AAOS Bulletin - June, 2006

Teaching limb reconstruction in Tanzania

By Lisa Cohen and Steven Abels

Tanzania, located on the east coast of Africa, is bordered by the Indian Ocean and the countries of Kenya, Uganda, Rwanda, Burundi, the Democratic Republic of the Congo, Zambia, Malawi and Mozambique. In this region of nearly 180 million people, access to health care is limited by poor road conditions, unreliable public transportation, poverty and a lack of trained professionals.

Robert H. Wilson, MD (second from left) instructs attendees at the Limb Reconstruction Workshop in the basics of pin insertion.

Not surprisingly, humanitarian aid—particularly educational assistance for health care professionals—is desperately needed.

In 2005, at the annual meeting of the Association of Surgeons of East Africa (ASEA) held in Dar es Salaam, AAOS, Orthopaedics Overseas, a division of Health Volunteers Overseas, and the South African Orthopaedic Association (SAOA) jointly sponsored an educational program on limb reconstruction. The AAOS, in cooperation with the Orthopaedic Research and Education Foundation, received an unrestricted educational grant from Stryker Orthopaedics to support the two AAOS faculty members.

Under the auspicious of the AAOS International Committee, this was the second jointly sponsored program in the region and to help improve the skills of local orthopaedic surgeons so that they, in turn, could train other health care providers. In this way, the AAOS can help satisfy the need for more effective orthopaedic surgical and medical intervention throughout the region.

AAOS fellows Robert H. Wilson, MD, and Javad Parvizi, MD—along with SAOA representatives Franz Birholtz, MD, and A. Howard, MD—served as faculty for the course, which was attended by 75 orthopaedic surgeons. In addition to instructional lectures on nerve injuries, common tendon transfers in the upper limb, normal lower limb alignment and specific approaches to limb reconstruction, the course included a practical workshop on the principles of external fixation. The workshop covered various tibial and femoral frame applications.

African surgeons face difficult challenges on a daily basis, particularly in orthopaedics. Musculoskeletal injuries are common, but orthopaedic care is available only in larger cities. According to the World Health Organization, Tanzania and its neighbors suffer a critical shortage of health care workers. The African region suffers more than 24 percent of the global burden of disease, but has access to only 3 percent of health workers and less than 1 percent of the world’s financial resources — even with loans and grants from abroad.

Despite these difficulties, the African surgeons were enthusiastic and eager to learn.

“Most attendees expressed a great desire to see similar programs in the future,” said Dr. Parvizi. “Almost every one of the surgeons attending the workshop borrowed our talks on the topics for later reference; they applauded the AAOS for recognizing the importance of this meeting.”

South African Orthopaedic Association instructor Franz Birkholtz, MD (center) demonstrates assembly of a tibial frame.

In addition to supporting orthopaedic education in subequatorial Africa, the workshop reinforced the bonds between the AAOS and various African orthopaedic communities, including the SAOA and ASEA.

“This was one of the best workshops I have ever attended,” said Dr. Parvizi. “The audience was engaging and interested; I thoroughly enjoyed the academic aspects of the program.”

Lisa Cohen is manager, international education programs, and Steven Abels is coordinator, international education programs, in the AAOS international department.


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