British volunteer annually trains orthopaedists in Ethiopia

One problem: patients must provide their own drugs and dressings.

Issue: Issue 6 2005

Through his volunteer efforts, orthopaedic surgeon Stephen K. Wood, FRCS, feels he has made a difference in the quality of care that orthopaedic patients receive at Black Lion Hospital in Addis Ababa, Ethiopia.

“It maybe only small, but I think it’s worthwhile,” Wood recently told Orthopaedics Today.

Ethiopia’s doctor/patient ratio — 1 to 77,000 — is one of the worst on the African continent, so the local consultants and residents welcome nearly any outside medical help they can get.

Wood has volunteered at Black Lion Hospital for about one month each year for the past seven years through the British section of World Orthopaedic Concern, an organization established to improve the standard of orthopaedic care and education worldwide.

During each trip — usually made in February — Wood primarily works with the three or four graduate orthopaedic students in the hospital’s university program.

“I help the local consultants prepare the exam papers and assist them with the examination of the students,” said Wood, formerly a senior lecturer at Southampton Hospital Medical School in Southampton, England.

The examination “just happens to happen while I’m there, but because of it, I go back the same time each year, and it fits in with my program in the United Kingdom, too,” said Wood, who travels to Ethiopia with his wife, Anita.

Acting as a problem solver

Wood said the most rewarding aspect of his trips to Addis is the realization that the Ethiopian surgeons resolved problems he encountered in prior visits. But sometimes he returns to find a different problem or challenge in its place, such as the staff trying to manage caseloads with one less doctor after a consultant relocated.

Still, Wood feels he helps the staff overcome each challenge, and they learn from that process. “They’re moving on and they are improving — or they seem to be improving — each time I go, which is very pleasing.”

Wood told Orthopaedics Today that rheumatoid arthritis (RA) is one of his main clinical interests, and he has frequently worked with neurosurgeons on cervical spine problems stemming from RA.

While he has visited other countries through World Orthopaedic Concern, the mainly British-based organization for which he is treasurer, none of those experiences truly prepared him for the conditions he encountered in Addis or at Black Lion Hospital.

The public, 800-bed tertiary referral hospital was built nearly 60 years ago. “In terms of what you might expect in the developing world, it’s not a bad hospital, but of course, it’s been slowly crumbling to pieces, particularly the cast iron plumbing,” Wood said.

Consequently, Black Lion workers have had to treat a constant flow of patients while workers extract the old plumbing and install a new system. On his trip there this February, Wood found one-third of the hospital closed in an attempt to speed up the repair process. “To lose a third of the beds of the hospital … is quite significant,” he said.

While there, Wood stays in the operating theater for orthopaedic cases, but does not operate. He prefers to serve as a teacher and support person, but even that can be trying at times.

“The theaters aren’t air conditioned, for instance. There is usually, but not always, running water,” Wood said. Should the water stop running, all operations cease because the equipment cannot be cleaned.

Wood recalled one instance when someone held a torch overhead so the operating physician could complete a case during a power loss.

Orthopaedists in Addis are often faced with treating burn contractures, like this one in the arm of a 6-year-old child.

Patients seeking admission to Black Lion Hospital must sometimes wait until their families can purchase necessary medical supplies for their operations. According to Stephen K. Wood, requiring patients to provide surgical supplies leads to lengthy surgical wait times.

Courtesy of Stephen K. Wood

Patients supply meds, dressings

Perhaps the most frustrating aspect of Wood’s trips: Patients have to provide their own dressings and drugs for an operation.

“If they haven’t got the money [to buy supplies], they don’t get the operation,” he said.

Patients who do not bring their own dressings and drugs with them, including trauma patients, are assigned a hospital bed to stay in until their relatives find enough money to purchase the necessary medical supplies.

“There are significant delays [in treatment] because of this situation. We’ve tried to think of ways around it,” Wood said.

Stocking supplies in the hospital would be futile. “It’s unlikely that they will remain there,” he added.

The majority of orthopaedic patients at Black Lion Hospital are trauma cases from motorized vehicle crashes. Although major trauma cases are handled quickly, physicians may not necessarily treat them in the operating theater. Instead, physicians in an auxiliary unit may oversee the initial management. “But, they cannot do definitive treatment because they can’t get them into the operating theater” due to the supply issue, Wood said.

Wood, at left, conducts seminars and other forms of training for orthopaedic students and medical residents during his month-long visits to Black Lion Hospital.

Wood also sees numerous deformities like clubfeet, chronic infections such as osteomyelitis, and some severe scoliosis cases in children that the hospital is not equipped to treat operatively.

Another nagging problem is the lack of anesthetists, many of whom now work at the city’s higher-paying private hospitals.

There are currently three orthopaedic consultants at Black Lion Hospital who see about 100 inpatients and hundreds of others in the fracture and referral clinics.

The number of consultant orthopaedic surgeons going into private practice has hurt public hospitals.

“What is in some ways helpful [for the hospital] is that the qualifications consultant surgeons get from Black Lion are not really up to the standard of orthopaedic qualifications in the First World, so they are not considered ‘properly’ trained,” he said.

Also, the hospital’s medical school does not have reciprocal arrangements with other countries. This has affected some Ethiopian physicians who went overseas hoping to work, but were turned away.

Providing training materials

To support Wood’s training efforts, Sally Tennant, FRCS, another surgeon with World Orthopaedic Concern focused on Ethiopia, is collecting older orthopaedic textbooks to ship to Addis. She is a consultant at London’s Royal National Orthopaedic Hospital.

The Ethiopian surgeons desperately need textbooks that explain and illustrate many basic orthopaedic procedures. For example, they are more interested in learning how to perform an osteotomy than reading about total joint replacements and more current technology covered in the newer texts, Wood said.

For more information:

Consultants or specialist registrars with five or more years experience who are interested in volunteering in Ethiopia through World Orthopaedic Concern should expect to teach residents and graduate-level students and stay for a minimum of four weeks. On-campus housing is provided.

To become a member, donate or volunteer, please contact the Treasurer, World Orthopaedic Concern, c/o British Orthopaedic Association, 35-43 Lincoln’s Inn Fields, London WC2A 3PN, England. Tel: +44-71-405-6507; Fax: +44-71-831-2676; or go to www.wocuk.org