Niger - April 2008

Confined to a 10 foot by 10 foot room with bare cement walls and floor, and a 115 degree temperature for 6 - 8 weeks is the typical plight of a person with a femur fracture in many areas of Africa. Moreover, such patients are treated with traction and thus are away from their family, village, and work for almost 2 months while their femur tries to heal. Amaidou was destined for this 2 month prescription as he flew through the air from the top of a "bush taxi" as it careened off the dirt road into a ditch. He was traveling to a nearby village to visit family sitting atop a dilapidated VW bus stuffed full with 20-30 passengers inside, outside and on top. Traveling by car is a dangerous adventure in much of Africa, and Amaidou was lucky to have escaped with his life. So it was that I was introduced to Amaidou in the Galmi Hospital in SE Niger, with a pin through his tibia connected by a rope to a used paint can full of hardened cement hung over the foot of the bed. Fortunately for Amaidou, the Galmi Hospital has available the SIGN system of intramedullary nails and I placed a retrograde femoral nail the day after arriving at the hospital. Amaidou returned to his village 3 days later. This is a dramatic piece of good fortune for Amaidou, his family and his village.

Life in much of Africa is unthinkably hard. Look at any metric of infant or maternal mortality, sanitation, education, income, preventable disease, or life expectancy and the prospects are daunting. If it is possible to imagine, life in Niger is harder still. Studies by the UN and WHO consistently place Niger in the top 5 poorest countries in the world. The health projects and initiatives that are undertaken focus on development and community health, not on medical care in hospitals. The funding for trauma care in Niger is essentially nonexistent. Some hospitals lack even Kirschner pins for traction, and it is common place to require the patient’s family to obtain intravenous fluids, medications, sutures, and implants prior to undertaking any procedure.

The SIGN system was introduced in the busy hospital in Galmi two years ago and I have had the opportunity to see its benefits at work, Amaidou being just one case in point. In addition, on a recent trip to Niger in April, I was happy to assist in training the doctors at the National Hospital in Niamey in the SIGN implant system. They were extremely grateful to receive the SIGN implant system; especially since there was no possibility of funding the system from insider Niger, and in this instance, SIGN donated the set in its entirety. Both the National and Galmi hospitals are extremely busy, with a steady flow of trauma patients and long bone fractures. Galmi is very well run and staffed, but is about 7 hours by road from the capitol of Niamey. On this trip I returned to Galmi and then was able to spend 3 days with the surgeons in Niamey, attending morning report, going on rounds, and performing surgery. The surgeons in Niamey are very capable and will make good and frequent use of the SIGN system. In addition, there is an orthopaedic training program at the National Hospital under the direction of Dr. Patrick Hoekman of Belgium; providing an opportunity to leverage the training at the National Hospital as these doctors leave with the knowledge and techniques of the SIGN system as they begin work in Niger or other parts of Africa.

Todd Ulmer, MD