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Dr. McConnachie reviews a radiograph during an HVO training program.

AAOS Now

Published 8/1/2007
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Peter Pollack

A hospital—and hope—for poor South Africans

Winner of 2002 Humanitarian Award continues his efforts in the Transkei

Many orthopaedic surgeons donate large amounts of their time, but few choose to undertake the lifelong commitment to assisting those in an underdeveloped region that Charles C.P. “Chris” McConnachie, MD, has. Winner of the 2002 AAOS Humanitarian Award, Dr. McConnachie has spent the better part of his professional life working in a part of South Africa known as the Transkei—a region in the Eastern Cape province originally set aside as a homeland for black South Africans under the apartheid system.

Dr. McConnachie’s connection to Africa began in the 1960s when he was a young physician working in general practice in Saskatchewan. While waiting for his orthopaedic residency to begin, he and his wife Jennie spotted an advertisement looking for volunteers to travel to South Africa as part of a project run by a missionary program.

“It seemed exciting,” he explains, “so we went off to the Transkei, which I’d never heard of. From our mission hospital, it was about three hours to the nearest orthopaedic surgeon. I had some emergency medical experience, but I hadn’t done any real orthopaedics.

“I used a textbook, which is really quite naughty, but the alternative was sending a patient down the road for three hours in a rickety vehicle. We worked there for 18 months; I was a sort of general practitioner and general surgeon, and my wife—who is an RN—was a nurse running the pediatric outpatient clinic.”

A bold decision
Dr. McConnachie returned to the United States for his orthopaedic residency, then spent a year in the United Kingdom studying total joint replacement. He started a practice in Hendersonville, N.C., in 1973, but returning to Africa was always in the back of his mind.

In 1978, Dr. McConnachie took a leave of absence and spent three months volunteering in a mission hospital in northern Zululand. While he was there, he met a former missionary physician who had been placed in charge of health care for the Transkei. At the time, Transkei was a “homeland,” or “Bantustan,” created to segregate the native Xhosa people from white South Africans. It had been declared a nominally independent state by the South African government in 1976, although—like other such homelands—the province remained economically dependent on the parent country and internationally unrecognized as a separate entity.

The official encouraged Dr. McConnachie to visit a hospital in Mthatha, the capital of Transkei, which he did in 1979, bringing a team of physicians and other medical personnel from Hendersonville to spend a couple of weeks working at Bedford Orthopaedic Hospital (part of the Mthatha Hospital Complex). By 1983, he and his wife had made several trips to Bedford, and were planning on taking an unpaid leave to spend an entire year there. They soon realized that they would have to choose between practicing in North Carolina or taking up residence in Mthatha.

“Starting the practice was great fun and very exciting,” he explains, “but carrying it on was less so. So we decided to bite the bullet and move to Africa. We sold our share of the practice and started in Mthatha in January 1985. To survive financially, we turned to the Episcopal Church, which took us on as medical missionaries. Between their modest stipend and our earnings in South Africa—about one tenth of what I made in North Carolina—we managed.”

Volunteer staffing
In 1987, Dr. McConnachie and his wife began inviting volunteers from Health Volunteers Overseas (HVO) to work at the hospital. Initially, those physicians would spend much of their time performing surgery, but now they focus on teaching orthopaedics.

“We have three orthopaedic surgeons, including myself,” says Dr. McConnachie, “and five ‘medical officers.’ They will never become orthopaedic surgeons—they’ve no formal residency—but they do the work. South Africa also requires medical school graduates to do community service, and we get a couple of those people every year. Within the last year, we were recognized as a training center, with two slots for orthopaedic residents from South Africa.

“We’ve also had orthopaedic residents from a university program in San Francisco—four or five a year, for a month at a time,” he continues. “They’re a great shot in the arm, and they’re really learning because they see pathology here that they don’t see in the States.” According to Dr. McConnachie, tuberculosis is a major problem, particularly in the spine.

Nelson Mandela steps in
“When we arrived, the orthopaedic hospital was run by the Holy Cross Sisters, and the operating room (OR) was just one room with no air conditioning. Progress was slow until we met Nelson Mandela,” says Dr. McConnachie. “He comes from the Transkei, and we had some uninterrupted time with him.” Mandela found funding for more ORs through an oil company. Today, the hospital has four ORs, three of which are in use on a daily basis.

“After the oil company, other industries came on board and funded the construction of an outpatient department and a radiology department. The South African government built a state-of-the-art spinal unit in the hospital,” says Dr. McConnachie.

Continuing challenges
Although he has seen much progress, Dr. McConnachie and his associates continue to face hurdles in bringing quality care to patients. A true professional, he does not rest on the foundation of his success, but is always seeking to improve conditions.

“Funding is available, but getting it is a long shot,” he says. “And some things that are ‘givens’ in the United States—like magnetic resonance imaging (MRI) machines —we don’t have. We have access to computed tomography scanners, but not MRIs.”

The greatest medical challenge is not orthopaedic, but anesthetic. “Anesthesiology is probably our single biggest limiting factor at present. Our time in the OR is limited by a lack of anesthesiologists,” he says. “Until Frank James, MD, retired from Wake Forest University, residents from the anesthesiology residency program at the Bowman Gray campus would come. It would be fantastic if we could get another program interested in sending residents.”