14Feb
Dr. Luijisyo Mwakalukwa reviewing XRays

 

Every day at CCBRT our orthopaedic and plastic surgeons perform life changing operations. On any afternoon, the theatre is full with doctors busy replacing hips and knees, reconstructing limbs, and setting fractures. Our Orthopaedic team consists of experienced surgeons who specialise in minimally invasive surgical techniques for treating fractures due to long bone trauma, conducting limb reconstruction procedures to treat massive bone infection or bone loss following trauma, and congenital limb deficiency, and correcting correction of angular deformities like knock knees and bowleg.

Their combined 50+ years of experience equips them with the expertise to prioritise minimal invasiveness and approach surgery with patients’ overall well being in mind.

When setting fractures, CCBRT surgeons create a 2-3cm incision and use a fluoroscope, a small wand camera that projects onto a screen, to navigate inside and repair the break. Orthopaedic surgeon Dr. Luijisyo Mwakalukwa noted, “The alternative method may involves a 15-30cm incision, which interferes with the fracture site and hematoma surrounding the injury, prolonging healing. Our approach reduces recovery time and the risk of infection”.

CCBRT orthopaedists take into account the patient’s overall well being and education needs when treating angular deformity. Our surgeons avoid acute correction (breaking the bone, straightening, and inserting pins) in favour of a longer term, less invasive approach. For children with bowlegs or knock knees, surgeons use the fluoroscope (commonly called C-Arm) to guide them during placement of short plates and screw insertion on either side of  the child’s growth plate of the bone through a two 2-3 cm incision on the skin of the affected leg. This temporarily stops growth. “As the insides of the legs continue growing”, Dr. Luijisyo explained, “they straighten”. He continued, “With this gradual and minimally invasive approach, kids can be on their feet, in school playing and learning while they’re healing. It also protects their parents’ time—they don’t need to nurse the children at home”.

Another CCBRT orthopaedic specialty is limb reconstruction. Bone infections sometimes require amputation or partial removal of the limb. When possible, our surgeons employ a bone elongation procedure or bone transport technique to correct the bone defect as opposed to  using a bone graft. Over the course of a week, pressure is gradually applied to the site using a special external fixation frame applied to the limb. The patient is then discharged and manages the treatment from home as their own bone regrows. Dr. Fulvio Franceschi, a CCBRT orthopaedic surgeon, is a pioneer in bone elongation. In addition to treating patients, he and the team are training surgeons from Iringa, southern Tanzania in this technique. CCBRT is one of the only health facilities in Tanzania using this method.

After serving patients for over 20 years, CCBRT is a centre of excellence and expertise in orthopaedics.

14Feb
Sharing family planning materials
Part of the Valentine's Day leaflet

 

On Valentine’s Day, CCBRT Emphasises Safety, Respect & Joy

This year the CCBRT Family Planning unit celebrated Valentine’s Day by sharing sweets and educational messages on love. Over 1,000 leaflets were distributed to patients, visitors, and staff at the CCBRT Disability Hospital with information harping on safety, joy, and respect as hallmarks of love.

These were designed for a broad audience, but with a particular focus on youth engagement, as sexual violence is prevalent in Tanzania. The leaflets included statistics on assault, consent, and condoms, such as: “10% of Tanzanian women aged 15-49 reported that their first experience of sexual intercourse was forced. Sexual contact without mutual consent =  Violence! No is No! Always!”.

The messages encouraged readers to be with a partner who makes them feel safe, be aware of infection and unwanted pregnancy risk, seek regular sexual health check ups, and remember that “if it doesn’t feel safe, don’t do it”. They also emphasized joy as a key component of love. This starts with self love and “feeling strong, confident, and protective of your own body”, as well as “being with someone who makes you feel happy, cared for, and secure”. The third and final theme was love as respect. Respect for “your own body and your partner’s body, for the decisions you make, for people of all ages and genders, and for the youth’s right to a bright future”.

Throughout the day patients and visitors were encouraged to take free condoms and learn more about sexual health and family planning options at Tim’s Corner, CCBRT’s onsite family planning unit.

Throughout the year, CCBRT prioritises family planning in its Maternal & Newborn Healthcare work and integrates it with disability services. With the combination of rapid population growth, high adolescent fertility rate, and minimal use of contraception, the need for family planning services in Tanzania is dire. Relatedly, the Tanzanian maternal and neonatal mortality rates are almost double the global averages. To address the impact of population growth, low contraceptive use, and maternal and newborn mortality, CCBRT offers extensive family planning services.

Tim’s Corner, offers a full range of short and long term modern contraceptive methods, free information, and educational materials on reproductive health, family planning, and disability. In 2016, nearly 600 people received comprehensive family planning services at Tim’s Corner. Furthermore, 83% of women being treated for obstetric fistula at the CCBRT Disability Hospital were educated in sexual & reproductive health and nutrition during their group rehabilitation sessions. CCBRT also shares Sexual & Reproductive Health and fistula prevention educational materials through outreach in communities in Dar es Salaam.

Family planning will be integrated throughout CCBRT Maternity & Newborn Hospital services -- from antenatal to postpartum care -- when it opens in 2018.

14Feb

CCBRT’s latest cerebral palsy training will make a huge difference for families in Tanzania. Cerebral palsy (CP) – a condition caused by brain injury developed around birth, limits a child’s development and mobility as they grow: something our own physical and occupational therapists working in communities around Dar es Salaam and Moshi frequently see. Because of a lack of skills and knowledge about this complex disability among parents, many children with CP and their families often struggle to manage the condition day to day, limiting children’s chances for participation in day to day life as they grow. Resources are also scarce: many children do not have access to therapy or assistive devices.

For 10 days, Motivation – a charity working with community-based organisations to improve the lives of people living with mobility-limiting conditions – sent one of its trainers from South Africa. Sue Fry, a master trainer in Parent Care Training (PCT) led a 4-day session for physiotherapists and occupational therapists from CCBRT’s Disability Hospital and Moshi rehabilitation facility on how to work with parents and impart the knowledge in skills to empower themselves and their families. For the next 4 days, parents and their children with CP were brought in and therapists worked directly with them on ways to handle their children during daily activities like washing and feeding.

The emphasis throughout the training was on having parents feel confident enough to continue using these techniques as their child grows, without having to depend on CCBRT for support. This is part of CCBRT’s evolving approach to community based rehabilitation: putting skills in the hands of parents to ensure that appropriate care is sustained. CCBRT’s Social & Empowerment Programme Manager, Naeli Mbiru, said: “CCBRT is focusing on empowering parents to handle their children better, and ensuring they can continue this approach back home. The training has gone really well.”

Parents gained confidence and increased interactions with their child. One participant, Stella, brought her baby Shija to the training. She commented on what she had gained from the 4 days: “Before attending this training I knew nothing – now I know my baby has cerebral palsy. When I used to feed him his body would twist around, but now I’ve learnt how to hold him and he is stable.”

For more information on the training programme, “Getting to Know CP”, developed at the International Centre for Evidence in Disability (ICED), London School of Hygiene & Tropical Medicine and disseminated through Motivation, click here.

13Feb
 

CCBRT joins hands with Government of Tanzania to save the lives of mothers & babies

The Government of Tanzania and Comprehensive Community Based Rehabilitation in Tanzania (CCBRT) partner to strengthen maternal and newborn health care services in Tanzania. In collaboration with the Government’s Regional Health Management Team and the Council Health Management teams, CCBRT aims to strengthen skills and expand the knowledge of clinicians, raising the quality of maternal and newborn care in 23 public health facilities in Dar es Salaam.

The success of this partnership is marked by a visit from the Honourable Ummy Mwalimu, Minister of Health, Community Development, Gender, Elderly, and Children and Erwin Telemans CCBRT’s CEO at Temeke Hospital to celebrate the inspiring results of the CCBRT’s Maternal & Newborn Healthcare work.

Each year, 8,000 women in Tanzania die due to complications of pregnancy and childbirth, and 42,000 babies do not survive their first month of life. 80% of maternal death could be prevented. The Government of Tanzania has prioritised reducing maternal and neonatal deaths under its One Plan II.

Since the inception of the Maternal & Newborn Healthcare Capacity Building programme in 2010, CCBRT has invested over 11 billion TZS into public health facilities in order to achieve the goals set out in the national road map and Health Sector Strategic Plan. This investment in human resource development, medical equipment, and infrastructure contributed to 200% improvement in quality of maternal and newborn healthcare delivered in the partner facilities[1] and contributed to a 30% reduction in maternal mortality in the Dar es Salaam Region.

The CCBRT team of doctors, nurse-midwives, and data managers work side by side with health care providers on a range of interventions and techniques, including comprehensive emergency obstetric and newborn care, antenatal care, surgical skills, anaesthesia, and neonatal care. In addition, they provide on-the-job mentoring and supply equipment and medicine to the sites. By providing this mentorship and support, CCBRT arms clinicians with the tools and skills to save mothers and their babies. Over 5,000 clinicians have been trained in topics including emergency obstetric care, vacuum delivery, surgical skills, evidence based standard operating procedures, and data collection.

These trainings have built the skills of Tanzanian health workers, which in turn improves outcomes for mothers and babies. During complicated deliveries, health workers are prepared to intervene to help the mothers and babies through caesarean sections and vacuum assisted deliveries. In 2011, the caesarean section rate was less than 3% in the partner facilities, below the WHO recommendation of 10-15% of all deliveries. By 2016, 14% of deliveries were caesarean section. Similarly, vacuum-assisted deliveries have increased to 3.1% (from 0.2%) in the 23 facilities, reducing the time that mothers are in prolonged labour, thus reducing their risk of developing obstetric fistula, and increasing survival of mothers and babies.

On site at Temeke Hospital, the honourable Minister Mwalimu toured the obstetric and neonatal wards to see the fruits borne of this effort. She officially commissioned $95,000 worth of neonatal equipment that was designed especially for low resource settings and provided by CCBRT MHCBP. Minister Mwalimu commented, "I want to see neonatal wards like this one in every district hospital". Without these tools at hand, clinicians were not adequately able to treat the top three causes of newborn death: prematurity, infection, and birth asphyxia. With CCBRT’s support, health workers can now help babies breathe, keep them warm, and prevent infection, thus saving their lives.

“Today we celebrate the incredible progress CCBRT and government health facilities have made saving the lives of mothers and babies in Dar es Salaam,” Erwin Telemans, CCBRT CEO noted. “With expert teaching, side by side mentoring, and the equipment that they need, public clinicians are building their skills and changing the way they practice medicine, which has improved outcomes for mothers and babies”.

CCBRT’s efforts to strengthen comprehensive maternal and newborn healthcare in Dar es Salaam are made possible by funding from the Vodafone Foundation through a public/private partnership with USAID/PEPFAR, and the financial support of the Government of Canada provided through Global Affairs Canada (GAC).


[1] Measured using the Standards Based Management Recognition tool (SBMR), developed by the Government of Tanzania in collaboration with the MAISHA programme, and Jhpiego, an affiliate of Johns Hopkins University. 

10Feb

"We should be the best because people need us".

This need orients Dr. Cyprian Ntomoka's practice and vision for eye care in Tanzania. As the Head of the CCBRT Eye Department, Dr. Cyprian envisions a Tanzania where eye care will be as available as the plentiful fruit stands throughout the country.

After training in Tanzania, Kenya, Germany, and India, he returned to Tanzania and saw the enormous need firsthand. Before joining the CCBRT, Dr. Cyprian worked as a Medical Retina Specialist in Tanzania's southern highlands seeing hundreds of patients each day. With a widespread reputation for expert eye care, CCBRT attracts nearly 400 patients each day: "Every morning our department is completely full with people from all over the country-- and they are just a fraction of those who need treatment. Why do they come here? Because they trust CCBRT. I am here so that they can get the services they deserve," he explained.

"I thought to myself, I have to join CCBRT to grow it and broaden access to treatment-- that is my passion". He dreams of expanding CCBRT's existing social franchise model to reach even more patients. This involves reinvesting revenue generated from private services in subsidized public care, resulting in affordable treatment for those who need it most.

Dr. Cyprian explained his dream with a metaphor: "Suppose you have a house that floods every year. You cannot sell that house. What do you do?" He continued, "You make a giant trench!" To address the daily "flood" of patients the CCBRT Disability Hospital in Dar es Salaam, "we should build trenches all over the city". These “trenches” are neighborhood eye clinics where patients would be seen for triage and receive basic ophthalmologic care. That way, patients are treated faster and closer to home, saving them time and money. 

In addition, only the most difficult cases would be referred to the Disability Hospital centre of excellence, thus reducing wait times and ensuring those who need urgent care receive it fast. He wants his patients to know: "We are so passionate about your conditions. It is not fair for you to wake up early to come here and not be seen".

Put simply, "We don't need people traveling from all over the country to get eye drops-- they should be able to have access at home!" After addressing the need in Dar es Salaam, a region home to more than 4 million people, Dr. Cyprian hopes to establish CCBRT clinics and centers of excellence throughout Tanzania.

As Department Head and President of the Tanzania Ophthalmology Society, we know Dr. Cyprian is improving eye care for all Tanzanians. In his words, “I am here for my people”. Thank you for your tireless dedication and enthusiasm.

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