Trip Report April 21 - May 2, 2015

Contents

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3 ....................Personnel

4 ....................Trip Schedule

5 ....................Courses

8 ....................Lectures

9 ....................Clinical Training

10.................Device Innovations

12 .................Research

15 ................USTOP Supporters

PersonnelMeeta Bhana, physiotherapist Audrey Hiebert, nurseDr. Marcin Kowalczuk, orthopaedic residentDr. Desmond Kwok, orthopaedic surgeonDr. Matthew Macleod, orthopaedic residentDr. Jaydeep Moro, orthopaedic surgeon

Franca Mossuto nurse Nathan O’Hara, coordinatorDr. Brad Petrisor orthopaedic surgeonShalaleh Rismani, biomedical engineering studentElizabeth Stec, nurse

USTOP would also like to thank Dr. Tito Beyeza, Dr. Isaac Kajja and the entire staff at Mulago Hospital, Dr. Rodney Mugarura our GPAS/USTOP scholar, Ms. Harriet Nambooze from the CNIS Skills Lab and Ms. Monica Kabagambe for all of her hard work to ensure this trip was a success.

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Trip Schedule

Sunday Monday Tuesday Wednesday Thursday Friday Saturday19 20 21 22 23 24

Arrive in Uganda

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Bioskills CourseNursing Course

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Bioskills CourseNursing Course

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Case DiscussionsMulago OR

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Case DiscussionsMulago OR

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Case DiscussionsMulago ORCoRSU Clinic

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Case DiscussionsMulago ORCoRSU OR

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AMTLS Course

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AMTLS Course

April 2015

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CoursesCNIS Safe Surgery Saves Lives - Perioperative Nursing CourseDate: April 25-26, 2015Location: CNIS Surgical Skills Lab, Mulago HospitalTopics:- Introduction to the Surgical Safety Checklist - Anaesthesia-Safety Assessment- Before Induction - Surgical Scrub/Glove/- Before Incision Gown Technique- Before Transfer From OR - Antibiotic Prophylaxis- Preventing Hospital Acquired Infections This was the fifth time that USTOP has partnered with CNIS to offer their two-day interactive course. The course uses the structure of the WHO’s Safe Surgery Checklist. The participants learn why each component of the checklist is vital, how to collaborate and assist the team in safe patient care, as well as specific perioperative skills – correct scrubbing, gowning, and gloving, and performing surgical counts. The course consists of lectures, group case studies, discussion, presentations, role play and skill sessions.

The course was taught to 16 nurses and theatre assistants over two 8 hour days. 2 from the Casualty Theatre, 2 from the Spine Theatre, 3 from the Main Theatre, 2 from Ward 7 Theatre, 2 from the VSC Theatre, 2 from the Ortho Trauma Theatre, 1 from the Gyne Theatre, 1 from the Eye Theatre and 1 from the Burns Theatre.

Following the course, the team participated with in-theatre mentoring and coaching. The Canadian surgical team (surgeons and nurses) modeled a team approach to perioperative patient care, including the use of the WHO Safe Surgery Checklist.

CoursesOrthopaedic Bioskills Course - BasicDate: April 25, 2014Location: Orthopaedics Dept. Seminar Room Mulago HospitalAttendance: orthopaedic residents (years I, II), surgical residents

Topics:LECTURE Surgical reduction techniquesLECTURE Spectrum of stabilityLECTURE Screw design and function LAB Position screws/ cortical lag screws/ cancellous lag screwsLECTURE Plate design and function LAB DCP vs. lag screw neutralizationLAB Tibial plateauLAB Buttress plate fixationLAB Cancellous lag screw fixationLECTURE Tension band principles LAB Olecranon, TBW principlesLECTURE IM nailing principles LECTURE External fixationLAB External fixation (uniplanar and modular)

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Orthopaedic Bioskills Course - AdvancedDate: April 26, 2015Location: Orthopaedics Dept. Seminar Room Mulago HospitalAttendance: orthopaedic residents (years III, IV)

Topics:LECTURE Neurologic assessment in spinal cord injury LECTURE Classification of C-spine fracture dislocationsLECTURE Classification of burst fractures in the T and L spine LAB Burst fracture reduction techniquesLECTURE Classification and mgmt of pelvic ring fracturesLECTURE Classification and mgmt of acetabular fracturesLAB Ex-fix pelvisLECTURE Proximal humerus fracturesLECTURE Distal humerus fracturesLECTURE Pilon fractures LAB Proximal humerus fracture fixationLAB Pilon fracture fixation

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Courses

Lectures

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Acute Musculoskeletal Trauma Life Support (AMTLS) Course Attendance: orthopaedic officers and 1st year orthopaedic residents

This was the first time the AMTLS course was offered outside of North America. The objective of the course is to prepare ER physi-cians, orthopaedic officers and junior level surgical residents for clinical situations encountered in the emergency room, learn how to recognize emergency injuries, how to triage injuries and the basic emergency management required for various injuries.

The content areas of the course includes: trauma (general), pediatric injuries, upper extremity injuries, lower extremity injuries, spine & pelvis and septic joints.

Orthopaedic Teaching SessionsAttendance: orthopaedic residents

Daily case discussion sessions were held with available residents. All of the visiting USTOP faculty participated in these rich learning activities.

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USTOP participated in a variety of cases with the staff and trainees at Mulago Hospital. Procedures were done in the casualty theatre, ward 7 theatre and the main theatre.

Clinical Training

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Device InnovationThis trip saw continued involvement from the UBC Engineers in Scrubs program, with pilot testing of several new devices. These devices are engineered to solve perioperative challenges in Uganda. Some of the projects include:

Drill Cover DesignThis Grand Challenges Canada funded innovation is a resterilizable cover to enable surgeons to use commercially available drills in the operating room. The design has tremendous potential in a low resource setting. This product is currently in the process of commercialization and should be available for widescale purchase in 2016.

Above Elbow Prosthetic ArmBuilding on the success of our partnership with the LN-4 prosthetic arm for people with below-elbow amputations, UBC engineering students are currently developing a prosthetic arm suitable for above-elbow amputations. A prototype from the group was brought to Uganda during this trip for feedback from patients and providers. This feedback will be incorporated into the next version of the design.

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Surgical Screw CutterLimit surgical supply inventory leads to deficiencies in common surgical screws sizes. A second-version of the screw cutter device designed by UBC MASc students enable a surgeon to cut surgical screws to the appropriate size intraoperatively before insertion.

Shalaleh Rismani, one of the designer, joined USTOP to get further feedback on the design from Ugandan surgeons. The device has garnered much interest from the surgeons and is moving towards commercialization.

Wound Closure SystemA second engineering student team has been working closely with USTOP and Ugandan orthopaedic surgeon, Dr. Tony Mutanda, to develop a device to advance the pace of would healing after a severe open fracture. Due to the high volume of road traffic injuries, Uganda sees hundreds of open fractures admitted each year. The current protocol has patients waiting on the ward while the wound heals.

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ResearchEconomic Impact of Orthopaedic TraumaThe findings of our study on the economic impact of orthopaedic trauma in Uganda has been completed. The results were presented during the visit at the Makerere University School of Public Health. Ugandan co-author Dr. Rodney Mugarura will be presenting the study at the 2015 Bethune Round Table for International Surgery in Calgary, AB. The findings have also been submitted for publication.

INORMUSRecent Makerere Orthopaedic graduate, Dr. Tony Mutanda, is the site-lead as Mulago Hospital participates in McMaster researcher Dr. Mohit Bhandari’s international cross-sectional study on the global impact of orthopaedic trauma. The site is expected to reach it’s target recruitment of 1000 patients within the month.

Another recent graduate, Dr. Pariyo Bonane, plans to begin recruiting for the study from his practice at Fort Portal Regional Referral Hospital in the following month.

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Innovation Hub - VGH K-Bro LinensMcMaster University MedlineOffice of Pediatric Surgical Evaluation and InnovationRegency Travel

Thank you

Canadian Consulate, KampalaCanadian Network for International SurgeryClearWealth AdvisorsCollege of Surgeons of East, Central and Southern AfricaConMed LinvatecEllen Meadows FoundationGlobal Partners in Anesthesia and SurgeryHamilton Health Sciencesanada

USTOP would like to thank our generous philanthropic supporters who make this collaboration possible. USTOP is deeply grateful to the following organizations for their ongoing partnership and would like to announce a new five-year partnership with ClearWealth Advisors.

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Synthes Canada UBC Branch for International SurgeryUBC Department of OrthopaedicsUBC Development OfficeUBC Faculty of EngineeringVancouver General HospitalZimmer Canada

For more information on USTOP, please visit our website or contact:

Nathan O’Hara, University of British ColumbiaP: 604-875-4111 x66270E: nathan.ohara@vch.ca

www.ustop.ca