Let’s walk together 2

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Title of the project

Let’s walk together 2

Place of the action

Asmara, Eritrea

Description of the context

As many African countries, Eritrea is a low-income country with a critical health situation, in particular in paediatric orthopaedics. In Asmara there is one orthopaedics dept at Halibet hospital: this is the only Orthopaedics ward in all Eritrea. The ward has 34 patient-beds, 2 operating rooms and 5 orthopaedics surgeons (1 for every 1,300,000 inhabitants) whose activities are oriented almost exclusively on trauma, neglecting paediatric orthopaedic pathology, which would require dedicated facilities, with trained MD and health personnel capable of early detecting and  treating children affected by orthopaedics deformities such as congenital clubfoot, developmental hip dysplasia, axial deviations of the limbs, scoliosis. If these pathologies are not early diagnosed and treated, they will worsen during growth, compromising any social relationship and quality of life. Furthermore, secondary deformities and late diagnoses are often very severe and require delicate and complex surgical interventions. Following an official request of the  Eritrean Ministry of Health, in 2008 AnlaDi started to support orthopaedic surgery through the project  “Let’s Walk Together” aiming at establishing the first Paediatric Orthopaedics dept in the country. In collaboration with the Rizzoli Orthopaedic Institute of Bologna and Halibet hospital in Asmara, from 2008 to 2019, over 1000 children have been visited and about 500 children have been operated for orthopaedics deformities such as congenital clubfoot.

In 2019, after 10 years of fruitful collaboration with the Eritrean authorities, the Eritrean Ministry of Health requested us to intervene in the treatment of Evolutionary Dysplasia of the Hip-DDH (hip development anomaly which occurs during intra-uterine life and leads to an alteration of the conformation and ligaments between the femoral head and the acetabulum. Because of its tendency to evolve and worsen over time, this pathology requires to be diagnosed and treated as early as possible. The treatment induces the best possible centering (“reduction”) to allow the coxo-femoral joint to develop properly. The Eritrean Ministry’s request is motivated by the frequency of this disabling pathology, especially among young girls and women, by the Halibet staff’s lack of adequate skills, and, above all, by the lack of a health registry and therefore epidemiological data.

The project

The project as a whole consists of a first mission of assessment and planification of interventions by a Annulliamo la Distanza and Meyer Hospital volunteers medical team, together with the involvement of neonatologists, pediatricians, orthopaedists and radiologists from the Halibet and Orotta Hospitals. There are also two training missions about the prevention and treatment of developmental hip dysplasia, where orthopaedists, pediatricians, anesthesiologists, nurses and physiotherapists will be present. We subject patients who suffer from undiagnosed congenital hip dysplasia to operation during the first months of life. In addition, meetings with neonatologists, pediatricians and orthopaedists will be organized in order to raise awareness about the importance of an early diagnosis of the pathology.
During the meetings, the necessary paths will be discussed to be able to clinically screen as many infants as possible, the way to perform ultrasound scans of the hips on infants of two to three months of age, which is an examination that constitutes the gold-standard for early diagnosis. Also how to prepare the conservative treatment that is indispensable to prevent deformities due to missed diagnosis will be discussed. One or two theoretical/practical training meetings will be needed and they will be made by a skilled staff to convey the needed competences for performing ultrasound scans of the hips to neonatologists and/or pediatricians and/or radiologists.

The team of trainers will be provided with all the equipment (primarily an ultrasound scanner with a specific probe and infant restraint apparatus for performing the examination) necessary to perform the examinations described. This material will remain at the disposal of the Eritrean medical staff to continue these examinations independently. During missions, which last about seven days, operations to correct undiagnosed hip dysplasia to children will be performed by skilled orthopaedists. Surgeons will be supported by Eritrean specialists and nurses to convey competences.

The project aims at the general improvement of the Eritrean public health services qualitative level. The project will do it in the Pediatric Orthopaedic field through the contribution of competences and the provision of equipment and materials in order to enable medical personnel to make a correct early diagnosis. Then it could be possible to prevent hip dysplasia deformities that are not diagnosed early, and consequently treat this pathology at all stages. Moreover, the project aims at ensuring to children basic health conditions, which aren’t only a right, but also an essential condition to create a peaceful and nonviolent culture which are fundamental for this country’s future.

The general objective of the project is to improve the quality of public health services in Eritrea, especially in the Paediatric Orthopaedics sectors, through trainings and supply of medical equipment for enabling Eritrean orthopaedic surgeons to effectively manage DDH in all stages: prevention, early diagnosis, bloodless and bloody treatment and follow up. The project aims at guaranteeing basic health conditions to children, indispensable conditions to start building a culture of peace and non-violence, fundamental for the future of this country. The specific objectives are:

  1. To provide the health services of a modern hospital where Eritrean population can receive the necessary care the impact of DDH-Developmental Hip Dysplasia in Eritrean infants and children.
  2. To improve paediatric orthopaedic quality, medical competences and surgical interventions
  3. To improve national guidelines for paediatric orthopaedic assistance, and to organise professional training programs for Eritrean orthopaedic doctors, nurses and health staff working in the operating rooms of Halibet Hospital.

The objectives of the project will be achieved through a collaboration with the Eritrean Minister of Health, the Admin of Halibet  Hospital, Meyer Hospital in Florence and Annulliamo la Distanza. The Italian medical team will be supported by a local team. During the mission, the Italian specialists will provide a training on the job. The Italian MDs will provide complete sets of the necessary surgical equipment and instruments which ultimately will be donated to the Eritrean MDs in order to ensure their  full autonomy.

The expected results are:

R1. Halibet Hospital has been equipped with surgical instruments and equipment dedicated to Paediatric Orthopaedics, in particular for the early diagnosis and treatment of DDH
R2: Three missions of the medical volunteers from Annulliamo la Distanza/ Meyer hospital has taken place in order to train local staff (orthopaedics, anaesthesiologists, and nurses) on ​​DDH and on the diagnosis, bloody and bloodless treatment of DDH
R3: Over 280 children with malformations have been visited  and at least 40 operations have been performed
R4: 30% children who were born at Orotta Hospital are screened for early diagnosis of DDH.
R4: 6 Eritrean MDs and 5 nurses have been trained.

Achieved result

In 2021 medical missions couldn’t be realized in the country due to COVID pandemic. According to preventive measures adopted by the Eritrean government for the first part of 2021, travelers from countries where cases of COVID-19 infection had been recorded, including Italy, were placed under quarantine for a period of 14 days. The quarantine was in a special hospital facility called ‘Villaggio Community Hospital’ located on the outskirts of Asmara.
In the second half of 2021, travelers from abroad were obliged to be swabbed on entering and leaving the country. If the swab tested positive, volunteers were not allowed to leave Eritrea until they had completed a minimum 7-day isolation period at the Village Community Hospital pending re-swabbing. This has made it impossible for our medical volunteers to travel to Asmara for short periods of time. In addition, during 2021, numerous flight cancellations by airlines that should have provided this route have prevented our medical volunteers from scheduling missions well in advance considering their professional commitments. In September 2022 the first post-pandemic mission was realized by the medical team of Bologna Rizzoli Hospital and the Florece AOU Meyer. It ended with 162 outpatient visits to children suffering from orthopedic pathologies and also 21 operations were made.
The collaboration with local doctors and nurses from Halibet Hospital was fully satisfying too. Children who will require in-depth diagnostics or new health care facilities have already been identified for the next mission.