Today the first joint replacement procedure ever.....was done in the new Machame orthopedic surgical theater.

Orthopedic surgeon Dr. Steve Meyer and his team from STEMM in Sioux City are back with us again and we had a patient with a badly deteriorated femur head. Normally, all we can do here is just remove it to lessen the pain and the patient goes about with one shorter leg and limited mobility. But a combination of Dr. Meyer's creativity and willingness, our new facility, equipment and other support from Alegent and others, and the leadership and staff at Machame ....resulted in Mr. Mfura receiving a functional artificial hip instead.

This really is a remarkable milestone in the development of the orthopedic program here at Machame. It is another bit of pay off for all the effort over the past years. And also a testament to faith. The artificial hip itself, along with the specific instrument set used to install it were all sent to Machame from Alegent Health in 2003, in the hope that one day it might prove of use. Special thanks to former long term Alegent employee Jim Simon who collected and made us bring these items (and so much more) thinking that one day we just might be able to use them. Well, today we just did!

We have some additional program development to do here before we should consider routinely replacing joints. But today's event shows how far we have come thanks to the long term support and commitment of so many. Thanks to you all.

The attached photo shows Dr. Meyer and Dr. Lyimo preparing to insert the artificial hip.

Note: Dr. Meyer wants it made clear that he remains a University of Iowa loyalist and that his wearing of the Cornhusker surgical hat is testament to Tanzania's environment of scarcity not to any change of heart.

In a poor land like Tanzania, where few have vehicles and public transportation is limited and cumbersome, local availablility of healthcare is key. People can only walk so far, especially if when sick, hurt  or about to give birth.

Our church partner operates 24 dispensaries that are like satelites around the three Diocese hospitals.  From the first investigatory trip in 2001, we have realized the importance of these clinics, especially in the more remote areas where there often is no alternative. We also realized that all these clinics were under severe economic pressure.They usually get little or no support from the government, and the patient population and even the churches they are linked to are too poor to provide much support.

Adopt a Dispensary was our first program in cooperation with the Nebraska Synod of the Evan. Lutheran Church in America. This program was created for churches and individuals who wanted to assist Tanzania in a very basic way. We decided that rather than provide direct monetary support we would provide the medicines that these dispensaries (known as Zahanatis in Swahili) need. This allows the dispensary to use its income to pay salaries and make improvements rather than to buy medicine. Each clinic is able to prioritize and select the medicines they specifically need up, to a certain dollar limit.

 This year we are providing medicines to 15 clinics. Support has continued to increase as word has gotten out or visitors have encountered the benefits of this program when they visit one of our dispensaries. Most support is from Nebraska but we have received aid from as far away as Deleware and New Hampshire.  I used to do every program task myself, but now have enlisted some assistance at the hospitals. It still is a good day when you hit the road with a truck load of medicines and deliver it to places you know it really is needed.

We are encourageing and facilitating greater cooperation between the church zahanatis and the goverment .This cooperation can result in better support and sustainability...but is a slow process. In the meantime, Adopt a Dispensary helps keep the clinics viable and their doors open.

Neema is Swahili for "Grace". This week I had several hospital staff coming to me to see if I could assist a patient named Grace. This is not so common because every day most of the people in the hospital need much, and I have made it clear that I cannot help everyone (one gets hard in Africa). 

Grace's story goes like this. She is 21 and lives in a mining area very near Dar es Salaam on the coast. She had given birth to her first child and then found out her husband planned to take the infant and sell her. Body parts are sometimes used in something like witchcraft ceremonies to bring about good luck and in this case to lead miners to the ore or gems they are looking for. I knew that albinos here especially have suffered from this belief, but apparently also a newborn will do. When Neema learned of her husband's plan, she escaped with the newborn and not much else and headed up country to Arusha to find an aunt to stay with. After much searching was unable to find any relations. She started traveling somewhere else but was quite ill and was brought to our hospital by a good Samaritan who found her and her child just wrapped in a cloth and sleeping beside the road.

Grace was very ill with Malaria, (Malaria Falciparum with more than 20 parasites per hpf including ring forms for you medical folks out there). She was treated and as the staff realized she had nothing with her at all the call went out for assistance. I was able to find some bits of baby clothes and blankets and hats that visitors have dropped off. I think it was not just that she was so very poor and sick (a common thing here) but that she had no family or extended family here to assist her that really affected the hospital staff.

Well, Grace is doing better health wise as you can see from the picture (she is up and about washing clothes outside the hospital). She was so sweet and appreciative and curtsied to me when I greeted her before asking to take her picture. What happens now? Well, we are not sure. It turns out there is some sort of social services agency as part of our district government and I guess we start there. Our hope is that economics do not force her back to husband. Happy endings are far from a sure thing here in Africa.

As noted in an earlier posting, we have some medical visitors assisting us. Last week, Dr. Tom Gapp, M.D., Radiologist from Lincoln, Nebraska, made his third visit to Machame Hospital. He and his wife Linda are leading some programs in the Kilimanjaro region, providing school scholarships for orphans and textbooks to the schools. They also took time to be with us at Machame. Dr. Gapp gave us some very basic training on the use of our C-arm x-ray, a surplus unit from Alegent that has been giving us some troubles. He also did some ultrasound exams. In Machame, ultrasounds are done by any physician or even the technician, so they very much value having an expert here looking over their shoulder, offering some advice and wisdom when they are doing an exam. Thanks Dr. Tom!!

Together with the ongoing construction of the patient wards and physical therapy department, we are beginning to receive foreign specialists who can help us move the program along. As a previous blog post noted, Alegent surgeon Randal Woodward visited us last summer. Surgical nurse Alan Olsen from Lincoln visited us during the month of September, and that was really a blessing. Last week, Dr. Steve Meyer, orthopedic surgeon and Mike Boose, orthopedic equipment supplier from Sioux City, visited us for a couple days. It was Steve's 21st trip to Tanzania and Mike's fourth representing STEMM—an independent mission group doing great work in Tanzania. While Dr. Meyer consulted with Dr. Lyimo on a couple cases, this was mostly a planning trip for this coming summer when STEMM will be sending a whole orthopedic surgical team to Machame. Next week, Dr. Tom Gapp, a radiologist from Lincoln, will be stopping by to in-service us the use of our C-arm x-ray unit and do some ultrasounds. Prof. Dr. G. Fuchs, orthopedic surgeon from our German church partner, will be with us for three weeks in February.

And finally, we have our first foreign patient today. Dr. Lyimo is putting a couple screws in the broken ankle of a ten year old Canadian girl living in Moshi, Tanzania.