Doing the best with what they have – our colleagues in Tanzania need our recycled surgical hardware and orthotics
I’m currently appreciating a pretty sobering demonstration of the inequities in global health. I am in Tanzania in East Africa, visiting surgical colleagues to evaluate how we can collaborate to improve the treatment of patients here. Although I was here in Tanzania many years ago, the contrast between what facilities that I take for granted in the UK, and those available to orthopaedic surgeons here in Tanzania are striking.
Where can I start? Today we operated on two patients with fractures of their thigh bones. The treatments available are limited by the resources available here. In the UK, we would have a range of surgical implants, a reliable way to sterilise instruments and we would have an xray machine in the operating theatre to provide real time imaging while implants were placed – basic fluoroscopy. Even in war zones, I have had this facility. However, here there are very few implants. For a femoral fracture today, I had to choose an plate from a bag of assorted implants. Of the two metal plates available, one was too big and the other too small. I am pretty sure these plates had been used previously in other patients and then removed. The screws available were mixed types of different diameters and lengths, but a narrow range of sizes. There was no sterilised drill available. Instead, we used a hardware store drill wrapped in surgical towels, which felt worrying. The drill bits were all broken. I couldnt find a single drill that had any tip, never mind a sharp one, for drilling holes for the screws, and in the end we used a K wire, a sharp wire that is not designed for that purpose. We managed to get the job done, and I hope the patient makes a good recovery, but it made a straight forward operation much more complicated and time consuming. The other patient had a metal rod in their femur that had been placed blind – without fluoroscopy – because there is none. The xrays taken after a previous operation showed that the metal rod was not holding the fracture. The operation today used a SIGN nail, which is designed for use without fluoroscopy in developing countries, but the instrumentation had bits missing, and other parts were broken. It is hard enough to operate with a full set of instruments and fluoroscopy, but without these, it means that patient care is compromised. The orthopaedic surgeons here are very good, but without many basic facilities, it is hard for them to offer the care that they want to give their patients. Dr B has completed fellowships abroad, and his orthopaedic knowledge and skills are second to none. However, he knows that he cant give his best treatment in the circumstances of this hospital. He shrugs when I ask him. He is doing his best – he has introduced the WHO checklist amongst other things – but without basic financial resources, he cant do more.
I have seen several patients with tibial fractures who are languishing because they cant afford to pay for emergency treatment. The system here is co-pay – the patient has to pay a part of the cost of their care. However, if they are poor, they dont get an operation, and this can prevent a working person being able to rehabilitate quickly and go back to providing for their family. It is a vicious circle.
There are few orthopaedic surgeons in the whole of Tanzania. There are more in the city of Manchester than this whole country. There is no CT scanner or MRI scanner in this regional hospital. Dr B is trained in arthroscopy and joint replacement but cant do either in this hospital, where there is no equipment and he feels it is not safe.
The NHS is justifiably the envy of the right thinking world. Providing equitable care for all with no prejudice based on ability to pay is something that we dont appreciate enough. I cant say that I will stop moaning about work, but I do value the system that we work in.
Orthocycle has some surgical equipment that has been recycled from the UK, and we are going to send a set of external fixators for Dr B and his colleagues to use. We are also going to come back to help set up a limb reconstruction service. Nursing colleagues from Manchester are also keen to come to help.
However, this hospital needs fluoroscopy, a decent autoclave and more instruments here. This is going to cost a lot for here – but not a great amount in UK terms – £10,000. We need your help to fund this. Please donate at www.orthocycle.org to help us to improve the care patients can get here in Tanzania, as well as other places we work. Even if this is just the cost of a cup of coffee a week, this will allow us to continue this work.
Injured by a bomb at the age of 7 – what kind of world are we living in?
The human impact of war and man made disasters is hard to imagine when our minds are cluttered with the minutiae of our first world problems.
Next time, you are worrying about how you are going to get up the next rung of the career ladder, or book that ‘experience’ that will see you one-up your friends or colleagues, please spare a moment to consider a young man that I met yesterday.
Adnan (not his real name) was only 7 years old living in Syria when a bomb dropped by an aircraft exploded and a fragment of the bomb entered his spine. His spinal cord was damaged and he lost the use of his legs, as well as bladder and bowel control. I wonder if the pilot who dropped the bomb ever thought about who he might have killed or injured.
Adan is now a refugee. He is an orphan. He is reliant on his neighbour (also a refugee) for help, as there are many things that he cant do. However, one thing that he did do was to brighten up our lives. This young man, with his infectious smile, and positive attitude, is quite a remarkable survivor. He touched our hearts, but I fear that the future is going to be difficult for him, as a refugee, with a disability, in a foreign country.
He came into our clinic with an ulcer on his thigh. Adnan has developed a scoliosis, a curvature of the spine, as well as windswept legs, all secondary to his injury. He is using a very basic wheelchair, which doesnt really cater for his lack of sensation, and his bony prominences. In this case the trochanter (the bump at the top of the thigh bone) has caused ulceration of the skin, where it presses on the wheelchair.
Adnan will need bespoke supports for his body within his wheelchair to support his body and prevent ulcerations on insensate skin.
We hope that we can help, and we also hope that you will be able to as well.
In my last posting, I was pleased to announce that we had raised enough money to buy another disabled man an electric wheelchair, so that he could regain some independence. I’m so grateful to those who contributed to the £1500 needed for that wheelchair. The cost of a cup of coffee for you can count to help make a difference for someone who is in desperate circumstances.
You can help to support Adnan by donating to the Orthocycle charity at www.orthocycle.org and using the on screen button. You can use any credit card. Even if it is just the cost of a cup of coffee, it will contribute to our work to help those in need, innocent victims of other people’s wars.
This is the sixteen visit I have made to treat Syrian refugees in three years. Unfortunately, I fear that there is no end to the number of injured, as I see new patients every time, and still more are being injured and killed every day, many of them children like Adnan.
Please share with your contacts, friends and colleagues.
In June, I made an appeal to raise money for one of my Syrian patients who has lost one arm and one leg in the civil war. He couldn’t get around with crutches due to the loss of his hand, and he also couldn’t use a normal wheelchair.
I’m really grateful to those of you who donated towards the wheelchair. I won’t list them all here, but the last £70 came from Clare Cleret from Chartres in France. I will email each of the donors personally to let them know and thank them individually.
As you can see from the photograph, he has now been given an electric wheelchair to give him some more independence. My Syrian colleague, Dr M, delivered the wheelchair, and sent me these photos on Friday. The smile on his face really made my day.
It is moments like this that make running the orthocycle charity worthwhile.
Although this is a good news story, there are so many more people who need help. This might be through orthotics, physiotherapy or mobility scooters. It may be through surgery that we can perform with our Syrian colleagues to heal broken limbs.
There are more and more injured every day. The current attacks on Idlib have killed 500 people since April, including 150 children. There are thousands more who have been injuried.
Please donate to Orthocycle at www.orthocycle.org to allow us to continue with this work.
Amputee Not Asking For Handouts But Desperate
Tonight, driving through the small Turkish town of Reyhanli, a stone’s throw from the Syrian border, I saw this man in the street. I will call him Ahmed, but this isnt his real name. I recognised Ahmed because I operated on him six months ago, as he had a painful nerve ending in his amputated left leg. He was sitting by the side of a road at a set of traffic lights, trying to sell packets of tissue paper to cars that had stopped at the lights.
Ahmed tries to get about with a crutch, but he cant manage well because he has only one arm. He cant use a normal wheelchair, because he cant manage that, again because he has only one arm.
We bought some tissues from him, and we tried to overpay him, but he wouldnt accept the extra money. He has a family, and is trying to make an honest living. It is heart breaking to see him unable to get around independently because of his disability. He was injured in an aerial bombing while at home in Syria, and suffered the traumatic amputation of two limbs.
The town of Reyhanli has a shocking number of amputees. Sitting in a roadside cafe in the town, it is remarkable how many people, especially young amputees, are getting around with crutches, wheelchairs and electric wheelchairs.
I dont normally use my postings to make a direct appeal, but I think that Ahmed’s fate is really shocking, and I believe that he would really benefit from an electric wheelchair to give him some independence back. The price of these locally in Reyhanli is about £1500.
I would be really grateful if you could please make a contribution, if you feel able to, in order to help buy Ahmed an electric wheelchair. Any contribution, no matter how big or small, will help.
You can make a donation at the Orthocycle charity’s website at www.orthocycle.org and as soon as we have raised enough money to buy the wheelchair, I will hopefully post a picture of him in the wheelchair to let you know that this objective has been reached.
Thank you in advance for any contributions. Please re-share with your friends and colleagues, so that we can reach this total.
Donate to Orthocycle by Pressing the Button Below
@Orthocycle1 @SyriaRelief @UOSSM mission last week – 7 ilizarov frames (3 tibial bone transports, 1 hexapod, 2 femora, 1 humerus), 2 tendon transfers, 3 amputation stump revisions…— Orthocycle (@Orthocycle1) June 19, 2019
Training for 3 syrian surgeons = sustainability for ilizarov treatment. Big thanks to our donors! pic.twitter.com/RmB7eVPpCa
Recycling Works! This boot donated to @Orthocycle1 charity in UK and now worn by syrian refugee after removal of his (also recycled) ilizarov frame!— Orthocycle (@Orthocycle1) June 19, 2019
Many thanks to Gersh and Lysbeth Lipshen, and all others who have kindly donated orthotics and crutches. @GLipshen @UOSSM pic.twitter.com/1wfbVx9E9w
My Syrian colleague Dr. M telling a patient about how his operation went today.— Orthocycle (@Orthocycle1) June 11, 2019
His thigh bone has had ten operations – hope our ilizarov frame finally solves the problem. 2 more syrian doctors have come to learn frame surgery techniques with us@Orthocycle1 @SyriaRelief @UOSSM pic.twitter.com/6ATy7GWWwG
Orthocycle Fundraising Dinner 3rd May 2019
Thank you to everyone who came to the fundraising dinner at Sultanahmet Restaurant! I hope that everyone enjoyed their meal and the company. We raised over £500!
Trustee Carol-Ann McArdle explained the concept of Orthocycle. Farhan Ali gave a fascinating talk on his visits to the Gambia to improve orthopaedic services there. Amer Shoaib gave a talk on how the UK benefits from the experience we have abroad, as well as how other countries benefit from the recycling of surgical equipment.
If you would like to donate to Orthocycle, you can click on the Pay Now button or you can make regular contributions by a direct debit.
Fundraising Dinner Friday May 3rd 1930
Sultanahmed Restaurant 1st Floor, Rusholme
Orthocycle will be hosting a fundraising dinner at the Sultanahmet restaurant in Rusholme, Manchester. This event is to bring together friends and supporters to find out more about what work we have done, and what we want to do in the future, with your help.
Please click here to find out more details about the dinner
The Best Laid Plans of Mice and Men….
July 18 2018
Todays picture shows a fairly content Syrian Orthopaedic Surgeon, Dr M, and the surgical team after a hard day’s graft treating Syrian refugees.
Treating Syrian War Casualties – Scarred Physically and Mentally…
July 16, 2018
It’s day one of another joint Orthocycle / Syrian Relief / SBMS / ATAARelief project treating casualties from the ongoing civil war in Syria. I landed at the airport in south east Turkey last night (or early today) at 0200 hours. Today was a full working day organising the logistics and seeing patients in an outpatient clinic, ready for another week of operating.
amer shoaib receiving certificate
examining 9 year old with leg injuries
infected hip joint and sacrum discharging pus
AMER SHOAIB RECEIVES CERTIFICATE OF THANKS
Manchester orthopaedic surgeon Amer Shoaib has just returned from South East Turkey, where he has spent a week working with Syrian surgeons, to treat victims of the civil war in Syria.
At the end of his week’s stay, Amer was presented with a certificate of appreciation by the hospital manager Mahmoud Kouidir.
Eight patients underwent complex external fixation surgery. This surgery is not available within Syria, and the equipment was all recycled or donated.
BIG THANK YOU TO BIOCOMPOSITES!
We are really grateful to our friends at Biocomposites, who have donated some Stimulan for treating infections in our patients. We have used this product, mixed with antibiotics to treat patients who have contaminated bone and soft tissues from war injuries. We have used it to primarily treat injuries of war – the first documented use of antibiotic space fillers for this purpose. We have used the experience from treating Syrian patients back to Manchester, where we used the same product to treat our bomb victims there. Biocomposites supported us with treatment of the Manchester bomb by giving us free Stimulan – we cant thank them enough for their generosity and humanity.
child with congenital deformity
Yasser Jabbar examines a nonplussed infant
Surgeon Yasser Jabbar operates on a child with DDH
MANCHESTER PAEDIATRIC TEAM COMMIT TO ORTHOCYCLE PROJECT
Consultant Paediatric Orthopaedic Surgeons from the Royal Manchester Childrens Hospital have volunteered to visit Turkey to assess and treat children from Syria. These surgeons are specialists in dealing with children’s musculoskeletal problems, from malformed hip joints to malaligned or short limbs.
We have been lucky to have had Dr Yasser Jabbar from Great Ormond Street visit Emel Hospital to perform surgery on children with developmental hip dysplasia and bone loss from injury. This mission was a great success.
The war in Syria affects children in many ways – physically, socially and psychologically. As there is no infrastructure left in the country, children do not have access to normal hospital services. This means that there is no specialised treatment for children with traumatic injuries, and also no treatment for children who have congenital or developmental problems that require input from an orthopaedic surgeon.
The Manchester team will be heading out late in 2017.