Well, we are on the way to Malawi, the final leg now, Johannesburg to Blantyre. Luckily we have made it this far with our 140 pounds of instruments and implants from Synthes- only one hurdle left to get the stuff to Queen Elizabeth and BEIT Cure Hospitals! David Katz and I are excited about spending the week with the surgeons, residents and staff at both hospitals. Check out our new Facebook page for updates during the week, including pictures. We’ll keep you posted!
Maribeth is 35 years old. The third daughter of a brood of twelve, she gave up the pursuit of her own dreams to support her family. A few years ago she left the Philippines to work overseas as a domestic helper. Toiling through work, homesickness and the demands of working in a foreign country she was able to send money home as the breadwinner of her family.
Through her hard work she supported not only herself, but her siblings and parents as well. She bore the educational expenses of her siblings so that two of her siblings have finished college degrees and now are helping the family as well. But as Maribeth earned more than the average Filipino, she remained the family breadwinner. She couldn’t stop even if she wanted to. Two other siblings were relying on her for their future.
Tragedy struck Maribeth and her family last year when she experienced back pain after she slipped and fell to the floor. Maribeth was unable to even walk, let alone work. The pain was unimaginable for her so she went to seek medical help. The doctors in the Middle East found out what was wrong. Her spine shifted forward at the base of the low back area, pressing on her nerves. When an estimate for the cost of her surgery was made, her employers refused to pay for her medical expenses. It was cheaper for them to hire a new domestic helper.
Marilyn was sent home broken and in pain. The tables were now turned. Her family was now spending for her. Her two siblings stopped their education to find work to help support the family and their bedridden sister.
For a year the family was slowly being drained of their financial resources. They went from hospital to hospital seeking treatment but to no avail. They could not afford the hospital bills and the intended spinal implants which were roughly to equivalent to four semesters in college.
Finally exhausted of their funds, they turned to the local regional government hospital, my hospital, Davao Medical Center (DMC). Government hospitals are given a bad rap in the Philippines. They are thought of as understaffed and underequipped compared to their private hospital counterparts. Especially in the field of Orthopedics where well trained personnel and state of the art equipment are scarce.
But the DMC is an exception. With the best spine surgeons in the region heading the Orthopedic Department, there is no shortage of talented manpower. The only problem remaining was the absence of expensive spine implants. All spine implants are imported from outside the country, and are difficult to come by.
When I started my residency training in DMC, patients like these would have waited a long time to have an operation. Residents like me would be lucky enough to be able to even see a spine surgery once every few months. Spine surgeries were so rare that they were reserved for the senior residents who were intimidated by the complex procedures. As a result, even though we had the skilled consultant staff, without the implants our spine experience was almost non-existent.
The problem with spinal implants all but came to an end late last year. Dr. Gilbert Cauilan, one of our spine consultants, met Dr. Dheera Ananthakrishnan at last year’s SIGN conference in Richland, Washington, USA. Dr. Ananthakrishnan was working on a project called Orthopaedic Link. We didn’t know at that time what it was all about, but we were given the feedback that it was a venue to where we could get a replenishable supply of spine implants. At first we were skeptical. Nobody is that crazy, we thought.
Our doubts were erased when an Orthopaedic Link team came to visit DMC earlier this year. When we were able to fulfill the qualifications as a recipient of the program, we were greeted with a sight that I would never forget. The day the Medtronic instrumentation arrived, it was like Christmas.
Through Orthopaedic Link we received an entire set of instrumentation and implants for spine surgery. The spine program of the hospital suddenly had the capacity to treat patients like Maribeth without taxing them further. We received gifts. Gifts we could give to others.
A few days ago, Maribeth received the treatment that she was denied a year ago. She is no longer in pain and is able to feel her legs again. I asked her what she would say to the people who gave her implants. She wrote me a short note in the native vernacular.
Dear Sir,
Good morning to you! I would like to thank for choosing me as a recipient of your stainless for my operation so I can stand up and walk again. I hope you can help more people and I again would like to thank you for the helping poor people like me. God be with you always.
Maribeth will be discharged in a few days. In a few months she hopes to be able to support her family again. We have seen her improving everyday. The residents, myself included, are no longer intimidated by spine cases. With Orthopaedic Link helping us, we know we can make a difference in the lives of patients like Maribeth. It has inspired us. Even to the point that one day, we may become spine surgeons as well.
Welcome to the new Orthopaedic Link website! Jim, Heather and I are really excited to work with you on this new venture. We plan to use this blog to carry on a dialogue with our corporate and philanthropic partners, volunteer and recipient surgeons, and donors.
Here, you’ll read the stories of real people whose lives are changed because of your efforts, and you’ll hear from those folks who are on the front lines in the developing world. We’ll bring you along on our upcoming journey to Malawi, when we deliver trauma instrumentation to surgeons who have dedicated their lives to providing care for some of the world’s poorest. And we’ll show you how your contributions allow a father to support his family after a devastating injury.
We’re thrilled you’re joining us for this mission, and we want to hear from you! Please add your own thoughts and comments, and let us know about your own experiences.
Dheera
An Early African Christmas?
As we arrived in Blantyre, Malawi last Monday with our crates of orthopaedic implants, the excitement amongst our local hosts was palpable. In a country with such limited resources, our packages brought necessary operations to several Malawians this past week.
To begin with, the people of Malawi truly live up to their reputation as “the friendliest in Africa.” We were immediately greeted with smiles and many thanks by the staff, patients, and surgeons of Queen Elizabeth Central Hospital. We were welcomed into their morning report, their ward rounds, and their operating rooms. We immediately felt a part of their community.
Our local host, Dr. Jes Bates, picked us up from the airport and greeted us with a case of his church’s own bottled water – Mkokomo, which means “sound of many waters” in Chichewa, the native language of Malawi. Although Jes was excited to see what implants we had brought with us, his main concern was getting us acquainted with our new surroundings. We were given a tour of the hospital, and we quickly came to appreciate the great need at this public facility, the only one in Malawi providing orthopaedic surgery.
Shortages were everywhere at Queen Elizabeth. From nurses to ventilators (of which they only had 1 in the ICU!), it was quickly apparent that many of the resources we take for granted in the United States are luxuries in other parts of the world. However, what they lacked in material goods they more than made up for in medical expertise. Most of their surgeons, including Dr. Bates and the chairman of Orthopaedics Dr. Nyengo Mkandawire, were trained abroad and chose to return to Malawi to practice. It was quickly obvious that a limiting factor in treating many traumatic injuries was a shortage of implants.
From an orthopaedic standpoint, lack of implants is a major issue at Queens. Fractures that we in the States routinely treat with surgery – such as forearm fractures – remain in casts because of a lack of plates and screws. These injuries are left to heal on their own, and more often than not heal abnormally, which severely limits the movement of the elbow and wrist. The story of a young Malawian male vividly captures the impact of this lack of orthopaedic implants.
Mafuno Magonja is a 24 year old farmer from a town just outside of Blantyre. He fell off his bike in July, and was placed in a cast by Dr Bates. After being seen in clinic and diagnosed with a radius and ulna fracture, he was told by Dr. Bates that his injury would be treated with a cast for the time being, because he the implants needed for his surgery were not available. Mafuno was starting to raise money to go to South Africa for his surgery, but Dr Bates persuaded him to hang on and wait for Orthopaedic Link’s arrival.
By the time we arrived, Mafuno’s fracture had almost healed, but in a crooked, nonfunctional position. Last week Mafuno Magonja went to the operating room (‘theatre’) at Queen Elizabeth and received his surgery with the appropriate plates and screws – taking his poorly functioning forearm and giving him a good chance at a great outcome. I was fortunate to be involved in this particular case, assisting Dr. Bates and his fellow Dr. Kevin Lakati (a senior registrar from Kenya training with Dr Bates for 6 months) in the operating room. The surgery went very well, and despite being trained worlds apart, the three of us – tied by common AO principles (www.aofoundation.org)– worked our way through the procedure using the Synthes instruments and implants brought by Orthopaedic Link.
This is just one of many stories we heard this past week in Blantyre, and there remains a huge need in this country for so many medical supplies. However, it was clear from our experience that Orthopaedic Link could have an enormous impact on the lives of many Malawians affected by musculoskeletal disease. We hope to continue our efforts!