Kenya Orthopaedic Project
Christoph McAllen, Consultant Orthopaedic Surgeon at Plymouth Hospitals NHS Trust, Kenya Orthopaedic Project
Q: What is the Kenya Orthopaedic Project and what is the driving force behind its vision to enhance the delivery of trauma and care in Africa?
A: Kenya Orthopaedic Project (KOP) was established in 2009 to try and improve the treatment of trauma patients in rural Kenya. At the time Lucy Obolensky, a UK surgical trainee, had 10 years’ experience working in rural Kenya to improve primary care. She and local General Surgeon, Samuel Ndanya, brought a UK surgical team to work alongside the Kenyans to develop their skills. Side by side working with local teams has proved very effective, hard work but invariably great fun. Initially we focused on the theatre environment, but in the last two years, with the help of a UK Government grant we have helped establish an Emergency Department in Nanyuki District Hospital as well as helping to improve pre and post-operative care of trauma patients. KOP Anaesthetists have developed a trauma course for local doctors and nurses. Global Recognition of the Acutely Sick Patient, GRASP, has been recognised by the resuscitation council of East Africa and is now largely delivered by Kenyans.
Q: How are the visits to Kenya funded?
A: The team members typically take unpaid leave or use annual leave from their NHS posts. In addition they contribute up to £1000 to cover the costs of travel and accommodation. This may seem like a large amount but a great number of volunteers return for another trip. The questionnaires completed by volunteers on their return show that they get a great deal out of the experience on both a personal and professional level. It is particularly satisfying to see how much these trips contribute to team building and professional development. There is no doubt that this experience makes you more resourceful as a doctor, nurse or ODP when back in your UK practice.
Q: Tell us about some special cases you have been involved with?
A: We are always struck by the stoicism and gratitude of the patients that we treat. Patient expectations are generally very low. On the first three days of our visits we see on average 100-200 patients in the outpatient clinics and on the wards. We tend to see a large number of young men with femoral fractures, who have been treated non-operatively with traction. Overcrowding of the trauma ward is common, with many sharing a very narrow hospital bed with another patient. These patients often spend several months in hospital on traction. If these fractures do heal they are frequently left with a very short leg. Some are discharged with either a fibrous union or non-union. Young men are frequently the only members of an extended family earning money. If they remain disabled a large number of people become poor. Introducing a sustainable nailing system designed for low-income countries has transformed the treatment of these patients. We treated one 19-year-old patient with just this story in November 2013. He had spent three months on traction for his open femoral fracture, which had not healed. He was mobile several days after his femoral nailing. Kenyan men generally do not share their emotions but he admitted to the hospital administrator that he had been suicidal at the thought that he would not be able to walk again before he was offered surgery.
Q: What are KOP’s current teaching and learning projects?
A: By working alongside Kenya teams we are able to identify some of the local problems and help find solutions. Prosthesis procurement is a particular challenge in a country where there is no state provision for trauma surgery. Currently patients or their relatives are asked to purchase any implants from a local pharmacy. Low cost implants and health care solutions are a particular focus of interest for us. We have successfully found a means of delivering power tools at a fraction of the cost to that in the UK. A low cost solution to providing topical negative pressure wound care is also in development.
Q: What could this mean for the future of orthopaedics overseas?
A: Two billion patients around the world do not have access to the sort of surgical services that we in the UK regard as essential. We hope to help inspire young Kenyan surgeons and nurses in particular. There is a brain drain of doctors and nurses from low income to high-income countries. Higher pay and living standards will contribute to this but we have also found evidence that if Kenyans can deliver more effective healthcare for their patients they are more likely to stay in Kenya. The UK orthopaedic community, including medical device companies, have a great deal to offer in worldwide orthopaedic development.
Q: Is it not better for Kenyan healthcare workers to come and train in UK hospitals?
A: Many of the concerns that preoccupy us are not relevant for poorer parts of the world. For example delivering effective, timely surgery for open fractures without a plastic surgeon is a significant problem in low-income countries. We are therefore at risk of training people in skills that they cannot use in their home countries. We however have an annual programme where four Kenyans visit the UK for a two-week period. This is particularly focused at those who are able to achieve changes when they return home.
Q: How closely do you work with medical device companies or organisations?
A: This is really a difficult issue for us. We all work in the NHS and see devices, implants and equipment thrown away rather than be recycled for use in low-income countries. We need to develop a UK-wide programme to help hospitals donate or sell unwanted items to organisations that could redistribute them to parts of the world where they would be used for many years. Compressed gas driven power tools are rarely used in the UK now but they can be readily recycled and used in low-income countries. We would welcome more collaboration with the UK medical device industry. There is a huge market waiting for an enlightened, ambitious organisation to explore. We aim to introduce sustainable implants systems to the hospitals that we work with. A good example of this is the SIGN nail system developed in the USA, to treat patients with poor access to trauma surgery. It has jigged, distal locking, which allows implantation without an image intensifier. There is one nail for all applications: femur, tibia and humerus. The SIGN programme encourages users to report follow up for patients via an online database.
Q: How can our readers become involved in the charity?
A: Please get in touch via our Facebook page (exploring global health opportunities) or contact me (christoph.mcallen@nhs.net). Our teams have recently become quite a mixed bunch. Last year a UK medical engineer joined us on a visit for the first time. We arrived in a hospital, which only had compressed oxygen to drive our air-powered tools. We asked whether there would be an explosion risk? Probably not, he replied! Not quite the level of reassurance we were looking for. So don’t worry if you are not a surgeon or a theatre nurse. You may well have something to contribute.
