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Musculoskeletal Trauma Services in Uganda

Musculoskeletal Trauma Services in Uganda. EK Naddumba,Mmed(MU),FCS(ECSA) Senior Consultant Orthopaedic Surgeon, Mulago National Referral Hospital Kampala Uganda. ABJS Carl Brighton Annual Workshop,Dec.11th-14th,2007,India. PURPOSE. Highlight Challenges Suggest solutions. PROBLEM.

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Musculoskeletal Trauma Services in Uganda

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  1. Musculoskeletal Trauma Services in Uganda EK Naddumba,Mmed(MU),FCS(ECSA) Senior Consultant Orthopaedic Surgeon, Mulago National Referral Hospital Kampala Uganda. ABJS Carl Brighton Annual Workshop,Dec.11th-14th,2007,India.

  2. PURPOSE • Highlight Challenges • Suggest solutions.

  3. PROBLEM • Population=28m • Growth rate=3.5%/yr • National Budget allocation to Health=9% • Inadequate resources.

  4. Orthopedics in Uganda 2007 23 Ortho surgeons Kampala 18 Mbarara 1 Masaka 1 Mbale 2 Kumi 1 Unreliable equipment Unreliable supplies Orthopedic Officers 200

  5. Health Care Referral system • National referral • Regional referal=10 • District Hosp=56 • Sub district Hosp=250

  6. 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.

  7. Pattern of Diseases • Acute &neglected fractures, • Infections, • Spinal injuries, • Clubfeet, • Polio contractures, • SCD Osteonecrosis, • Tumors.

  8. 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.

  9. CAUSES • Boda Boda • Traffic mix • Urbanization • Motorization • Poor roads • Poor drivers.

  10. SERVICES AVAILABLE • SIGN Nail • Cast, • Skeletal traction, • ORIF, • External Fixators • TBS.

  11. 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)

  12. Orthopedics Mulago Hospital, Kampala Makerere Medical School Professor Ronald Huckstep 1962 Professor Ronald Belcher 1990 Round Table Polio Clinic 8 Surgeons 16 Residents (4yrs) 100 Medical Students py

  13. SERVICES Infections 1 Theatre 2 days per week 500 cases per yr Emergencies Shared Theatre 7 days per week 500 cases per yr Elective Surgery 2 Theatre 3 days per week 400 cases per yr

  14. 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.

  15. 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.

  16. Conclusion • Musculoskeletal Trauma Services in Uganda are largely inadequate resulting in neglected Trauma • High population growth,urbanization,motorization &poverty are compounding factors.

  17. 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,

  18. References Ralph K Ghormly.Progress report of the joint committee on postgraduate training in orthopedic surgery.JBJS(Am.)1946:28;399-401 John P Dormans,MD.Orthopedic surgery in the developing world.Can orthopedic resident help?JBJS{Am.)84;1086-1094(2002) Olajede Olaolu Ajaye &Clement Adebayo Adebamowo,Surgery in Nigeria.Arc.Surgery.Feb 1999;134:2:206-211 CBD Lavy,N Mkandawire&WJ Harrison.Orthopedic training in developing countries.JBJS(Br.);87-B,issue 1/10-11,(2005)

  19. References 5 .Peterson:Neglected femoral fractures.JBJS;25(4),page 871 6. Klenerman I Neglected trauma.March 1998,JBJS,255.

  20. THANK YOU

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