AHEAD OF THE CURVE
Young state scoliosis patients are finally receiving pro bono surgical help in a joint venture between Mediclinic Pietermaritzburg and Greys Hospital.
Braden Moonilall, 15, was diagnosed with congenital scoliosis last year after X-rays revealed that one of his vertebrae was triangular, causing his spine to curve to one side and causing a growing lump on one shoulder.
As a state patient, the KwaZulu-Natal teen was on a waiting list to receive much-needed surgery. But thanks to to a partnership between Greys Hospital and Mediclinic Pietermaritzburg, he was among the recent beneficiaries of pro bono scoliosis surgery.
The joint venture assists young, state healthcare patients who need scoliosis surgery and is the brainchild of Dr Alberto Puddu, a spinal surgeon at Greys.
“Braden required surgery. If he hadn’t had the surgery, he would have had a deformed spine for the rest of his life and the condition could have worsened. For this type of scoliosis, the only treatment option is surgery,” says Dr Puddu.
“Scoliosis is particularly progressive during a child’s growth spurts. In another 10 to 15 years’ time, Braden might have developed attrition of the spinal cord, in which the spinal cord becomes damaged after rubbing over the deformity, possibly causing weakness in the legs, and bowel and bladder problems too.”
Collaborative effort
Dr Puddu’s initiative was motivated by the patient needs he witnesses daily in the government health sector. “In the state system, our theatre time is under enormous pressure and our patient load is too high, which means our surgical waiting lists get longer. Elective operations, like Braden’s, are repeatedly pushed to the bottom of the line as they’re not emergencies,” he says.
Intensive care unit (ICU) beds are also in short supply at state hospitals and if Dr Puddu can’t guarantee a high-care bed at Greys post-op, the surgery must be delayed.
As a solution to this problem, Dr Puddu contacted Tabitha Lolliot at Mediclinic Pietermaritzburg, who was then the Hospital General Manager. He suggested the idea of a partnership in which Mediclinic would provide theatre time and a post-op, high-care bed for his patients.
“Off the bat, Tabitha [now Operations Executive, Mediclinic Southern Africa], was positive about the idea and took it up with Head Office,” Dr Puddu says. “Three days later, Mediclinic Southern Africa’s Industry Affairs Executive Bob Govender contacted me, saying he wanted to get involved in the programme. Mediclinic has been amazing throughout this whole process: forthcoming and positive, with a ‘how can we make this happen?’ attitude.”
Sharing the healthcare burden
Between October 2022 and January 2024, Dr Puddu has performed 26 such operations at Mediclinic Pietermaritzburg on children needing scoliosis surgery. The programme was due to be completed at the end of February, when a further three patients were to receive operations.
As the pro bono scoliosis surgeries have proven so successful, Dr Puddu would love to repeat the initiative and further cement partnerships between Greys and Mediclinic Pietermaritzburg.
“This partnership is a simple and workable solution to bridge the gap between private and public healthcare. It is a way to alleviate some of the challenges faced by the state health sector,” he says.
Ear, nose and throat (ENT) surgeons at Greys and Mediclinic Pietermaritzburg conducted a similar pro bono programme prior to Dr Puddu’s initiative. Since the scoliosis programme began, a urology initiative has also begun, with Greys urology surgeons operating at Mediclinic Pietermaritzburg.
“I think our programmes can help pave the way for such approaches [between the private and state medical sectors],” says Dr Puddu.
Positive impact
Prior to the operation, Braden had some pain in his back, which is no longer a problem.
Particularly problematic for him was the cosmetic aspect of his scoliosis, the asymmetry. With one shoulder being higher than the other, he had worn oversized jackets to cover up his back.
Dr Puddu says Braden’s three-and-a-half hour operation and subsequent recovery went according to plan. The day after the operation at Mediclinic Pietermaritzburg, he was transferred back to Greys, where he spent two weeks in rehabilitation. A couple of weeks later, he was walking and back at school.
“Braden should have a normal life now. He might have some back or neck pain in future, but most of us experience that kind of pain during the course of our lives.”
While Braden was scared to undergo the surgery, he has certainly noticed the difference, post-surgery.
“I spent almost two weeks in hospital and the pain was crazy, but it got better as time went by,” he says. “Now, six months later, I’ve healed very well and have much less pain. It’s more manageable and I’m doing so much better.”
He says he is careful to take things as easy as possible to avoid injuries, but feels much more free. “The operation has given me so much more confidence. I’m able to dress smartly without worrying about who is looking at me. I’m no longer conscious about my appearance and I feel normal again.
“Having the operation was the best choice I could ever have made and I now look to a brighter future. I thank God for sending Dr Puddu and Dr Josh de Kiewit [then an orthopaedic registrar at Greys] into my life. They are my real-life heroes and role models.”
Logistics of a pro bono healthcare initiative
In Dr Puddu’s programme, two days before each operation, on a Wednesday, the patient is admitted to Greys where blood and other tests are conducted. On the Thursday, the patient is transferred to Mediclinic Pietermaritzburg, where they overnight under the care of Mediclinic nurses. They also spend the Friday night following the surgery at Mediclinic, and most patients are transferred back to Greys on the Saturday to start their post-op rehabilitation.
While most of the surgeries so far have involved the services of District Anaesthetist Professor David Bishop or the Greys anaesthetist, some private anaesthetists have also assisted pro bono.
The nursing staff, including the theatre staff, radiographers, and post-op ICU nurses, are paid for by Mediclinic Pietermaritzburg, while the state pays for Dr Puddu’s surgical services.
“It is important for both parties in this partnership to feel they are contributing. To keep things semi-equal in terms of cost, Greys Hospital also covers the cost of any implants, which is substantial,” explains Dr Puddu.
If Braden hadn’t had the surgery he would have had a deformed spine for the rest of his life. For this type of scoliosis, the only treatment option is surgery.
A collaborative effort
Dr Puddu’s initiative stems from needs he witnesses daily in the government health sector.
“In the state system, theatre time is under enormous pressure and our patient load is too high, which means our surgical waiting lists get longer. Elective operations, like Braden’s, are repeatedly pushed to the bottom of the line as they are not emergencies,” says the surgeon.
Intensive care unit (ICU) beds are also in short supply at state hospitals in general and, if Dr Puddu can’t guarantee a high-care bed at Greys post-op, the surgery must be delayed.
As a solution to this problem, Dr Puddu contacted Mediclinic Pietermaritzburg Hospital General Manager Tabitha Lolliot about a partnership in which Mediclinic was asked to provide theatre time and a post-op, high-care bed for his patients.
“Off the bat, Tabitha was positive about the idea and took it up with head office. Three days later, Mediclinic Southern Africa’s industry affairs executive Bob Govender contacted me, saying he really wanted to get involved in the programme,” says Dr Puddu. “Mediclinic has been amazing throughout this whole process: forthcoming and positive, with a ‘how can we make this happen?’ attitude.”
Sharing the healthcare burden
Between October 2022 and January 2024, Dr Puddu has performed 26 such operations at Mediclinic Pietermaritzburg on children needing scoliosis surgery. The programme is due to be completed at the end of February 2024, by when a further three operations will be completed.
As the pro-bono scoliosis surgeries have proven so successful, Dr Puddu would love to repeat the initiative and further cement partnerships between Grey’s and Mediclinic Pietermaritzburg.
“This partnership is a simple and workable solution to bridge the gap between private and public healthcare. It is a way to alleviate some of the challenges faced by the state health sector,” says Dr Puddu.
Ear, nose and throat (ENT) surgeons at Grey’s and Mediclinic Pietermaritzburg conducted a similar pro-bono programme prior to Dr Puddu’s initiative, while, since Dr Puddu’s programme began, Grey’s urology surgeons and the private hospital have begun a similar initiative as well.
“I think our programmes can help pave the way for such approaches [between the private and state medical sector],” says the surgeon.
The impact for Braden
Prior to the operation, Braden had some pain in his back, which is now no longer such a problem. What was particularly problematic for Braden was the cosmetic aspect of his scoliosis, the asymmetry. With one shoulder being higher than the other, he wore big jackets to cover up his back.
Dr Puddu says Braden’s three-and-a-half hour operation and subsequent recovery went according to plan. The day after the operation at Mediclinic Pietermaritzburg, he was transferred back to Greys, where he spent two weeks in rehabilitation. A couple of weeks later, he was walking and back at school.
“Braden should have a normal life now. He might have some back or neck pain in future, but most of us experience that kind of pain during the course of our lives.”
While Braden was scared to undergo the surgery, he has certainly noticed the difference, post-surgery.
“I spent almost two weeks in hospital and the pain was crazy, but it got better as time went by,” says Braden. “Now, six months later, I’ve healed very well and have much less pain. It’s more manageable and I’m doing so much better.”
He says he is careful to take things as easy as possible to avoid injuries, but he feels much more free. “The operation has given me so much more confidence. I’m able to dress smartly without worrying about who is looking at me. I’m no longer conscious about my appearance and I feel normal again,” he says.
“Having the operation was the best choice I could ever have made. It has benefitted me a lot and I now look to a brighter future. I thank God for sending Dr Puddu and Dr Josh de Kiewit (then an orthopaedic registrar at Greys) into my life. They are my real-life heroes and my most-looked-up-to role models.”
The logistics of a pro-bono healthcare initiative
In Dr Puddu’s programme, two days before each operation, on a Wednesday, the patient is admitted to Greys where blood and other tests are conducted. On the Thursday, the patient is transferred to Mediclinic Pietermaritzburg, where s/he overnights under the care of Mediclinic nurses. Friday night, following the surgery, is also spent at Mediclinic, and most patients are transferred back to Greys on the Saturday where they embark upon their post-op rehabilitation.
While most of the surgeries so far have involved the services of district anaesthetist Professor David Bishop or the Greys’ anaesthetist, some private anaesthetists also assisted, pro bono.
The nursing staff – including the theatre staff, radiographers and post-op ICU nurses – are paid for by Mediclinic Pietermaritzburg, while Dr Puddu’s surgical services are paid for by the state.
“It is important for both parties in this partnership to feel they are contributing. To keep thing semi-equal in terms of cost, Grey’s Hospital also covers the costs of any implants, which is substantial,” explains Dr Puddu.
