Musculoskeletal Trauma Services in Uganda
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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.
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PURPOSE
Highlight Challenges
Suggest solutions.
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PROBLEM
Population=28m
Growth rate=3.5%/yr
National Budget allocation to Health=9%
Inadequate resources.
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Orthopedics in Uganda 2007
23 Ortho surgeonsKampala 18Mbarara 1Masaka 1Mbale 2 Kumi 1
Unreliable equipment Unreliable supplies
Orthopedic Officers 200
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Health Care Referral system
National referral
Regional referal=10
District Hosp=56
Sub district Hosp=250
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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.
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Pattern of Diseases
Acute &neglected fractures,
Infections, Spinal injuries, Clubfeet, Polio contractures, SCD Osteonecrosis, Tumors.
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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.
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CAUSES
Boda Boda
Traffic mix
Urbanization
Motorization
Poor roads
Poor drivers.
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SERVICES AVAILABLE
SIGN Nail Cast, Skeletal traction, ORIF, External Fixators TBS.
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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)
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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
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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
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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.
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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.
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Conclusion
Musculoskeletal Trauma Services in Uganda are largely inadequate resulting in neglected Trauma
High population growth,urbanization,motorization &poverty are compounding factors.
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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,
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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)
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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.
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THANK YOU