March 6, 2019
Moshi, Tanzania, East Africa

I am now at Kilimanjaro Christian Medical Centre in Northern Tanzania. This is my twentieth trip volunteering with Orthopedics Overseas, a group dedicated to teaching orthopedics in less developed countries. My wife, Suzanne, and I came here as medical students in 1985, and were frustrated (as were all the doctors working here) at the difficulty treating needy patients in a resource-poor environment. I started the KCMC teaching program in 2008, and we have had orthopedic surgeons from around North America volunteer here, as well as sponsored doctors from KCMC to come to the United States for specialized training. Sue and I have also sent 7 containers of medical equipment here, the most recent of which arrived the day before we did.

The hospital has around 800 beds and serves as a referral center for 15 million people. It is also a major teaching center, with medical and nursing schools and many postgraduate training programs including the orthopedic residency, which is the main focus of our teaching program. Before starting residency, the physicians have all practiced general medicine for at least three years, and the orthopedics training is four years. When they take their final exams they are expected to be knowledgeable and competent in all aspects of orthopedics. We volunteers especially focus our teaching on aspects of orthopedics the residents may not be exposed to as much while caring for patients here. As an example, I brought an arthroscopy unit here, and we had a teaching session for the residents using cow knees from the market before performing the first arthroscopy in the region on a patient with excellent results. Prior to this they could only read about sports medicine procedures.

Trauma makes up the majority of our work here. As in much of the developing world, road-traffic accident rates are skyrocketing due to the availability of cheap motorcycles, more cars and careless driving. As at home, cell phone use, speeding and alcohol are major contributing factors. Trauma is the leading cause of death and disability ages 20-40. As a referral center, we are sent the most severe cases and there are many compound or open fractures. Last year when I was here for two weeks, we saw three patients with bilateral open femur and tibia fractures (above and below the knee). We now have 80 patients in the hospital. I will relate some of their stories next.

Glen Crawford, MD, Atlantic Orthopedics and Sports Medicine

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