Mozambique is a country of about 20 million people recovering from a long civil war & a couple of devastating floods. It right now depends on foreign aid as it tries to grow a proper economy. Maputo the capital is a city of 2 million with a friendly mixed populace & the language is Portuguese. They boast a lovely cuisine, beautiful beaches with a warm climate. (I felt very much at home.)

Maputo Central Hospital is the main referral & academic hospital for the country & has 200 orthopedic beds with 4 attendings & about 6 registrars. The hospital director Dr. Candido is an orthopedic surgeon. The other attendings are Dr. Langa (Dept Head), Dr. Fernandez & Dr. Juan a Spaniard who had naturalized. The 2 registrars responsible are Dr. Bernabbe (project manager) & Dr. Arturo his assistant. The senior surgeons trained in Zimbabwe (when things were still good) & they are involved with the Central African College of Surgeons & the Asian orthopaedic Association.

We arrived on Sun 26th Mar & were met & put up in a nice hotel (Pensao Martin) by the department of Orthopaedics. There were no problems with customs at the border. I went on this trip with a water engineer friend of mine who took all the photos on the trip.
This photo shows myself, Dr. Bernabbe, and my friend Ian Rushton.

Mon 27th: We attended the Orthopaedic Dept morning meeting at which cases admitted over the weekend were presented. These were mostly trauma with a couple of badly communited femoral fractures & a few tibias. The senior faculty waited after for a SIGN presentation at which I showed a PowerPoint presentation of the brief history of SIGN, the SIGN vision & mission statement, SIGN activity world wide & a summary of the system & what is expected of a SIGN project. This was very well received & we then moved to a detailed demonstration of the instrumentation with a saw bones demonstration.

A ward round followed at which I was able to see a variety of cases they managed & see a few of the proposed instructional cases. They are able to do hip arthroplasties but treat mostly fractures. The Kuncher nail is the main stay of femoral fracture treatment with AO plates for other fractures. They of course see all the problems of the K-nail. There was one on admission.

There were plenty of open tibia fractures treated with the orthofix external fixator. They have a C-arm & a fracture table but these are used sparingly as the Grosse & Kempf locked nail system they use is not restocked. Referrals are also late so they are unable to use their locked nail system as ops are done at over 10 days after. They are extremely capable surgeons with the kind of innovative minds we have come to expect from developing world surgeons.

The photo below shows the Orthopedic department staff. We then proceeded to the OR to see the set up & run another training session for the OR staff & also show them how to organize the equipment & implants. They use an OR that has 2 tables with ops going on simultaneously. They were very quick to grasp the basics.

Tues 28th: Our fist case was a very difficult severely communited femoral fracture. I tried to emphasize the femoral entry point for ante grade nailing & I also did not expose the area of communition only exposing the junction of the communition & the distal main thus fixing the distal & proximal main fragments with nail lying alongside the communition. Very tough case. Wed 29th: One of the attendings Dr. Fernandez asked to do a communited 2 week old femur while I watched & supervised. A perfect teaching case as it turned out. The pre – op X-rays were poor & showed a probable old sub trochanteric FX with sclerosis. This proved to be a night mare to ream & he struggled to put in an 8mm nail with a lot of heavy hammering. It was a nightmare case but gave me the opportunity to show some improvisational techniques in finding the slot.

The last session was database training for Dr. Bernabbe the project director. They are really concerned about their other 2 hospitals up north that have trained orthpods or will have orthopods soon & they feel like SIGN would be needed there. I educated them that SIGN is not a ‘rich’ charity & they would have to demonstrate commitment to this 1st project then we ‘would see’ about the others. Their people are a bit tall & I think 400mm nails will be needed in the future. I should be going back their sometime this year for a Primary Trauma Care (PTC) Course & will be able to check up on them, all in all.

it was a fruitful trip & I was able to take in some of their famous seafood. I really hope for good things.

A big thanks to you Lew, Jeanne & SIGN for the opportunity to be a blessing to less fortunate people.