TANZANIA:
-The NEED:
At the start of our program in 2016 there was only one fellowship trained Pediatric Orthopedic surgeon in Tanzania, a country with an estimated population of 60 million, with roughly one half of the population being under 17 years of age. In high income countries, for pediatric orthopedics, the ratio of surgeon specialists to population is at minimum 1:400,000… therefore by western standards, Tanzania could benefit from 125+ Pediatric Orthopedic specialists. Nation-wide two orthopedic residency programs currently graduate 7-9 surgeons per year. The vast majority of these orthopedic surgeons are generalists/ traumatologists.
Currently, graduate medical education (GME) training involves sending surgeons desiring specialized training to other countries. Usually these are several month to 1 year fellowships-only, where hands-on experience is often limited and language barriers may be problematic. Other sources of training include experience with visiting teams from other countries who fly specialists in with their own team and implants for one to two weeks at a time every 6-12 months and leave behind limited training experience. A greater impact comes from experienced solo trainers training young surgeons in-country for a sustained period of time… usually years. This requires true dedication and resources and is unfortunately uncommon.
The PROGRAM: Our program commenced Sept. 15, 2016
A total of 12 experienced volunteer pediatric orthopedic surgeons from the Pediatric Orthopedic Society of North America and equivalent international societies around the world traveled to the Muhimbili Orthopedic Institute (MOI) in Dar Es Salaam over a continuous 12-month training period, and a subsequent 5 month period in the 2nd year. This 2nd five months of training was generously supported by a grant from the Rotary Foundation.
MOI is the premier orthopedic training program located in the commercial capital of Tanzania. We have collaborated with the MOI faculty and the College of Surgeons of East, Central and Southern Africa (COSECSA) in developing a new 2 year fellowship training program for their country. Each COEDN surgeon-educator spent 4-6 weeks at MOI training 3 of the brightest orthopedic surgeons (selected from across the country) in pediatric orthopedic surgery. We also trained select non-MD health care providers, such as orthopedic technicians, nurses, etc. Rotations were sequenced in order to provide two continuous 12 + 5 month periods of training over 2 years. An ongoing log of patients, interventions, and outcomes was maintained during the training period (and over the subsequent 2 year period) for a review of trainees, to conduct a formal program evaluation and for research purposes.
The program was a great success! Our 3 new Pediatric Orthopedic Surgeon graduates are now training 4 fellows of their own. Congratulations Grads!.. and a very big thanks to our dedicated trainers!
MEET OUR THREE GRADUATES:
Msami Ngowi, M.D.
While in medical school, I developed an interest in Orthopaedics after assisting at Muhimbili Orthopaedic Institute to repair a valgus (bent) knee. This interest persisted during my internship at Selian Orthopaedic Institute, Arusha, Tanzania, where we encountered many trauma victims and other musculoskeletal deformities, both in adults and children. This further stimulated my already existing interest and 3 years after completing my internship, I continued on to residency at Kilimanjaro Christian Medical University (KCMC). Soon after residency began, I found it very fulfilling to assist a ailing children to return back to normal. This seemed to be my calling for Paediatric Orthopaedic Surgery, which then became my passion, my dream. A dream of delivering optimal, well trained, specialized care, a dream of bringing missing information to Tanzania, a dream to endless possibilities.
My residency dissertation is entitled “Fracture pattern around elbow in children seen at Kilimanjaro Christian Medical Centre”. I developed interest in this topic after realizing that many children coming in with elbow deformities were misdiagnosed at peripheral health facilities, hence, were also mismanaged. Frequent cases of osteosarcoma of the distal femur and proximal tibia at KCMC were also a research initiating finding. In 2014, I participated in data collection retrospectively evaluating statistics of bone tumors at KCMC using the Cancer registry from 1998-2012.
Paediatric Orthopaedic fellowships were not available in Tanzania before this proposed Children’s Orthopedics Education for Developing Nations program. Though, some paediatric training for trauma care is available, it is incomplete. For instance, in September 2014, I had to travel to Muhimbili Orthopaedic Institute for an external rotation to seek more experience on paediatric care. To find a centre where I could do a Paediatric Orthopaedic fellowship after residency is proving difficult; all available options are out of the country. Now that a fellowship program is available locally in Dar es Salaam, I can realize my dream.
I believe I can offer much to this fellowship program. I have experience training juniors and students within other programs of the medical field. As a resident at KCMC, I teach undergraduate medical students first-year anatomy, orthopaedic conditions and trauma to fourth-year medical students as well as to assistant medical officers at the School of Physiotherapy. Through teaching I have developed an interest in academia. In ten years time, I see myself as a well established Paediatric Orthopaedic surgeon, with also a specialty in spine surgery and osteo-oncology, at a teaching/research institution.
Bryson Mcharo, M.D.
I, Dr. Bryson Mcharo, am an Orthopaedic and Trauma Surgeon working at Muhimbili Orthopaedic Institute in Dar es Salaam, Tanzania. I did my bachelor of medicine at Muhimbili University College of Health Sciences in Dar es Salaam and graduated in 2006. I thereafter worked for one year as an intern doctor at Lugalo General Military hospital. After one year of internship I was lucky to be employed at Muhimbili Orthopaedic Institute in October 2007 working as registrar to September 2009. I joined Muhimbili University of Health and Allied Science for postgraduate studies on October 2009 and was graduated in 2012 as general orthopaedic and trauma surgeon and thereafter dedicated most of my time to treating Paediatric Orthopaedic and Trauma patients.
I have attended several short courses on paediatric orthopaedic and trauma in the country and abroad. I recently attended a three-month mini fellowship for pediatric orthopedic at Istanbul University. I love and care for the pediatric community, and in the future would like to be the best pediatric orthopedic and trauma surgeon in Tanzania, Africa and world at large. My dream is to be able to provide the best orthopedic care to Tanzanian children similar to USA and European standards. I also like research work and teaching especially pediatric orthopedic and trauma surgery.
I am married to my beloved wife, Dr Magreth, and we have four lovely children.
I currently reside in Dar es Salaam Tanzania.
Revocatus Benard, M.D.
I was born in Mwanza, Tanzania and now live in Dar es Salaam. Since completion of my degree in Doctor of Medicine in 2008, and one year of internship, I have been an employee of Muhimbili Orthopaedic Institute (MOI) as a Medical Officer. I have now just completed my Master of Medicine studies and work as a general orthopaedic surgeon at MOI. I am a well determined person and pleasantly calm, ready to learn appropriate new surgical skills from different orthopaedic surgeons.
I enjoy working as an orthopaedic surgeon, motivated by my love and passion in paediatric cases. Throughout my career, I have embraced an interest in paediatrics by involving myself in various researches concerning children. As a medical student, I did a study on availability and accessibility of basic paediatric resuscitation equipment in primary health care centers in Mwanza, Tanzania from July to August, 2007 as researcher (unpublished). Furthermore, I participated in several other unpublished studies based on pediatrics such as prevalence of respiratory syndrome and outcome among pre-term infants in Muhimbili National Hospital neonatal ward from 28th May to 11th June, 2007 and prevalence of malnutrition among children under age five and factors affecting its magnitude in Tanga Municipality ( Nutritional study) in 2005. I have been attending workshops and conferences focusing on children’s issues such as 1st Tanzania Paediatric Orthopaedic and Trauma Congress, at MOI in 2015.
Future forecast of my life, I see myself completing the fellowship in Pediatric Orthopaedic Surgery, and be a successful Paediatric Orthopaedic surgeon in East, Central and Southern Africa regions. In addition, I envisage myself as a contributor in nurturing and developing young surgeons with interest in pediatrics worldwide.