been treated and had ended in a painful and stiff elbow. After extensive consultation it was decided to operate on him, which let to a reasonable function of the elbow.

Thanks to the good work of Dr. Krogedahl, clubfeet in recent years are treated in an early stage resulting in less numbers of neglected clubfeet in the elder patient. Still there are a lot of patients seen in our outpatient clinic with various stages of clubfeet as shown in the picture below.
Benjamin Cosmos was a special patient. He had severe limb deformities, which could not be treated in Haydom. We decided to bring him and his father back to Arusha to operated him in the ACLM hospital.

On Sunday, April 10the we went to Arusha. The weather was beautiful and the pilot decided to make a small detour over Lake Manyara, a beautiful natural area.

In Arusha, we booked rooms in the old monastery of the Holy Ghost Fathers. However, all the nuns were gone. It had become a more commercial guesthouse, with rental prices higher than we were familiar with.

On Monday April 11the at 8 o’clock we were present at the opening of the ALMC (Arusha Lutheran Medical Centre) in Arusha. At the end of the ceremony we had to introduce ourselves to the hospital workers. For me it was already the thirteenth time that I had to do so. For me visiting Arusha is coming home more and more each time.

The outpatient clinic was once again a great exciting experience. The rehabilitation center in Monduli had sent many children with severe postural abnormalities of the legs. The out-reach program of the ALMC hospital collected many children with an abnormality and had been able to convince the parents of the need for treatment. Fatalism, whether or not motivated by poverty, is large: if God has given this deviation at birth, who am I to change that …

The pictures below illustrate the colorful array of abnormalities in the patients we saw.

Child with “windswept Deformity”.
Child with congenital pseudarthrosis.

On the picture above you see a girl with a “windswept Deformity” as if the child was hit by a severe storm from her right side by the knees.

The next photo is a child with a congenital defect in the bones of the lower leg (congenital pseudo-arthrosis), which results in painful leg while weight bearing with a leg length difference. For this condition amputation with prosthesis is an adequate solution.

In the picture above a child with an untreated congenital bilateral knee dislocation. Fortunately, this still can be treated with reduction and plaster immobilization. On the picture on the right, René explains to the Maasai mother how to treat her 1-week-old child with congenital dislocation of both knees.

Sometimes we can make the difference. The presence of someone or something at a certain time or at a certain place, for someone a world of difference.
What we see in this radiograph is a dislocated femoral head with a fractured acetabulum.  Treatment plan for this patient was to put this young woman in a bed for a given time waiting for the pain to come done. Thereafter mobilization with a shorter leg using crutches probably for the rest of her live. The best option is to fix the fracture and relocate the hip in the fixed acetabular socket. After a rehabilitation program the young women should be able to walk on a more ore less normal leg without the use of crutches. So that is what we have done under Rene’s supervision.

And of course there was also the flow of fluorosis victims with their crooked legs, a large number of which we have operated. Unfortunately, there were also many children who were not fit enough for surgery because of additional problems. Especially in the rainy season there are many upper respiratory infections and anemia due to malaria and / or worm infections. Surgery is not wise.

After a few days, our work for Foundation Njokuti was done. It was very exciting and very inspiring. For me working for Njokuti, along with Rene, was a deja vue experience: work very hard while having a lot of fun doing so.

Harry and Rene de Vries of the Vineyard

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