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Expatriate surgeons have helped advance orthopaedic care in Africa

BMJ 2012; 344 doi: (Published 08 February 2012) Cite this as: BMJ 2012;344:e938
  1. Richard Brueton, honorary consultant orthopaedic surgeon, Royal Free Hospital, London
  1. bruetons{at}

The light suddenly went out, but the window in the wall of the theatre let us see that the un-united femoral shaft fracture was now firmly held by an old fashioned unlocked intramedullary nail, kindly provided by donors. I was spending three weeks at the Africa Inland Church Hospital in Kijabe, Kenya, 50 km northwest of Nairobi. It was 2001, and I was visiting Africa for the first time, before spending two years in Malawi. I had come from the United Kingdom, where I was still working in the NHS as an orthopaedic surgeon.

There was no permanent orthopaedic surgeon in Kijabe—Kenyan or otherwise. Trauma was managed predominantly by visiting US orthopaedic surgeons, who stayed for weeks, months, or occasionally a few years. In their absence, the general surgeons got by.

I had found myself at the sharp end—in a world of compound fractures from road traffic crashes together with untreated and often un-united or malunited fractures. A radius and ulna malunited at three months provided a challenge.

Before …

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