A Letter from Dr. John Tanksley

In a few hours I will board a plane bound for Addis Ababa, Ethiopia, where I will work at the Black Lion Hospital (BLH), the government teaching hospital. Black Lion Hospital is massive, underfunded, and extremely inefficient. Surgery may be canceled on a given day due to lack of water, breakdown of the sterilizer, lack of clean linen, and the list goes on. Yet, for over 20 years Black Lion has managed to maintain a rare jewel for Africa: a training program for orthopaedic surgeons. We all hear the urgent cries for treatment of the infectious disease epidemics like HIV, malaria, and tuberculosis. But there is an even bigger world wide epidemic of trauma victims that does not get much press. Did you know that the World Health Organization estimates that the world wide cost of years of life lost to death or disability caused solely by accidents is greater than "life years" lost from HIV/AIDS and malaria and tuberculosis combined?
    In Asia and Africa it is not uncommon to see a family of 6-8 people riding on a single motorcycle. For only $50 down a $400 motorcycle may be purchased on a monthly payment plan providing a family with cheap but hazardous transportation. Add to this the common means of transportation of the poor in Africa, which is a 15-passenger van packed with over 20 occupants and piloted by reckless and irresponsible drivers over rutted roads, and you understand where the accident epidemic comes from. But for the survivors, surgery to fix broken bones is expensive, and trauma care is a low priority for the strapped budgets of many governments. A victim who lives long enough to make it to a hospital, often lies in bed for weeks waiting for his family to collect the money to purchase the necessary surgical implants at a local pharmacy before surgery is scheduled. Or months in traction may follow, all the while the patient's family attends to the injured person's needs, taking even more earning power away from the increasingly impoverished family. Non-united fractures, deformity, infections, arthritis and disability often result.
    By the generosity of an organization started by surgeon Lew Zirkle from Washington, I am taking a supply of SIGN nails specifically designed for use in the developing world. Presently at Black Lion, patients with broken thigh bones are treated for weeks or months in bed in traction followed by more weeks in a cast or on crutches. But after SIGN nailing they are out of bed the day after surgery. I will work with staff orthopaedic surgeons to start a SIGN program at BLH.
    I hope you will pray for the plight of trauma victims to be improved in Ethiopia. I want to find people to train and to encourage who have skill and a heart to help people. Pray for me to see the good things God is doing in a difficult situation. And pray that the people I work with will be inspired and encouraged to help others. Ask God to raise up a movement around the world moving champions from churches, the press, governments, and donors to find ways to provide resources like organized trauma systems, surgeons, nurses and implants, as well as laws and enforcement to combat the causes of trauma.

"..I was sick and you looked after me,...(Lord) when did we see you sick?...Whatever you did for one of the least of these brothers of mine, you did for me.." Jesus (Matt. 25:35-45)

-- John Tanksley

SIGN Conference

Richland, Washington, August 12-15, 2009. Curiosity prompted me to fly cross country to attend the SIGN (Surgical Implant Generation Network) Conference. The theme of Treatment of Difficult Fractures Around the World was clearly appropriate. Orthopaedic surgeons from all corners of the world presented papers, lectures and discussions of their work with the SIGN Nail system. North American presenters complemented the international presentations. All at this meeting faced the anathema of poverty in caring for orthopaedic patients worldwide. It was readily evident that the attendees had respect, love, and devotion for Dr. Zirkle, who has committed his life to bringing equality of fracture care around the world. His is a remarkable story of commitment and persistence and an inspiration to all of us.
    The SIGN system is developed to provide fracture care for poor countries without the ancillary assists that we enjoy such as x-ray, image intensifier, modern operating rooms, etc. The system is developed to a remarkable degree, and the course design was for sharing and teaching. In addition to the lectures and discussions, there was a “Sawbones” lab where we could actually learn hands-on and practice introducing the implants.
    The persistent poverty in the world prevents mitigating the human suffering. As orthopaedic surgeons we are called to address that task of improving quality of life. This was a meeting and fellowship of like-minded folks. Thanks, Dr.Zirkle, for your work and inspiration. (See slideshow in sidebar.)
-- Don

Preparation

Considerable time and effort has been expended to obtain orthopaedic implants and instruments, items that are useful to us in Ethiopia; however, they have been written off by the benefactor here in the states. These are charitable gifts with no resale value. I anticipate that this good start will permit us to initiate a meaningful teaching program for the residents. They are eager and anxious to learn how we do orthopaedics. We are continuing to secure materials for this purpose.
   Shipping is troublesome. Orthopaedists do things big! Orthopaedic implants and instruments usually made of stainless steel are bulky and heavy. The airlines frown on excess weight these days and charges can be costly. Fortunately we have been offered space in a container from the Greater Orlando Area bound for Addis Ababa, within several weeks. A serendipitous joy, albeit a mountain of paperwork required.
   The key to this project is the volunteers! Docs and staff that are willing to take 2 -4 weeks away from family and practice to contribute to the education of their Ethiopian peers is the cornerstone to improving the health care of their people. We are not going in and doing it for them. This is a sharing and teaching project directed to and created for their health care team. Starting in January 2010 there are volunteers taking on this challenge. I am confident that they will be rewarded greatly in personal satisfaction knowing that they have shared with those in need with what we have so generously been given.
   To those who have graciously given of time, money and support a big thank you. One day when each of the Ethiopian docs stops and reflects on how they have been impacted, how did this come about, what went into this and why, then the true goal of the project will be realized. (See slideshow in sidebar.)
-- Don