Trip Report | April 8 - 25, 2014

Contents

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3 ....................Personnel

4 ....................Trip Schedule

5 ....................Courses

8 ....................Lectures

9 ....................Clinical Training

10.................Rehabilitation

11 ................Device Innovations

12 .................Research

15 ................USTOP Supporters

PersonnelDr. Piotr Blachut, orthopaedic surgeonRegina Colistro, physiotherapistDr. Tymothy Frank, orthopaedic residentAudrey Hiebert, nurseSherry Kennedy, nurseDr. Jeremie Larouche, orthopaedic surgeon

Michelle Lord, nurseDr. Peter O’Brien, orthopaedic surgeonNathan O’Hara, coordinatorThomas O’Hara, photographerDr. Jeff Potter, orthopaedic residentTrina Stephens, researcher

USTOP would also like to thank Dr. Tito Beyeza and the entire staff at Mulago Hospital, Dr. Rodney Mugarura our GPAS/USTOP scholar, Ms. Harriet Nambooze from the CNIS Skills Lab, Ms. Alice Kabakwonga for her research support and Ms. Monica Kabagambe for all of her hard work to ensure this trip was a success.

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Trip ScheduleApril 2014

Sunday Monday Tuesday Wednesday Thursday Friday Saturday

8 9 10 11 12

OR (Casualty) Hospital Rounds

OR (Casualty, Ward 7)

OR (Casualty, Ward 7, Main)

Perioperative Nursing Course

Perioperative Nursing Course

13 14 15 16 17 18 19 Basic Bioskills Course

OR (Casualty, Ward 7, Main) Morning Rounds/ Case Discussions Econ Patient Interviews

OR (Casualty) Hospital Rounds Morning Rounds/ Case Discussions Econ Patient Interviews

OR (Casualty, Ward 7) Morning Rounds/ Case Discussions Econ Patient Interviews

OR (Casualty, Ward 7, Main) Morning Rounds/ Case Discussions Peter, Sherry to visit CoRSU

GOOD FRIDAY Outpatient Clinic OR (Casualty) Morning Rounds/ Case Discussions

Advanced Bioskills Course

20 21 22 23 24 25 26 EASTER MONDAY

OR (Casualty) Morning Rounds/ Case Discussions

OR (Casualty) Hospital Rounds Morning Rounds/ Case Discussions

OR (Casualty, Ward 7) Morning Rounds/ Case Discussions USTOP to visit CoRSU

OR (Casualty, Ward 7, Main) Morning Rounds/ Case Discussions

Outpatient Clinic OR (Casualty) Morning Rounds/ Case Discussions

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CoursesCNIS Safe Surgery Saves Lives - Perioperative Nursing CourseDate: April 11 - 12, 2014Location: CNIS Surgical Skills Lab, Mulago HospitalTopics:- Introduction to the Surgical Safety Checklist - Anaesthesia-Safety Assessment- Before Induction - Surgical Scrub/Glove/- Before Incision Gown Technique- Before Transfer From OR - Antibiotic Prophylaxis- Preventing Hospital Acquired Infections This was the fourth time that USTOP has partnered with CNIS to offer their two-day interactive course. The course uses the structure of the WHO’s Safe Surgery Checklist. The participants learn why each component of the checklist is vital, how to collaborate and assist the team in safe patient care, as well as specific perioperative skills – correct scrubbing, gowning, and gloving, and performing surgical counts. The course consists of lectures, group case studies, discussion, presentations, role play and skill sessions.

The course was taught to 20 nurses and theatre assistants over two 8 hour days. 3 from Main Theatre, 2 from Casualty Theatre, 3 from Ward 7 Theatre, 3 from the Uganda Cancer Institute, 3 from Gyne Theatre, 1 from the Labour Suite Theatre, 1 from Infection Control, 1 surgery area manager and 3 from CoRSU Hospital in Entebee.

CoursesOrthopaedic Bioskills Course - BasicDate: April 13, 2014Location: CNIS Surgical Skills Lab, Mulago HospitalAttendance: orthopaedic residents (years I, II), surgical residentsTopics:LECTURE Spectrum of stability LECTURE Plate design and function LAB Review of basics: lag / neutralization radius / LCDC ulnaLECTURE Tibial plateau fractures: unicondylar LAB Tibial plateau: ORIF ButtressLECTURE Patella fractures LAB Patella : TBWLECTURE IM nailing principles LAB IM nail tibiaLAB IM nailing Femur: antegrade IM nail / retrograde IM nailLAB External Fixator: Pelvis

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Orthopaedic Bioskills Course - AdvancedDate: April 19, 2014Location: CNIS Surgical Skills Lab, Mulago HospitalAttendance: orthopaedic residents (years III, IV)

Topics:LECTURE Principles of articular fractures LECTURE Distal humerus fractures LAB Distal humerus: ORIF LAB Distal Radius: ORIF Volar PlatesLECTURE Distal femur fractures LAB Distal Femur Coronal split lateral condyleLECTURE Bicondylar tibial plateau fractures LAB Tibial plateau:Bicondylar - simple medial / split depression lateralLECTURE Pilon fractures LAB Pilon fracture: Distal tibia

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Courses

Lectures

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Morning Orthopaedic Teaching SessionsAttendance: orthopaedic residents

Topics:Review of the work-up and management of pathological fracturesManagement of periprosthetic fracturesAcute management of a polytraumatized patientFracture dislocation of the ankleReview of the treatment of open tibia fracturesReview of the treatment of Terrible Triad injures of the elbowManagement of non-unions in the lower extremitiesCase Review: malunions in the lower extremitiesCase Review: polytraumatized patientCase review: subtalar dislocationsProximal humeral dislocationsShoulder fracture dislocationsHumeral shaft fracturesIntra articular distal humeral fracturesElbow fractures / dislocationsPelvic fracturesAcetabular fracturesOpen fractures

Aseptic Technique - Sterilization - Scrubbing/Gloving/GowningAttendance: Orthopaedic Officer Students

A presentation on basic aseptic technique, sterilization andscrubbing/gowning/gloving was given to 44 orthopedic officer students. Orthopedic officers students work in the theatre as part of their training but do not receive any formal education regarding these principles.

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USTOP participated in a variety of cases with the staff and trainees at Mulago Hospital. Procedures were done in the casualty theatre, ward 7 theatre and the main theatre.

Clinical Training

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Prosthetic Hands ProgramThe LN -4 Prosthetic Hands project, which was initiated last year, was formalized further. This project is a collaboration between USTOP, the Mulago Hospital Occupational Therapists and the Ellen Meadows Foundation (USA) which provides the prosthetic hands. A presentation was given to the orthaopedic residents at the bioskills course and to the Mulago physiotherapists at their staff meeting, on the LN-4, with the aim of increasing appropriate referrals to the OT’s. Three more amputee patients were fit during this trip.

Physiotherapy Assessment FormsAt the request of Mr. Richard Kasiita, the Director of Physiotherapy, Mulago Hospital, a basic physiotherapy assessment form was drafted for out-patient therapists, but which can also be used for in-patients.

Educational SessionsTopic - AudienceSpinal Cord Injuries - ICU nurses, Spine Unit nurses -Physiotherapy students**Assisted by Brenda, who suffered a spinal cord injury4 years ago and is now living in the community.

Infrastructure SupportFacilitation of the design, and production of a physiotherapy mat and parallel bars for the spine ward rehabilitation project. This involved USTOP, the spine ward staff and the orthopedic workshop. A teaching session on transfers, balance, etc. using the mat was provided to the nurses and rehab staff.At the request of Dr. Larouche and in conjunction with the OT’s of Mulago, a Sarmiento type brace for humeral fractures was designed and manufactured by the Mulago workshop.with a view to have them readily available for the local orthopedic surgeons/residents.

Rehabilitation

Additionally, physiotherapy support was provided to the USTOP surgeons and Ugandan surgeons/residents. The support was primarily as a facilitator/link the Mulago physiotherapists who cover the respective wards and the surgical teams.

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Device InnovationThis trip brought several new innovations developed in collaboration with UBC Engineering. These devices are engineered to solve perioperative challenges in Uganda. Some of the projects include:

Drill Cover DesignNow in it’s fourth version, this Grand Challenges Canada funded innovation is a resterilizable cover to enable surgeons to use commercially available drills in the operating room. The design has tremendous potential in a low resource setting. The current prototype is under revision and looks to move towards testing for possible FDA or Health Canada approval in the near future.

Surgical Screw CutterLimit surgical supply inventory leads to deficiencies in common surgical screws sizes. A new design by UBC MASc students will enable a surgeon to cut surgical screws to the appropriate size intraoperatively before insertion.

Bone RetractorTo improve the outcomes of patients with delayed management of long bone fractures, UBC MASc student Florin Gheorghe is working to develop a device to assist during operation.

Targeting ArmA first project with BCIT’s Product and Process Applied Research Team, USTOP co-developed a targeting arm to aid in the insertion of locking screws for intramedullary nails without the assistant of intraoperative imaging.

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ResearchEconomic Impact of Orthopaedic Trauma64 of the 74 patients recruited in October were interviewed to assess their socio-economic situation six months after a lower limb long bone fracture. The study is a partnership between USTOP and faculty members from the Vancouver School of Economics to quantity the economic burden of orthopaedic trauma in Uganda. Data is currently being analyzed with plans for publication and presentation before the end of year.

Orthopaedic Trauma Injury Patterns at Mulago HospitalWith the assistance of Rose Mulwana, head nurse for Ward 3A, USTOP has collected admission data for the past 23 months at Mulago Hospital. Dr. Rodney Mugarura and the USTOP team will analyse these data for a description of injury patterns.

INORMUSRecent Makerere Orthopaedic graduate, Dr. Tony Mutanda, will be the site-lead as Mulago Hospital participates in McMaster researcher Dr. Mohit Bhandari’s international cross-sectional study on the global impact of orthopaedic trauama.

Management of Open Tibia FracturesDr. Rodney Mugarura is initiating a study to compare the treatment of open tibia fractures with external fixation to those treated with intramedullary nails.

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Innovation Hub - VGH K-Bro LinensMcMaster University MedlineOffice of Pediatric Surgical Evaluation and InnovationProduct & Process Applied Research Team (BCIT)Regency Travel

Thank you

Canadian Consulate, KampalaCanadian Network for International SurgeonsCollege of Surgeons of East, Central and Southern AfricaConMed LinvatecEllen Meadows FoundationGetinge Canada Ltd.Global Partners in Anesthesia and SurgeryHamilton Health SciencesHealth Partners International - Canada

USTOP would like to thank our generous philanthropic supporters who make this collaboration possible. USTOP is deeply greatful to the following organizations for their ongoing partnership.

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Salama Shield Foundation Synthes Canada UBC Branch for International SurgeryUBC Department of OrthopaedicsUBC Development OfficeUBC Faculty of EngineeringVancouver General HospitalZimmer Canada

For more information on USTOP, please visit our website or contact:

Nathan O’Hara, University of British ColumbiaP: 604-875-4111 x66270E: nathan.ohara@vch.ca

www.ustop.ca