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How to Better Treat Trauma Injuries in the Developing World

May 15, 2012 at 12:00 AM EDT
At San Francisco General Hospital, surgeons from developing countries are learning the latest techniques from top U.S. specialists. With just over 100 orthopedic surgeons serving the 80 million people of Kenya and Tanzania, it's admittedly a small step. But doctors there say it's a worthy one. Spencer Michels reports.
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RAY SUAREZ: Modern machinery has caused a spike in injuries in the developing world. Now, a hospital in San Francisco aims to train doctors to treat them.

NewsHour correspondent Spencer Michels has our story.in

And a warning: This story does contains some graphic images.

SPENCER MICHELS: In recent years, the number of motorized vehicles on the roads in developing countries has skyrocketed, and so have the accidents.

DR. RICK COUGHLIN, University of California, San Francisco: We know that the global impact of injury in road traffic crashes is more than HIV, T.B., malaria combined. Did you know that? No one knows that. And yet that’s the case.

SPENCER MICHELS: Rick Coughlin, an orthopedic surgeon at the University of California, San Francisco, is on a crusade to improve the care of those who sustain traumatic injuries in the developing world.

DR. RICK COUGHLIN: Anyone who goes to a foreign country, a developing-world country, your fear isn’t that you’re going to get HIV. Your fear is that you’re going to be in a car accident and your leg is going to be exposed, and you’re — you’re in trouble now.

SPENCER MICHELS: For the last four years, Dr. Coughlin has been spearheading a unique program which brings orthopedic surgeons from low-income countries around the world to San Francisco, to one of the country’s leading trauma hospitals, San Francisco General.

MAN: And everyone has got covers.

SPENCER MICHELS: Five surgeons from Kenya and Tanzania recently arrived for a week of training and hands-on experience, learning the most up-to-date surgical techniques.

Dr. Nedford Ongaro is one of only 70 orthopedic surgeons in all of Kenya, a country of more than 40 million people. He says lack of supplies contributes to dangerous delays in treating traumatic injuries.

DR. NEDFORD ONGARO, Nigeria: We do not talk like surgical implants or surgical resources, so we give a prescription, someone has to go to buy hardware. That can take several days. So this accessibility is quite limited. And really that increases the burden, perhaps infections. People can lose limbs. And they don’t get back to work that quickly. So they have quite morbidity.

SPENCER MICHELS: While accurate numbers are hard to come by, the World Health Organization estimates that for every person killed by traumatic injury, somewhere between 10 to 50 times more suffer non-fatal injuries, which often require advanced medical care. Without that care, the risk of amputation increases dramatically.

DR. RICK COUGHLIN: The global burden or global impact of amputation is quite enormous. There are enormous numbers of what we call open injuries, where the bone, especially lower leg injuries, the lower leg bones get exposed to the air, the dirt, become contaminated.

And the soft tissue surrounding those bones are injured. And now the bones are exposed. And in that capacity, if we can teach the surgeons how to cover these exposed bones in an expeditious fashion, then we eliminate the cycle of going down the path of infection, soft tissue infection, bone infection. And then the only salvage is an amputation.

MAN: The biggest issue with osteotomies is that you have some bone missing because, if you use a saw, it takes a tiny bit of bone away.

SPENCER MICHELS: On the day we visited, the surgeons from Africa were practicing on the elbow bone of a cadaver and the soft tissue around it. And they were learning how to drill and insert sophisticated orthopedic pins in artificial bones.

Dr. Edmund Eliezer from Tanzania says the training he’s received, especially in techniques to prevent amputations, has saved more than limbs.

DR. EDMUND ELIEZER, Tanzania: Most of the times, these patients are the ones who are taking care of the families. So with the two legs, life is difficult. Now you can imagine, with the only remaining one leg, life would be very difficult.

SPENCER MICHELS: In much of Africa rural hospitals have few supplies. Heavy stones are sometimes used as traction devices. But both Dr. Ongaro and Eliezer work in the capital cities in their countries in fairly well-equipped hospitals.

Still, they say, they are having a hard time caring for the rising number of road traffic injuries.

DR. RICK COUGHLIN: So this is a mutual exchange.

SPENCER MICHELS: And, for his part, Dr. Coughlin says one main goal is to simply spread the message that traumatic injuries in the developing world are not getting the attention they deserve.

DR. RICK COUGHLIN: Why? Because HIV has the lobbying power and infection disease people have the lobbying power. I have no doubt in my mind that we are undersupplied, underfunded for research in this regard.

SPENCER MICHELS: The Kenyan and Tanzanian doctors say they will share the techniques and skills they have learned during their week in San Francisco with colleagues back home.

With just over 100 orthopedic surgeons in their two countries, serving a total of 80 million people, this program is admittedly a small step. But doctors here say they expect what they call a multiplier effect to spread the training to other surgeons in the developing world.

RAY SUAREZ: Last year, the United Nations launched the Decade of Action for Road Safety, which aims to prevent the loss of more than a million lives each year by 2020.

To learn more about the program highlighted in this report, click here.