Tuesday, March 29, 2016

Hand and Burn Surgery in Kigali, Rwanda Week 1

Lydia Helliwell, MD
Resident in Plastic & Reconstructive Surgery, BWH

I have traveled to Kigali, Rwanda with two of my colleagues, Dr. Simon Talbot and Sarah Kinsley, Physician Assistant, both part of the Plastic Surgery Department at Brigham and Women’s Hospital. Dr. Talbot is fellowship trained in hand surgery and I will be completing my fellowship this upcoming year. We learned through contacts in Kiagli that a total of two plastic surgeons worked in the entirely of Rwanda, a country of nearly 12 million people. For comparison, we have 15 plastic surgeons at Brigham and Women’s alone. Thus, tough reconstructive problems, and specifically tough hand and burn reconstructive cases, can often go untreated. We partnered with our colleagues at the University Teaching Hospital of Kigali (aka. CHUK), to help provide hand surgery teaching to attendings, residents and students over a two-week period.
Outside view of CHUK

We arrived in Kigali late Sunday evening and the following morning a Ministry of Health truck picked us up from the hotel and drove us the 30 minutes across Kigali to CHUK. There we met with Dr. Fausten, the only plastic surgeon serving the public hospital. We started the day with a 2-hour clinic, where patients from the local area with various hand problems were brought in to meet us. We saw approximately 20 patients in that 2 hour period, almost all with operative hand problems spanning both congenital and post-traumatic issues, including pre- and post-axial polydactyl, complex burn injuries, encondromas, syndactyly, fractures, tumors and Volkman’s contractures. We booked 14 surgeries for the next 3 days, in conjunction with Dr. Fausten, as well as the general surgery residents and students.

Operating in the CHUK O.R. with one of the general surgery residents
After clinic we toured the surgical wards and the burn unit. The units were large rooms containing several beds where patients were being attended to by medical students, nurses, residents and their families. We saw a variety of complex injuries in the surgical ward and a number of tough pediatric burn cases in the burn unit. Although their units lacked most of the modern conveniences we enjoy, the students, residents, nurses and families worked incredibly hard to provide the best care to their patients without the resources we have at our disposal. It certainly made me appreciate the resources available in our Boston hospitals, which can be easy to take for granted.

View down the CHUK operating room hallway
We arrived early the next morning for our first full day of operating. The operating rooms were located in a large building dating from the 1950’s. Although it was old and lacked many of the modern machines and technology that our own operating rooms contain, I was impressed by the complexity of the cases going on around us. CHUK is a public hospital, which is the referral hospital for approximately two-thirds of Rwanda, so the pathology and complexity they see is impressive. However, performing hand surgery and complex reconstructive surgery is difficult in this environment for several reasons. One, they lack the tools needed for hand surgery, including everything from sharp surgical instruments to fine sutures to microscopes. Additionally, with only two plastic surgeons, there are few people trained to take care of these problems, and hand and and burn injuries are incredibly common here, especially in a population that has many people performing manual labor and working with fire.

That first day we performed five procedures in conjunction with the local team, and 9 more over the following two days. The days were long (and hot!), but it was incredibly rewarding to provide care to patients that they might not otherwise receive and to work with the local physicians to teach them techniques to deal with problems they see commonly. Next week we will continue to operate with plans to undertake several burn reconstructive procedures for patients who have been in the burn unit for several days to weeks. We will also continue to work with students and residents, to both help start their training in plastic and hand surgery, and hopefully inspire them to potentially pursue further training.

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