Fellowship opens opportunity for orthopaedic resident

How do I write about an experience that has changed me forever? Going to Mthatha in July 2007 and working at Bedford Hospital was one of the most formative times in my orthopaedic training on multiple levels. Thanks to the OREF-OO fellowship, I could take this trip.

I was one of the last residents to have the privilege of working with Charles P. McConnachie, MD, and his wonderful wife Jenny.

Dr. McConnachie, a recipient of the AAOS Humanitarian Award in 2002, moved to the Transkei, a South African homeland, in 1985 with the intention of staying for 5 years. He stayed for more than 20 years, working to improve the quality of orthopaedic care in the Eastern Cape region.

When I arrived on July 1, a major public sector strike throughout South Africa had just ended. Bedford had been closed for a few weeks and the cases had been piling up. The entire staff and orthopaedic team at the hospital were extremely friendly, and I was quickly oriented to the situation. Bottom line: There was a lot of work to be done.

A day in the life…
My wife and I stayed in one of the volunteer houses in the hospital compound. It was very safe and actually rather comfortable. The hot water situation was unpredictable at times, but overall, we loved our little cabin.

Days began with a quick breakfast and the daily meeting. All the attending physicians and residents would be present; we would discuss all the admissions from the night before. My wife worked at the Itipini Community Project, a medical clinic and school within a transformed squatters’ camp.

I was on the male service with Dr. Lakshmanan and four other residents. Our service was by far the busiest. The other teams consisted of Dr. David Oloruntoba’s female service and Dr. McConnachie’s pediatric team. After the meeting, we did rounds on the wards—an unforgettable experience. We would routinely see anywhere from 30 to 50 patients, half of whom were in traction and the rest waiting for surgery.

We would operate everyday except Wednesday, which was our clinic day. Operating room functionality depended on how many anesthesiologists we could find. Most cases would be intriguing trauma injuries that are not routinely seen in the United States.

Our first case of the day commonly involved intramedullary (IM) nailing—usually without the benefit of a C-arm. Although I struggled a bit in the beginning, I soon became an expert with the SIGN nail, an IM nail developed for under-resourced hospitals.

Other cases might require basic plating, such as a both-bone forearm fracture or Galeazzi open reduction internal fixation (ORIF). These fractures, however, could be up to 8 weeks old! Other common injuries involved tendon repairs and irrigation and débridement (I&D). In my 4 weeks at Bedford, I probably performed about four both-bone ORIFs, two or three distal radius ORIFs, seven to ten IM nail procedures for either femur or tibia fractures, three or four tendon repairs, countless I&Ds, and a couple of external fixator procedures and patella fractures.

The breadth of cases was astounding and they never stopped coming. It was a great opportunity to exchange treatment and surgical ideas with the staff. I’d like to think they gained a bit of knowledge from me because I definitely learned a ton from them.

Clinic and call
The clinic was always packed with people—many of whom had traveled for 4 days to receive orthopaedic care. There were great translators available, the cast room was always helpful, and I saw 60 to 70 patients each clinic day. A few admissions directly from clinic were also inevitable.

I was on call every fourth night, but luckily did not have to cover any weekends. The cell phone I acquired from Johannesburg airport was invaluable and generally is a necessity in South Africa. The nurses (or “sisters” as we called them at Bedford) would simply call me on my cell phone and I would walk in and see patients in the clinic as they came. I did many small procedures at night.

Weekends were wonderful
The weekends were always an adventure. The first weekend we spent in Johannesburg and visited the central courthouse, which everyone should see. It is built around the old jail and helps you understand the vile conditions that apartheid created. I was also able to walk into Gandhi’s old jail cell, which was a moment I’ll never forget.

The next weekend we visited a small beach community named Bulungula on the Wild Coast. This small, self-sustained beach community is run by the local Xhosa people and a group of good-hearted white South Africans. Race relations in South Africa are continually running high, but this small community was a great glimpse into what could be.

My wife and I celebrated our 2-year wedding anniversary on safari at the private game reserve, Shamwari. It was a bit pricey, but definitely worth every cent! Finally, we spent an additional week on our own driving to Cape Town. The Garden route is very similar to the Pacific Coast Highway: breathtaking views and excellent scenery. We even stopped along the way and did the highest commercial bungee jump on earth at Bloukrantz.

In Cape Town, we visited museums, hiked up Lion’s Head and Table Mountain, and generally soaked up the history and sociopolitical confusion that exists in this experiment called South Africa. We visited an underground jazz club, made some lifelong friends, and even got to see some of the wine country.

Overall, this experience reminded me of why I became a doctor in the first place. It fortified my desire to go into orthopaedic trauma and has given me back my passion and focus, which the healthcare system in the United States can often take away. I will be a lifelong member of HVO and I would like to sincerely thank everyone who has made this possible for me and my family.

Swapnil B. Shah, MD, is a member of the San Francisco Orthopaedic Residency Program. He can be reached at swapnil365@gmail.com

Editor’s Note: Since 1999, the Orthopaedic Research and Education Foundation (OREF) has generously funded a traveling Fellowship in conjunction with Orthopaedics Overseas (OO), a division of Health Volunteers Overseas. Swapnil B. Shah, MD, spent his OREF-OO Fellowship in South Africa and prepared this report.