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AAOS Now

Published 3/1/2007
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Jennie McKee

International surgeon sharpens his axe—with orthopaedic skills

Christopher Amuwa, MD, an orthopaedic surgeon from Nigeria, hungered for knowledge when he visited the AAOS headquarters in June 2002. It was the first time he had ever left his home country, a nation where the ratio of orthopaedic surgeons to the general population was 1:1,000,000.

As one of four recipients of an AAOS Corporate Advisory Council Orthopaedic Learning Center (OLC) International Scholarship that year, he compared his desire to learn the latest techniques in orthopaedic surgery to a familiar tool.

“When the axe is dull and its edges unsharpened, more strength is required,” he wrote on his scholarship application. “With improved skills, I am bound to succeed.”

Christopher Amuwa, MD

Since then, he has traveled throughout the United States and beyond to learn surgical skills and contemporary orthopaedic techniques to take back to his native country. After completing the OLC course, he completed a fellowship at University Hospitals of Leicester in England and trained at two other English hospitals, Medway Maritime Hospital and Lancashire Teaching Hospital.

Dr. Amuwa has also trained at Wishaw General Hospital in Scotland and completed a fellowship with George Russell, Jr., MD, at the University of Mississippi Medical Center in Jackson, Miss. He has participated in an advanced trauma life support course in St. Louis and has taken courses in Chicago and Rochester, N.Y. In between these learning opportunities, Dr. Amuwa traveled back to Nigeria to put into practice what he had learned.

This past January, when Dr. Amuwa visited the Academy before returning to Nigeria’s Baptist Mission Hospital in Ogbomosho, he no longer worried about being a dull axe.

“I understand the orthopaedic language so much more now,” said Dr. Amuwa. “There’s hardly anything I read now that I don’t understand, and I’m able to build my future based on that. I feel like I’m an international surgeon now. I have the competence to do what most surgeons can do—if I have the infrastructure,” he added.

Lack of infrastructure challenging

Insufficient infrastructure is one of the main obstacles to practicing orthopaedic medicine in Nigeria. For example, without a solid infrastructure and enough funding, it is difficult to procure supplies and repair medical equipment.

Dr. Amuwa recalled a conversation that occurred during his training in Mississippi in 2003. When asked how he would treat a femur fracture, Dr. Amuwa responded that Nigerian physicians use Kuntscher nails, which were used during World War II to treat fractures. In the United States, where intramedullary nails are now the preferred treatment, Kuntscher nails are considered artifacts.

“When I got back to Nigeria and had to start using Kuntscher nails again for femur fractures, I felt really deflated,” said Dr. Amuwa. “In Mississippi, I was given many intramedullary nails to take back to Nigeria, but we couldn’t use them because we didn’t have the X-ray machines we needed.”

Fear of amputation and bonesetters

Orthopaedists in Nigeria must also counter the common belief that going to the hospital with an orthopaedic injury will automatically result in amputation of a limb. Although some orthopaedic patients do end up requiring amputation, these are often the result of mismanaged patient care.

Poor people who lack the means to pay for hospital treatment may seek treatment from traditional bonesetters, explained Dr. Amuwa. The bonesetters have no formal medical training and treat fractures by immobilizing them with bamboo. But misaligned bones and improper bracing are common. “Simple fractures lead to gangrene due to poor care,” said Dr. Amuwa. “That leaves the orthopaedic surgeon with no choice but to amputate.”

Growing number of orthopaedists

“The reason that I went into orthopaedics was that I was interested in it and didn’t understand why other people weren’t,” said Dr. Amuwa. This is now changing, however, as Dr. Amuwa pointed out. “Every year we have more and more orthopaedic surgeons,” he said. He estimates there are currently 400 orthopaedic surgeons in Nigeria—more than triple the number just five years ago.

Dr. Amuwa plans to provide training to his colleagues in Nigeria to help them learn from his experiences abroad. He is proud that he can often provide the kind of care to patients in Nigeria that they used to have to travel to England or South Africa to receive. “It is very rewarding that I can now provide that kind of treatment,” said Dr. Amuwa.

If you wish to correspond with Dr. Amuwa, e-mail him at chrisamuwa@hotmail.com.