Visit to St. Orsola Mission Hospital Matir

In November 2021 I had the opportunity to visit St. Orsola Mission Hospital, the most active SIGN hospital in Kenya. The hospital is located in the rural mountainous Tharaka Nithi County of the Meru District, some 220 km north-east of Nairobi, the last 15 km on mud road. There I joined Beppe Gaido, MD an outstanding surgeon, covering for general, gynecological, obstetric and trauma surgery. Nevertheless the focus is on trauma surgery which represents 75-80% of the activity in the surgical theatre. In this year Beppe Gaido has performed more than 700 SIGN surgeries. In the month of November 50 SIGN nails, including two SIGN hip constructs were done. I had the chance to appreciate Beppe Gaido’s large experience. He has an excellent routine in all aspects of the SIGN technique. I was able to contribute to the retrograde nailing for femur fractures with the patella tendon split approach. The needs of the patients with fractured limbs are the driving energy of Beppe Gaido daily work. He tries to find a solution for every aspect of the patient’s problem not only in terms of surgical care but also concerning mobilization, weight bearing, wound care and length of the stay in the hospital (as short as possible to limit infections). 

Beppe Gaido makes M. M’M. f. 81 y walk, some days after reversed intertrochanteric fracture and SIGN nail with plate. She was on the way to church as she fell from a motorbike-taxi. As in many low and medium income countries, there are many limitations for patients and families to regain mobility after the common long-bone fractures after road traffic accidents. It’s the SIGN nail that has opened a perspective for many, who cannot pay for costly implants. I’m grateful to be part of this worldwide SIGN family. The support of SIGN is also extending to articular fractures and difficult open fractures by donating excellent material as a large set of the AO® External Fixator with carbon rods and closed and open clamps. There are donated plates available for large medium and small bones, including pre-contoured plates for special situations as distal humerus or comminuted intra-articular distal femur and proximal tibia fractures. Part of the screws are donated, part are purchased from an Indian manufacturer, as they are much cheaper. in the four weeks I spent with Beppe Gaido we mostly had the right implant available. Nevertheless I remember one situation, where I had wished to be able to contour 3.5 mm plate in both planes vertically an horizontally, as the AO plate plier allows. The patient had a distal comminuted humerus fracture, treated with a 3.5 mm plate and a Gerwin access to the distal humerus and humerus shaft. Wit the available benders the plate could only be bent in vertical direction. Finally the distal humerus was adapted to the plate, which compromised the reduction. M.G. m. 32 y. Extra-articular comminuted distal humerus fracture after RTA A plate plier, that allows pre-contouring of 3.5 and 4.5 mm osteosynthesis plates in vertical and horizontal direction, would allow SIGN surgeons to pre-contour plates to difficult situations of joint fractures. There are some challenges for the surgical team of St. Orsola Mission Hospital. The hygiene in the theatre could be improved by some simple additional measures, which is a pivot instrument to reduce postoperative infections (e.g. alcohol for surgical hand disinfection, sterilization of transfer clamps on regular intervals). The use of antibiotics should be adapted to antibiotic stewardship standards, to limit the development and spread of antibiotic resistant bacteria. Overall I was deeply impressed by the standard and quality of surgical care for trauma patients under the difficult conditions of a hospital in remote Kenya. I thank Beppe Gaido who opened me many doors, to the hospital, the staff and the patients. Especially the theatre staff has welcomed me and supported me in many ways. They took even care that I participated in the regular meals. After four weeks the staff, the sisters of the congregation and the hospital management organized a farewell party with a fantastic meal. Becoming part of the SIGN family is a much appreciated experience that SIGN Fracture Care made possible. Thank You. 

Yours Volker Roth Trauma and orthopedic surgeon, Germany