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Eritreans rely on German orthopaedic surgeon to treat their children
When Peter Griss, MD, visits Asmara, Eritrea, he is the only pediatric orthopaedist in the country.
Western orthopaedic surgeons might find it hard to imagine only operating in spring and autumn, those times of year when infection risk is typically lowest, so their cases have the greatest chance of success.
They might also find it difficult to examine a child with a grotesque malignant bone tumor in advanced late stages. They might find it even harder to not amputate the child’s limb to save his or her life solely because the parents are morally opposed to amputations.
Images: Griss P |
Peter Griss, MD, regularly faces these circumstances in his orthopaedic volunteering experience in the small country of Eritrea in Northeast Africa. For the past four years, he has participated in a humanitarian medical program there through Hammer Forum, eV, based in Hamm, Germany.
Working alone
Twice a year, Griss, 64, past head of the University Department of Orthopaedics in Marburg, Germany, and retired professor of orthopaedics, spends about one month treating children with orthopaedic deformities and other conditions mainly in Asmara, Eritrea’s capital city.
He does not mind the time away from home either, staying in a $20-a-night government hotel and working in a World War II-era children’s hospital modernized with refurbished second-hand equipment from Germany. These things do not bother him because he knows how greatly his services are needed.
“When I’m down there in Asmara, I’m the only children’s orthopaedic surgeon in the country for 3.5 million inhabitants,” Griss said.
The rest of year they go without pediatric orthopaedic treatment, although there are other orthopaedic surgeons in the country mainly working in the military hospitals, Griss said. In fact, two general orthopaedic surgeons work in Asmara, but they focus on adult traumatology.
Therefore, the Eritrean children and their parents rely heavily on orthopaedic care from Griss and those who regularly accompany him to Africa for his March and September trips — a handful of medical students and an orthopaedic resident.
Patient screening
He takes two days out from each trip to hold a clinic at a small hospital in Keren, 90 kilometers northwest of Asmara. “Just to give you a number, in spring I screened 150 patients in two days in Keren.”
Last spring he screened about 300 children and operated on 65 of them.
In Asmara, Griss trains a young orthopaedic surgeon in the surgical techniques and theory of pediatric orthopaedics. Yet he predicts it will be some time before that training starts to benefit the local people, and even longer before he can begin to think of cutting back on the time he spends in the region.
“There is so much pathology in children for an orthopaedic surgeon, I do not think we will stop this activity during the next 10 years,” Griss told Orthopaedics Today.
Congenital problems
The congenital orthopaedic problems in Eritrea are widespread. Vaccinating for poliomyelitis only started there in 2002. “There are still many, many children who suffer from sequelae from poliomyelitis. There are many congenital disorders and deformities because there is a high rate of consanguinity in Eritrea,” he said.
Griss mostly sees cases of clubfeet, congenital short femurs and hand deformities. “It’s fantastic for a European orthopaedic surgeon. I never saw that much [back home],” he said.
In addition, with a birth rate of 8,000 babies per year, the young population keeps growing and so do their medical problems. Statistics show about 50% of Eritreans are age 20 years or younger.
Lengthening program
Griss recently started a children’s limb lengthening program in Eritrea for children with postpolio leg shortening. He believes it will be particularly successful because two physicians involved with Hammer Forum now stay in Asmara year round, each taking turns at following up Griss’ patients for a half-year at a time. With them on-site, longer limb lengthening procedures are possible, he said.
Griss’ patients previously achieved only about 2 cm to 2½ cm of increased limb length in the three weeks between when the process started and Griss left for home, which “is not enough for most of the cases.” To complicate matters, he was unable to follow up with the patients after leaving Eritrea.
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With his two colleagues, a plastic surgeon and a pediatric surgeon now supervising the cases and getting paid to do that through a Swiss citizen’s sponsorship, he expects the program could lengthen kids’ limbs 4 cm to 6 cm.
Grateful people
To treat such young patients under these circumstances requires a certain kind of courage on the part of the volunteer, Griss explained. “The most sophisticated diagnosis is not possible. Only X-rays and clinical. That’s it.”
But, the Eritrean people are warm, friendly and extremely grateful for the medical care their children receive from those involved with Hammer Forum, which has grown to include pediatric urology, neurosurgery and cardiac surgery. “The patients, especially the mothers of the children, are very grateful if you help them. But, you have to have a good clinical experience and a sensitivity for the problem without knowing the language.”
Griss relies heavily on equipment and supplies donated by orthopaedic manufacturers with whom he had good relationships when he was in practice, like Aesculap, ESKA Implants and Zimmer.
Right before Orthopaedics Today talked with him, he had arranged with Zimmer to take some packets of Palacos bone cement on his next trip to Eritrea in September, which he plans to use on a young patient with a bone tumor.
When in Germany, he also spends a lot of time contacting organizations and companies who might help cover the costs of shipping all the supplies down to Eritrea, either via air cargo or shipping container.
“Any orthopaedic surgeon interested in children’s orthopaedics, in extreme cases, is invited to join me,” Griss said.