Musculoskeletal Trauma Services in Uganda

EK Naddumba,Mmed(MU),FCS(ECSA)Senior Consultant Orthopaedic Surgeon,Mulago National Referral HospitalKampala Uganda.ABJS Carl Brighton Annual Workshop,Dec.11th-

14th,2007,India.

PURPOSE

Highlight Challenges

Suggest solutions.

PROBLEM

Population=28m

Growth rate=3.5%/yr

National Budget allocation to Health=9%

Inadequate resources.

Orthopedics in Uganda 2007

23 Ortho surgeonsKampala 18Mbarara 1Masaka 1Mbale 2 Kumi 1

Unreliable equipment Unreliable supplies

Orthopedic Officers 200

Health Care Referral system

National referral

Regional referal=10

District Hosp=56

Sub district Hosp=250

Resource Distribution & Access to Services

Specialist Services,only available at Regional &National referral Hospitals

Lower health units offer PHC,Maternity,General surgical and medical services.

Pattern of Diseases

Acute &neglected fractures,

Infections, Spinal injuries, Clubfeet, Polio contractures, SCD Osteonecrosis, Tumors.

Musculoskeletal injuries in Uganda

2000 lives/year are claimed through RTA

Kampala,RTA account for 35.1%of all injuries,

Males of 15 to 45yrs are the majority.

CAUSES

Boda Boda

Traffic mix

Urbanization

Motorization

Poor roads

Poor drivers.

SERVICES AVAILABLE

SIGN Nail Cast, Skeletal traction, ORIF, External Fixators TBS.

PREVENTIVE STRATEGIES

Specialist Training (MMED,FCS(COSECSA) Train all levels of Health workers in their

environment to ensure a sustainable supply of human resource(JP.Dormans)

Govt effort to improve the Infrastructure& Equipment supply.

Law enforcement on poor road users. Orthopedic outreach program to enhance Access. International Collaboration(HVO,UBC,JAPAN)

Makerere Medical School

Professor Ronald Huckstep 1962Professor Ronald Belcher 1990 Round Table Polio Clinic

8 Surgeons16 Residents (4yrs)100 Medical Students py

Orthopedics Mulago Hospital, Kampala

Elective Surgery2 Theatre3 days per week400 cases per yr

Infections1 Theatre2 days per week500 cases per yr

EmergenciesShared Theatre7 days per week500 cases per yr

SERVICES

DISCUSSION

Access to quality specialists services is a global concern due to poor infrastructure,and inadequate resources.

Uganda is among the most affected

Solution to the problem is through human resource training, deployment, Infrastructure development&Equipment supply.

Discussion

By 2020(WHO)Trauma will be the leading cause of life lost by both developed &developing countries.

Low and middle income countries account for 85%of the deaths&90%of the annual DALYs lost because of RTA.

Conclusion

Musculoskeletal Trauma Services in Uganda are largely inadequate resulting in neglected Trauma

High population growth,urbanization,motorization &poverty are compounding factors.

Recommendations

Need for Government to plan for the growing population to access essential Musculoskeletal trauma services.

Ensure sustainable supply chain of consumables &Infrastructure development

Training of specialists in their own environment. North to South collaboration in participatory

development,

ReferencesReferences

1. Ralph K Ghormly.Progress report of the joint committee on postgraduate training in orthopedic surgery.JBJS(Am.)1946:28;399-401

2. John P Dormans,MD.Orthopedic surgery in the developing world.Can orthopedic resident help?JBJS{Am.)84;1086-1094(2002)

3. Olajede Olaolu Ajaye &Clement Adebayo Adebamowo,Surgery in Nigeria.Arc.Surgery.Feb 1999;134:2:206-211

4. CBD Lavy,N Mkandawire&WJ Harrison.Orthopedic training in developing countries.JBJS(Br.);87-B,issue 1/10-11,(2005)

1. Ralph K Ghormly.Progress report of the joint committee on postgraduate training in orthopedic surgery.JBJS(Am.)1946:28;399-401

2. John P Dormans,MD.Orthopedic surgery in the developing world.Can orthopedic resident help?JBJS{Am.)84;1086-1094(2002)

3. Olajede Olaolu Ajaye &Clement Adebayo Adebamowo,Surgery in Nigeria.Arc.Surgery.Feb 1999;134:2:206-211

4. CBD Lavy,N Mkandawire&WJ Harrison.Orthopedic training in developing countries.JBJS(Br.);87-B,issue 1/10-11,(2005)

ReferencesReferences

5 .Peterson:Neglected femoral fractures.JBJS;25(4),page 871

6. Klenerman I Neglected trauma.March 1998,JBJS,255.

5 .Peterson:Neglected femoral fractures.JBJS;25(4),page 871

6. Klenerman I Neglected trauma.March 1998,JBJS,255.

THANK YOU