Medical Students: South Africa

-Referral Patterns in a Sub-Saharan Africa Orthopaedic Centre

-Assessment of Outreach Education in Primary Fracture Care as a Public Health Intervention in the Eastern Cape of  South Africa

 

Referral Patterns in a Sub-Saharan Africa Orthopaedic Centre

In order to better understand the burden orthopaedic related injuries place on a hospital system, especially in a resource constrained setting Edward Aluede, a 1st year medical student, during the summer of 2008, spent eight weeks initiating an observational study at the Bedford Orthopaedic Centre in Mthatha, South Africa. This study was done in collaboration with the Walter Sisulu Medical School in Mthatha, South Africa and Dr. Yinka Oloruntoba at the Bedford Orthopaedic Centre. This project focused on identifying the burden of orthopaedic referrals that Bedford managed, the status of referrals and the management of these patients at the referral sites. This study is in adjunct to the Primary Musculoskeletal Fracture Care and Trauma Management Course that IGOT is developing along with Dr. Olorutoba. Edward’s findings helped to identify specific needs that the course can address as a sustainable educational outreach.

Edward Aluede, BS¹ Amber Caldwell, BA², Richard Coughlin, MD, MSc², Harry Jergesen, MD² Yinka Oloruntoba, MD³

1 School of Medicine, University of California, San Francisco, USA

2 Department of Orthopaedic Surgery, University of California, San Francisco, USA

3 Department of Orthopaedics, Walter Sisulu University Medical School, Bedford Orthopaedic Centre, Mthatha, South Africa

Abstract

Traumatic orthopaedic injuries are increasing globally, but not enough human and material resources are allocated to address this concern. Additionally, it is extremely difficult to find reliable data in Sub Saharan Africa (SSA) to evaluate the baseline of orthopaedic trauma and the burden of these conditions on healthcare facilities. This observational study assesses the outpatient department of the Bedford Orthopaedic Centre located in the South Eastern Cape of South Africa. Bedford, having only 180 beds, serves a population of approximately 4 million people and is the only specialty referral hospital for the region. The study will collect data to recognize, record and describe referral patterns, modes and aspects of diagnosis, methods of previous and current treatment, with the objective to estimate the burden of orthopaedic trauma that this resource constrained facility experiences. Data obtained on new patients referred to Bedford Orthopaedic Centre for treatment of orthopaedic and traumatic related injuries can be analyzed to determine patterns, which ultimately result in increased workload and complexity of definitive management.

 

Assessment of Outreach Education in Primary Fracture Care as a Public Health Intervention in the Eastern Cape of South Africa

Monica Grova, a 1st year medical student during the summer of 2009, spent 8 weeks continuing the second phase of the outreach education project in collaboration with the Bedford Orthopaedic Centre and IGOT. Ms. Grova expanded upon Edward Aluede’s initial research conducted during the summer of 2008 to study the initial impact the Primary Musculoskeletal Fracture Care and Trauma Management Course had on acute referral patterns. Monica’s findings helped to identify the initial impact and advocate for continued exposure to the course.

Monica Grova, BS¹ Amber Caldwell, BA², Richard Coughlin, MD, MSc², Harry Jergesen, MD² Yinka Oloruntoba, MD³

1 School of Medicine, University of California, San Francisco, USA

2 Department of Orthopaedic Surgery, University of California, San Francisco, USA

3 Department of Orthopaedics, Walter Sisulu University Medical School, Bedford Orthopaedic Centre, Mthatha, South Africa

Abstract

The Bedford Orthopaedic Centre (BOC) is located in the eastern portion of the Eastern Cape of South Africa in a resource-constrained setting. The Centre is a 180-bed hospital with 1 full time and one part-time orthopaedic surgeon that serves a population of 4 million people who are cared for in 11 district hospitals. 90% of the caseload at the BOC is comprised of trauma cases. Some of this trauma burden arises from the referral of cases that could be managed by non-orthopaedic surgeons. The treatment of other patients is complicated by incorrect initial diagnoses and management, unrecognized injuries, and delayed referrals. Dr. David Oloruntoba, Chief of Orthopaedic Surgery at BOC, and personnel from the Institute for Global Orthopaedics and Traumatology (IGOT) have collaborated in designing an outreach education course addressing these concerns and an associated research study to assess the effects of this intervention. Baseline data for all new patient referrals for an 8 week period in the summer of 2008 was collected in the BOC Outpatient Department before the courses were initiated. To date, the Primary Musculoskeletal Trauma Care (PMSTC) outreach education course has been given at three district hospitals; a fourth will be included soon. In this study, additional identical data will be collected to assess any changes in inappropriate referral diagnoses, prevalence of correct initial diagnosis and management, prevalence of missed injuries, quality of wound management and the prevalence of delayed referrals. Data for patients referred from district hospitals where the courses were given will be compared with baseline data already collected during the summer of 2008. Data for patients referred from those hospitals where the courses were not given will be compared for both time periods, and used to provide control information.