Orthopaedics

  • Leicester Lead: Laurence Wicks 
  • Gondar Lead: Dr Mensur

In 2013 I was awarded the David Watkins Overseas grant, by University Hospitals of Leicester, to try and establish an orthopaedic link between Leicester and Gondar. I made my first visit to Ethiopia at the end of November 2013, really as a fact finding mission before a longer visit I have planned in August 2014.

The Gondar surgical department is made up of 10 general surgical consultants, each with an area of specialist interest. Dr Mohammed is the sole consultant taking an interest in orthopaedics (almost exclusively trauma).

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There is a morning meeting on Tuesday and Thursdays to discuss the admissions. The residents are generally left to deal with the emergencies, and call a consultant if there is big case beyond their abilities to manage. Wednesdays are dedicated to education, with residents giving presentations (and a monthly morbidity and mortality report). Dr Mohammed will do a ward round and clinic on Tuesdays, and operates all day on a Friday.

As with many African countries, the incidence of trauma is increasing as the number of roads and vehicles rises. This provides a significant workload for the staff at Gondar. Many of the trauma patients have multiple injuries, require high levels of care, and spend a lengthy time in hospital.

Currently in Gondar the trauma patients are brought through a triage area and are then directed to the Emergency room. If they require emergency resuscitation and surgery, they are taken to the ‘recovery area’ which is used for pre-op, post-op and sick surgical patients. This system is inefficient and so there is desire to create a dedicated ‘trauma unit’ which would streamline and improve the care of these patients. The surgeons in Gondar have been collaborating with the trauma unit from Vancouver, and when I was in Gondar I met with Professor Richard Simons who was visiting at the same time. I therefore do not plan to become heavily involved in development of the trauma service in Gondar, but will keep in contact with Professor Simons (who is originally from Leicester!) to work together constructively in the future and to avoid stepping on each other’s toes.

My interest in Gondar instead will focus on working with Dr Mohammed to support the orthopaedic unit. He is in desperate need of some basic surgical equipment and I am meeting with Tim Beacon from MedAid to try and secure this.

Following my visit last year, it is clear to me that there is a need to develop training of the surgical residents as they work towards the COSECSA MCS. The collaborative teaching project website makes it possible to do some of this without travelling to Ethiopia, and I hope to encourage my colleagues to become involved in this way. Part of the difficulty for trainees, I feel, is a lack of mentorship and I hope to establish a partner scheme, where trainees in Leicester can support individual residents in Gondar by email.

As part of the training in Gondar I am looking to run the Primary Trauma Care course which had become a well established alternative to ATLS for low and middle income countries. By training up a local course faculty, this can become a regular part of the training calendar.

An orthopaedic link between Leicester and Gondar is taking time to establish but I hope that by developing a good relationship with surgeons in Gondar, and by focussing on training and education, that the link will be sustainable.

Written by: Laurence Wicks
Orthopaedic trainee

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