Beryl watches on as Azalea Lehndorff of Calgary and Dr. James Mogire assess her leg in Kenya in late December. Beryl has already had two surgeries to improve her limited mobility resulting from a rare disorder that she and two of her siblings share in which one of the bones of the leg, the tibia, does not develop. She will require at least one more surgery to assist her to continue being able to walk.
By LAURA TESTER
Along the shores of Africa’s largest lake is a community where children wait for orthopedic surgeries.
A Better World Canada has helped to improve mobility for many children in Kendu Bay near Lake Victoria, but is eager to do more.
Last December, ABW conducted its first-ever surgical assessment at Kendu Adventist Hospital in western Kenya. The need for a thorough assessment was great, considering more than 80 children were awaiting surgery at that time.
The assessment was aimed at developing a more sustainable, ongoing orthopedic surgery program at the hospital that has been open since 1925. Kenyan experts were part of the assessment team and included retired orthopedic surgeon Dr. James Mogire as well as orthopedic surgeon Dr. Victor Oteki.
ABW first partnered with the hospital in 1990 after discovering disabled children crawling to get water from a river. At the time, retired physiotherapist Ken Hill from Canada was present to assess the children. He later acquired Kenyan government funding to hire a physiotherapist for a nearby school.
ABW began sponsoring corrective surgeries and rehabilitation, and soon surgeons from Finland became involved through Adventist Development and Relief Agency (ADRA) Finland. Overall, ABW’s rehabilitative and surgical program has assisted more than 10,000 children since 1990.
The assessment was a response to the need for a more sustainable program better able to meet the ongoing needs of the community, and at the request of the hospital for assistance in upgrading anesthetic and surgical equipment.
ABW’s goal is to ensure improved access to orthopedic surgery for children and improved access to safe essential surgeries for the whole community.
Azalea Lehndorff stands in the operating room with Dr. Oteki at Kisii Teaching and Referral Hospital to get a sense of how things work in a OR in a low-resource regional hospital.
Azalea Lehndorff was part of the five-day visit. She will soon graduate from University of Calgary’s Cumming School of Medicine and was accepted for a surgical residency in Vancouver starting in July.
She met Beryl (pictured) and two siblings who each have a hereditary condition where the tibia bone and kneecap are missing in both legs.
They’ve undergone surgeries to help them to walk and Beryl will require more surgery. Finnish surgeons and local staff worked on these cases.
“It’s a pretty big deal when you can change someone’s life,” said Lehndorff.
Thanks to funding from ADRA Finland, the surgical facility is considered adequate as it includes three operating theatres, a recovery area, a sterilization room, a laundry room, an office, and a kitchen area.
Lehndorff said she learned that only one out of three operating rooms is typically open because of inadequate equipment and insufficient staff.
As well, the four-bed recovery room is not used because of a shortage of nursing care and there isn’t any patient monitoring unit or oxygen care. Once a patient comes out of surgery, the individual is typically left in the theatre for a while, said Lehndorff. Then the patient is wheeled to the surgical ward where one nurse can watch over the recovering patient within the 25-bed unit.
“Having access to safe surgeries is one of the biggest challenges in developing countries,” said Lehndorff.
The assessment team’s recommendations included better anesthesia and surgical equipment that would meet World Health Organization (WHO) standards for safe anesthesia and safe surgery. It also suggests better post-operative monitoring of patients with a goal to set up a high dependency unit for patients requiring a higher level of care.
Local Kenyan surgeons Dr. Oteki (left) and Dr. Cheryuit are helping to keep orthopedic surgeries going year-round at Kendu Adventist Hospital.
Lehndorff said she’d like to see a “code team” set up to resuscitate patients in the event they stop breathing or their heart stops.
“Every hospital here (in Canada) has that,” she said.
She added she’s “really excited” that ABW can help to reduce complication rates after changes are made.
“We only know if that’s successful if we measure that. That may be the next step to figure out, a data collection system that’s effective.”
Improved local access and sustainability will be achieved through a partnership with local orthopedic surgeons who can operate regularly and at a fee that the hospital and ABW can afford.
“We recognize that having a team of surgeons come from another country is good and we appreciate that, but we also want to make sure the hospital is equipped to provide pre- and post-operative assessments and to continue to improve surgical outcomes,” Lehndorff said.
The surgical review also realized that training must play a key role in improvements.
“I think the medical team (of ABW) has been moving towards sustainability and building relationships to build that local capacity,” Lehndorff said.
Thanks to compassionate donors, ABW has raised sufficient funding for the most urgent needs at Kendu Bay, and it’s also pleased that Loma Linda University through Adventist Health International is providing expertise to this partnership.
ABW co-founder Eric Rajah said the surgical reviews will help the organization make the right investment decisions. It gives donors confidence that their dollars are being used in conjunction with careful analysis for the best outcomes.
“It helps our partners to see an unbiased view of their situation and helps them to discuss issues, with their leadership.”
These surgical assessments are vital moving forward.