Trip Report - USTOP

Trip Report September 11 - October 14, 2015

Contents

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

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

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

9 ....................Mbarara

10 ................Fort Portal

11....................Physiotherapy

13 ..................GPAS Conference

14 ..................Design Innovation

16 ...................Research

17 ....................USTOP Supporters

PersonnelAudrey Hiebert, nurse Camila Guan, emergency medicine residentChad Johnson, orthopaedic residentDavid Stockton, orthopaedic residentJeff Potter, orthopaedic surgeonLana Leeson, physiotherapistLaura Chng, emergency medicine residentLawrence Buchan, biomedical engineer

Marie-Eve Pelletier, orthopaedic surgeonMaureen Duggan, physiotherapistMichelle Lord, nurseNathan O’Hara, coordinatorRegina Colistro, physiotherapistPeter O’Brien, orthopaedic surgeonPiotr Blachut, orthopaedic surgeonSherry Kennedy, nurse

USTOP would also like to thank Dr. Isaac Kajja, 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 and Ms. Monica Kabagambe for all of her hard work to ensure this trip was a success.

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CoursesCNIS Safe Surgery Saves Lives - Essential Skills for Perioperative NursesDate: September 11, 2015Location: Ward 7 Theatre, Mulago HospitalAttendance: Theatre nurses from Ward 7, trauma, casualty, and the private theatre

The Essential Skills for Perioperative Nurses course included lectures, demos, skill sessions and role play covering:- what do perioperative nurses do, why, when, where and how and whom for and with whom- aseptic principles, sterile field monitoring, aseptic technique, opening sterile items- scrubbing, gowning, closed gloving, gloving others- teamwork- sponges and sutures- counting- Surgical Safety Checklist

The full CNIS Nursing Report for this tripcan be found in the “Trip Reports” sectionof www.USTOP.ca

Courses

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Sterilization Principles CourseDate: September 18, 2015Location: Ward 7 Theatre, Mulago HospitalAttendance: Theatre nurses from Ward 7, trauma, casualty, and the private theatre

The Sterilization Principles course included lectures, demos and skill sessionscovering:- transmission of infection- asepsis principles related to sterilization- cleaning and preparing instruments- packing and processing surgical instruments and supplies- indicator tape- sterilization process, loading and drying- wet packs- applying ethics to the sterilization process- sterile supply storage- theatre cleaning

The full CNIS Nursing Report for this trip can be found in the “Trip Reports” section of www.USTOP.ca

Orthopaedic Bioskills Course - BasicDate: September 13, 2015Location: CNIS Surgical Skills Lab, Makerere Medical SchoolAttendance: orthopaedic residents (years I, II), surgical residents

Topics:LECTURE Use of Drill CoverLECTURE Safe Surgery Saves LivesLECTURE History o Fracture CareLECTURE Surgical Reduction TechniquesLECTURE Spectrum of StabilityLECTURE Screw design and function LAB Position screws/ cortical lag screws/ cancellous lag screwsLECTURE Plate design and function LAB Lag screw with neutralization plateLAB Dynamic Compression PlateLAB Buttress plateLECTURE Tension band principles LECTURE External fixationLAB External fixation (uniplanar and modular)

Three lectures were provided from recent graduates of the Makerere Orthopaedics program.

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Courses

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CoursesOrthopaedic Bioskills Course - AdvancedDate: September 20, 2015Location: CNIS Surgical Skills Lab, Makerere Medical SchoolAttendance: orthopaedic residents (years III, IV)

Topics:LECTURE Use of Drill CoverLECTURE Safe Surgery Saves Lives LECTURE Principles of Articular FracturesLECTURE Distal Humerus FracturesLAB Distal Humerus FracturesLECTURE Distal Femur FracturesLAB Distal Femur FracturesLECTURE Tibial Plateau FracturesLAB Tibial Plateau FracturesLECTURE Pilon fractures LAB Pilon fracture fixation

Two lectures were provided from recent graduates of the Makerere Orthopaedics program.

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MbararaWith many of the recent graduates of the Makerere University Orthopaedic training program now taking posts in the regional hospitals, USTOP divided during the second week of the trip to work in Mbarara and Fort Portal.

Dr. Kisitu Kyengera is the only orthopaedic surgeon in Mbarara Regional Referral Hospital, which serves a catchment of 5 million people and is the teaching hospital for Mbarara University of Science and Technology.

A USTOP team which included surgeons, nurses, and physiotherapists worked with Dr. Kyengera for four days. The visit focused on organizing new supplies, providing basic orthopaedic training to the perioperative staff, and developing a protocol for a proposed clinical trial.

Dr. Dan Mwayafu, another recent orthopaedic graduate now based at Mbale Regional Referral Hospital, made the long journey down to Mbarara to join the team and participate in the clinical training. Mbale and Mbarara are both fortunate to have a C-Arm, something that is not routinely available during the training at Mulago Hospital. Dr Mwayafu had particular interest in learning to navigate fracture management using the C-Arm.

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Fort PortalA second group of surgeons and a nurse travelled to Fort Portal Regional Referral Hospital, situated in the foothills of the Rwenzori Mountains and serving a catchment of over 3 million people. Dr. Pariyo Bonane, a recent Makerere University orthopaedic graduate, took the post available in Fort Portal over a year ago. The USTOP team travelled to Fort Portal with updated supplies, provide clinical support on operative fracture techniques, and provide orthopaedic-specific training for the perioperative nurse team.

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PhysiotherapyThis USTOP trip had three physiotherapists on the team. Over a three week period, the physio team was able to accomplish numerous objectives including:

- A fact-finding trip to Mbarara to meet with local physiotherapists and an orthopaedic technician, discuss possible training partnerships, and setting up a LN-4 prosthetic hand program at that Regional Hospital

- Met with key people at the school of physiotherapy and the physiotherapy department to develop a strategy for future USTOP collaboration

- Discussed a future training partnership with CoRSU Hospital

- Provided continuing education training on lower and upper extremity assessment and treatment for physiotherapists at Mulago Hosptial

- Provided lectures for 3rd year physiotherapy students on lower and upper extremity assessment, and the ASIA neurological assessment specific to spinal cord injuries

- Provided educational and practical support for physiotherapists working on the clinical wards at Mulago Hospital

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- Met with Makerere University administrators to discuss the transition from a Diploma in Physiotherapy to a degree program

- Continued to develop and expand the LN-4 prosthetic hand program. To date 18 individuals have received the prosthetic hands donated from the Ellen Meadows Foundation and fitted by occupational therapists at Mulago Hospital.

- Provided coordinated home visits with Mulago physiotherapists for spinal cord injury patients near Kampala

- Arranged for the local construction of a wheelchair, walker, and repaired the parallel bars used on the spine ward

Future Plans- Continue to support the Physiotherapy Departmen tat Mulago Hospital in terms of regular continuing education sessions

- Continue to support the School of Physiotherapy with regular guest lectures

- Continue educational support to the ward physiotherapists, and students on the wards at Mulago, and expand to Mbarara Hospital as the USTOP program is expanding.

-Continue the LN-4 hand project at Mulago and expand towards implementation of the project at Mbarara, and other cities such as Mbale, and Soroti. Newly qualified orthopaedic surgeons affiliated with the USTOP are aware of the LN-4, are keen to have them provided in their region.

GPAS Conference

The 4th Global Partnership in Anesthesia and Surgery conference was held in Entebbe, Uganda on September 25-26, 2015. USTOP co-sponsored the biennial event which attracted an attendance of over 200 participants from 15 institutions across three continents. Several members of the USTOP team were featured in the conference program. Dr. Piotr Blachut , Dr. Rodney Mugarura, Victoria Sebudde, and Audrey Hiebert gave podium presentations. Lawrence Buchan, Greg Allan, and Dr. Pariyo Bonane were selected for poster presentations. Dr. Alex Bangirana and Dr. Moses Kakyama served as moderators for a session on trauma.

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Device InnovationThis trip saw continued involvement from the UBC Engineers in Scrubs program, with pilot testing of several new devices. These devices are engineered to solve perioperative challenges in Uganda. Some of the projects include:

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Drill Cover DesignThis 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. This product is currently in the process of commercialization and should be available for widescale purchase in 2016.

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Surgical Screw CutterLimit surgical supply inventory leads to deficiencies in common surgical screws sizes. A third-version of the screw cutter device designed by UBC MASc students enable a surgeon to cut surgical screws to the appropriate size intraoperatively before insertion. The device has garnered much interest from the surgeons and is moving towards commercialization.

Wound Closure SystemAn engineering student team has been working closely with USTOP and Ugandan orthopaedic surgeon, Dr. Tony Mutanda, to develop a device to advance the pace of wound healing after a severe open fracture. Due to the high volume of road traffic injuries, Uganda sees hundreds of open fractures admitted each year. The current protocol has patients waiting on the ward while the wound heals. The team is aiming to make the device compatible with a low-cost negative pressure wound pump that should soon be available.

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ResearchEconomic Impact of Orthopaedic TraumaThe study team was able to follow-up on 84% of the 74 person sample at two-years post-injury. The one-year results from the study have been presented at the Bethune Round Table and the Orthopaedic Trauma Assocation Annual Meeting.

INORMUSMulago Hospital became a recruiting site for Dr. Mohit Bhandari’s Internatioanl Orthopaedic Multicenter Study in Fracture Care (INORMUS) study in 2015 and was able to quickly reach it’s targer recruitment of 1000 under the leadership of local prinicapl investigator Dr. Tony Mutanda. Another recent graduate, Dr. Pariyo Bonane, plans to begin recruiting for the study from his practice at Fort Portal Regional Referral Hospital in the following month. Both investigators were included in the authorship on a recent Journal of Orthopaedic Trauma publication of the study protocol.

Ellen Meadows FoundationGlobal Partners in Anesthesia and Surgery Hamilton Health SciencesK-Bro LinensMcMaster University MedlineOffice of Pediatric Surgical Evaluation and Innovation

Thank you

AO AllianceArbutus MedicalCanadian Consulate, KampalaCanadian Network for International SurgeryClearWealth AdvisorsCollege of Surgeons of East, Central and Southern AfricaConMed Linvatec

anada

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

USTOP would like to thank our many partners and supporters who make this collaboration possible.

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

Nathan O’Hara, University of British ColumbiaE: [email protected]

www.ustop.ca

Documents

Trip Report - USTOP