Knee Replacement in Congo – Part 2

September 2, 2016

I am part of a group of female orthopedic surgeons (WOGO) who travel to third world countries to improve the lives of people by improving mobility through joint replacement. In July, we traveled to the Democratic Republic of Congo (DRC) as guests of the Dikembe Mutombo Foundation to perform knee replacement surgeries. This was an incredibly challenging trip. Here is Part 2 of our story.

As described in Part 1, our cargo had not yet cleared customs when we arrived in the country. We lost a day of surgery while the necessary signatures were obtained. Although we were at the hospital until midnight unpacking cargo, we were ready to start surgery the next day.

Beginning Surgery

The buses left the hotel at 7:00am. We were tired but excited to start operating. The scrub techs quickly got started preparing the rooms and opening sterile drapes and instruments. The first patients were brought down to the preoperative area and our interpreters helped us answer patient questions. The anesthesiologists placed femoral nerve blocks and spinals.

By 9.30am, the first patients rolled into the operating rooms. We had 3 rooms, with 2 surgeons per room. The goal was to do 3 cases per room per day for a total of 9 patients. Most of the patients needed bilateral knee replacements. In addition to our team of an anesthesiologist, 2 surgeons, a surgical assist, and a circulating nurse, we were joined by surgeons and anesthesiologists from the hospital and orthopedic residents. We spent a lot of time teaching.

Challenging Patients, Unfamiliar Equipment

These were challenging surgeries as most of the knees were stiff and very deformed. The equipment we were using was not the small, minimally invasive state of the art instruments that we are used to in the United States. The surgical teams incorporated people from all over the country who last worked together 2 years ago on our last mission trip. The surgeries took a bit longer than usual because of these factors, but they all went really well.

We were focused on getting our cases done because we had already lost one day of surgery and the patients we had selected on the pre-trip had been admitted to the hospital in preparation for their surgeries. For that reason, I started my last case that first day at 9.30pm. It was another long day, with the early team not getting back to the hotel until after 10:00pm and the late team staying at the hospital past midnight. We were all exhausted but happy the cases had gone so well. Fourteen knee replacements were done! We were proud to have done the first knee replacements in Kinshasa, DRC.

Problems Increase

The problems with the sterilizer started the next day. Because of issues with electricity and water pressure, not all of the equipment was sterile. Ruth Kanyere, the equipment engineer for the hospital was so helpful in trying to get the machine to work. The delays meant another long day, but by the end we had accomplished our goal of 14 more joints.

The third operating day was when everything started to fall apart. The sterilizer broke down again. We ended up sending some of our equipment to another hospital to be sterilized. We were able to do some cases. One of the surgeons was sick and had to return to the hotel. Other team members were hit by gastro-intestinal illnesses and were getting IV fluids. We were all exhausted.

For the first time we were not able to do all the cases scheduled for the day. Thirty-eight knee replacements had been completed. We started trying to figure out how we would be able to get all of the cases done. Even in the best case scenario, if the autoclave worked perfectly that night and the next day, it would be nearly impossible to do all the cases we had promised to do. We had only one more day left to operate as the OR was booked for another foreign surgeon for the remainder of the week. We started the difficult process of trying to decide which cases we could do. But we would wait until tomorrow to make the final decisions.