Orthopaedics Training at the University Teaching Hospital (UTH), Lusaka, Zambia
By Emmanuel Malabo Makasa
The University of Zambia (UNZA) School of Medicine offers a Master of Medicine degree in orthopaedics at the University Teaching Hospital (UTH). I have had the privilege to study on this program for the last four years and I am now in my final year. Entry qualifications and other details on course outline and fees can be obtained on the university website; http://www.medguide.org.zm/somnew/Default.html and therefore I will concentrate on my experiences on the program.
Suffice to say that Part I consist of a one-year curriculum in the basic sciences which includes lectures tutorials in Anatomy, Biochemistry, Immunology, Microbiology Pathology, Pharmacology, Physiology, and Psychology. This part is followed by written and oral examinations. This part also covers material essential for all fields of training. Part II of the MMed programme consists of clinical work, a research project and the preparation of a dissertation based on the research project. The Part II examination is by written papers, practical clinical examination and a viva.
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| Ridgeway campus hostels for medical
students, University of Zambia,
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I joined the program in the year 2003 and there is only one other colleague in my class. By coincidence both of us are called Emmanuel! He is Dr.Emmanuel Simwanza while I am Emmanuel Makasa. Nevertheless, we have other colleagues coming after us on the program, all of them Zambians but there is enough room for any foreigners who would like to join us. This is a 4 years program in general orthopaedics.
I have had a lot of support from the faculty staff in the department of Surgery and from the surgical fraternity through out the entire region of East, Central and Southern Africa. At home, we have had the opportunity to continue to work with our General surgery colleagues especially on their call days. I understand that the term “General Surgeon” is quickly disappearing from practice in developed countries but for us in Africa, we have not sub-spcialised because of the reduced manpower. Hence, even orthopaedic trainees would have to learn general surgical skills just in case a situation arises, as is usually the case. Orthopaedics does not stand alone as a department yet at the UTH and so we all belong to the department of surgery together with all others subspecialties in surgery.
We also train at a private catholic hospital called the Zambia-Italian orthopaedic Hospital (ZIOH) and are very grateful to the Dean, Prof. Y.Mulla and Prof. J.Jellis. As though that is not enough, we are also privileged to operate around the country with our consultants on the FLYSPEC program where we fly to different locations around Zambia to operate on poor rural communities that would otherwise not make it to Lusaka.
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| Sometimes, the little plane would not start and so here Dr.Goran Jovic and Dr.Makasa try to put their aeromechanics theories into practice (very trying for the light hearted….) |
You should note that orthopaedic surgeons in Zambia are very few and can only be found in the capital, Lusaka. The Flyspec program fall under LORET (Lusaka orthopaedics Research and Education Trust). On such trip, we are privileged to work with our Plastic surgeon, Dr. Goran J.
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| Dr.Emmanuel Makasa in front of the
Beech-craft used on the flyspec program at Kaindu airfield,
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Trying as it may seem, its always a pleasure to look at the amazing Zambian landscape on the way back home after a successful outing. Here the Zambezi escarpment in the background and Luangwa river in the South Luangwa National Park after a stop over to refuel at Mfuwe on our way to Chilonga mission hospital in Mpika district across the escarpment.
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| Muchinga Escarpment |
Some of the things I get involved in as part of my training include the Club Foot Week. This is an initiative that the doctors and nurses both in theatre and clinic came up with to try and clear the backlog of clubfoot patients that we have all over the country. As you may or may not be aware of, orthopaedics is only done in Lusaka at the UTH in Zambia.
This last one was co-ordinated by Sr.Chitolo and Drs Munthali James and Maudu Chowa.
We fundraised from the Ministry, Celtel and The Maureen Mwanawasa Initiative. We needed to fundraise because we had to take on extra time and materials to use in theatre and we operated the whole week. So we needed funds for material, Lunches for personnel and a little allowance for motivation.
Such initiatives come about because at times, we don't have enough operating time and there is a timeframe on which to operate on these children if one is to expect fairly good results or for the children to have a good start in life.
People are made aware of this through National Radio and parents are encouraged to bring their affected children.
After careful selection, the actual
management of these children depends on the severity of the clubfoot and the age of the child and it ranges from manipulation with serial pop casting (ponsentty method), Tenotomies of the TA and TP tendons on the affected foot to the PMR (posteromedial release) which is a major operation.
I should mention that we need lots of financial support to continue this project because the staff are very willing to work and give these little angels a good start in life.
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| Severe Clubfoot in right limb Pre-op |
Clubfeet constitutes a large number of cases operated on to give these young children a good start in life. Above is a picture of a severe type of clubfoot affecting the right limb before operation
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| After the Posteromedial release (PMR) operation |
From the Sub-region, we have traveled extensively and have had the opportunity to interact with others surgeons at scientific meetings that that are held in a different country each year under the College of Surgeons of East Central and southern Africa (COSECSA) and the Association of Surgeons of East Africa (ASEA). This is always a great opportunity for training through workshops and we get a chance to make out presentation of research that is on going in our region. Our South African colleagues have played an essential role in this. We also had had great support from organizations such as the AO Foundations through their social economic chairman, Dr. Paul Demmer.
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| The Zambian delegation at the last
COSECSA/ASEA meeting in
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The support is overwhelming, the experience enriching. We would really like to share this with colleagues from Zambia, the whole of Africa and indeed anyone else from whole wide world. Ours is a very humble but very satisfying existence. For me, happiness is all I can ever hope to get out of this life and so with my little friends, we can afford to smile even when everyone thinks that we are suffering…
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| My smiling and happy little friends from
St.Francis Mission,
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Dr.Emmanuel
Malabo Makasa (Bsc.HB,
MBChB)
4th Year M-Med (Ortho) Student
University
Teaching Hospital,
Tel:
+260-95-455987