Dr. Rick Cunningham spends time working side-by-side with Rwandan doctors
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I recently went to Rwanda in East Africa to work with the few orthopedic surgeons that practice there.
Rwanda is one of the smallest African countries, but it has one of the highest population densities. Rwanda is characterized by rolling hills and has a temperate, tropical highland climate. Germany and later Belgium colonized Rwanda starting in the late 1800s. Rwanda gained its independence in 1962.
Many know of Rwanda from the genocide of 1994 in which Hutu extremists killed an estimated 1 million people, mainly Tutsis. The Tutsi-led Rwandan Patriotic Front ended the genocide by ousting the Hutus from power and taking control of the government. They continue to govern to this day under President Kagame. Security is a top priority for the government there, and you see police officers seemingly standing on every corner with semi-automatic rifles.
Rwanda’s economy has been based on agriculture, but in recent years the country has modernized somewhat and now has a fledgling tech industry. China has significant investments in Rwanda and benefits from its natural resources.
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Tourism is also a large part of its economy with many people traveling to see the mountain gorillas in nearby Virunga National Park. Unlike neighboring Congo which is lawless, Rwanda has done a very good job of protecting the mountain gorillas from poachers and helping to preserve their habitat. I had the opportunity to trek in and see the mountain gorillas while on a medical mission to Rwanda four years ago. It was amazing to see these incredible creatures in their natural habitat.
PERFORMING SURGERY TOGETHER
Rwanda has only four full-time orthopedic surgeons for a population of 12 million people. Fortunately, they recently started an orthopedic residency and are training new orthopods. Needless to say, many Rwandan’s lack basic medical and orthopedic care.
During this most recent trip, I worked primarily with Dr. Emmanuel Bukara and the residents teaching Bukara shoulder arthroscopy and open rotator cuff surgery. Bukara and his colleagues trained mainly in South Africa before going into practice in Rwanda. They are all excellent surgeons, but only Bukara is learning arthroscopic surgery, whereby the surgery is done through tiny incisions, and using a small telescoping camera in the knee or shoulder. The other surgeons there do only open surgery.
Four years ago when I was there, I taught knee arthroscopy and the purpose of this trip was to teach shoulder arthroscopy. Arthroscopy is very equipment dependent, but fortunately their hospital has a rudimentary arthroscopy set.
We spent the first day in clinic seeing primarily shoulder patients and then spent the rest of the week doing surgery together. In clinic, we saw patients with shoulder complaints that had many of the same diagnoses that I see in my office here in the Vail Valley, namely impingement syndrome, rotator cuff tears, shoulder arthritis and shoulder instability. We worked at King Faisal Hospital in Kigali, Rwanda. By the week’s end, Bukara was reasonably comfortable doing diagnostic shoulder scopes and then open rotator cuff repairs.
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My plan is to try to collect arthroscopy equipment and implants to send to Bukara in Rwanda.
Much of what we use in the U.S. are single usage pieces of equipment. This equipment is then discarded after each surgery done in the U.S. In Rwanda, they re-use everything to the point where the equipment is useless as the arthroscopic shavers and burrs are dull or bent. They cannot afford the suture anchors we use in the U.S. to treat rotator cuff tears and dislocating shoulders. Fortunately, there are older techniques for addressing these problems that do not require expensive implants and work quite well.
All in all, it was a great trip. I hope that some of the techniques Bukara learned will help a great many of his patients in the future.
Dr. Rick Cunningham is a knee and shoulder sports medicine specialist with Vail-Summit Orthopaedics. He is a physician for the U.S. Ski Team. Visit his website at http://www.rcunninghamorthopedics.com. For more information about Vail-Summit Orthopaedics, visit http://www.vsortho.com.
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