Musculoskeletal Trauma Services in Uganda EK Naddumba,Mmed(MU),FCS(ECSA) Senior Consultant Orthopaedic Surgeon, Mulago National Referral Hospital Kampala Uganda. ABJS Carl Brighton Annual Workshop,Dec.11th-14th,2007,India.

PURPOSE Highlight Challenges Suggest solutions.

PROBLEM Population=28m Growth rate=3.5%/yr National Budget allocation to Health=9% Inadequate resources.

Orthopedics in Uganda 2007 23 Ortho surgeons Kampala 18 Mbarara 1 Masaka 1 Mbale 2 Kumi 1 Unreliable equipment Unreliable supplies Orthopedic Officers 200

Health Care Referral system National referral Regional referal=10 District Hosp=56 Sub district Hosp=250

Resource Distribution & Access to Services Specialist Services,only available at Regional &National referral Hospitals Lower health units offer PHC,Maternity,General surgical and medical services.

Pattern of Diseases Acute &neglected fractures, Infections, Spinal injuries, Clubfeet, Polio contractures, SCD Osteonecrosis, Tumors.

Musculoskeletal injuries in Uganda 2000 lives/year are claimed through RTA Kampala,RTA account for 35.1%of all injuries, Males of 15 to 45yrs are the majority.

CAUSES Boda Boda Traffic mix Urbanization Motorization Poor roads Poor drivers.

SERVICES AVAILABLE SIGN Nail Cast, Skeletal traction, ORIF, External Fixators TBS.

PREVENTIVE STRATEGIES Specialist Training (MMED,FCS(COSECSA) Train all levels of Health workers in their environment to ensure a sustainable supply of human resource(JP.Dormans) Govt effort to improve the Infrastructure& Equipment supply. Law enforcement on poor road users. Orthopedic outreach program to enhance Access. International Collaboration(HVO,UBC,JAPAN)

Orthopedics Mulago Hospital, Kampala Makerere Medical School Professor Ronald Huckstep 1962 Professor Ronald Belcher 1990 Round Table Polio Clinic 8 Surgeons 16 Residents (4yrs) 100 Medical Students py

SERVICES Elective Surgery 2 Theatre 3 days per week 400 cases per yr Infections 1 Theatre 2 days per week 500 cases per yr Emergencies Shared Theatre 7 days per week 500 cases per yr

DISCUSSION Access to quality specialists services is a global concern due to poor infrastructure,and inadequate resources. Uganda is among the most affected Solution to the problem is through human resource training, deployment, Infrastructure development&Equipment supply.

Discussion By 2020(WHO)Trauma will be the leading cause of life lost by both developed &developing countries. Low and middle income countries account for 85%of the deaths&90%of the annual DALYs lost because of RTA.

Conclusion Musculoskeletal Trauma Services in Uganda are largely inadequate resulting in neglected Trauma High population growth,urbanization,motorization &poverty are compounding factors.

Recommendations Need for Government to plan for the growing population to access essential Musculoskeletal trauma services. Ensure sustainable supply chain of consumables &Infrastructure development Training of specialists in their own environment. North to South collaboration in participatory development,

References Ralph K Ghormly.Progress report of the joint committee on postgraduate training in orthopedic surgery.JBJS(Am.)1946:28;399-401 John P Dormans,MD.Orthopedic surgery in the developing world.Can orthopedic resident help?JBJS{Am.)84;1086-1094(2002) Olajede Olaolu Ajaye &Clement Adebayo Adebamowo,Surgery in Nigeria.Arc.Surgery.Feb 1999;134:2:206-211 CBD Lavy,N Mkandawire&WJ Harrison.Orthopedic training in developing countries.JBJS(Br.);87-B,issue 1/10-11,(2005)

References 5 .Peterson:Neglected femoral fractures.JBJS;25(4),page 871 6. Klenerman I Neglected trauma.March 1998,JBJS,255.

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