Namibian children who need orthopaedic surgery no longer need to travel to South Africa for complicated procedures, thanks to a successful support programme spearheaded by a surgeon at Mediclinic Windhoek.

Young children in Namibia with cerebral palsy, congenital deformities, hip dysplasia, dislocations and other growth complications were historically at a distinct disadvantage to their counterparts in South Africa. Although Namibia is home to highly competent orthopaedic surgeons – and surgical after-care is world-class – paediatric orthopaedics is a niche field. Compared to other subspecialties in Orthopaedic Surgery, there are far fewer surgeons dedicated to paediatric orthopaedics throughout Africa and none reside in Namibia. Families were having to make the pilgrimage to bigger medical centres in South Africa to get treatment for their children.

Dr Karl Frielingsdorf, orthopaedic surgeon at Mediclinic Windhoek.

When Dr Karl Frielingsdorf, an orthopaedic surgeon at Mediclinic Windhoek, first relocated to Namibia, he immediately identified the country’s need for a specialist paediatric surgeon with experience in paediatric deformities and congenital abnormalities. “Travelling with children to a foreign country for intense surgical procedures is extremely uncomfortable for several reasons. I thought, instead of making families journey from Namibia to South Africa, why not ask my Cape Town-based colleague, Professor Jacques du Toit, to fly up three times a year to meet the huge need? We studied together and have remained close friends.”

Professor Jacques du Toit, orthopaedic surgeon and Head of Division, Orthopaedic Surgery: Tygerberg Academic Hospital and Stellenbosch University Faculty of Medicine and Health Sciences.

Fast forward 15 years, and Professor du Toit, who who heads up the Division of Orthopaedics at Tygerberg Academic Hospital and Stellenbosch University Faculty of Medicine and Health Sciences, is now a familiar face at Mediclinic Windhoek. “Since starting this supportive programme, we’ve successfully assessed and operated on a good number of children in their hometown,” he says.

“I visit Namibia for these outreach periods while on annual leave and although we work extremely hard, it is an opportunity to visit this beautiful country and meet up with old friends.”

Three times a year Professor du Toit spends a week in Namibia. Together with Dr Frielingsdorf, he tackles up to five cases a day, which means around 60 paediatric orthopaedic patients have received life-changing surgery at Mediclinic Windhoek each year (before the COVID-19 pandemic).

“I’m excited to continue with this relationship,” Professor du Toit says. “Dr Frielingsdorf and I do it for the sake of the kids.”

Dr Frielingsdorf adds that while surgery doesn’t always guarantee these children will walk again, it can mean they’ll be able to sit up or manage a wheelchair or be able to use walking aids. “Kids are often tougher than our older patients,” he says.

Blessing Makura benefited from surgery to correct a rare type of bow-leg deformity.

The Makura Family is one of many who have benefited from this informal outreach programme. “When Blessing was growing up, we noticed she couldn’t really walk,” says her mother, Chawa Makura. “She fell often, and her legs started bending outwards. Initially we thought it was rickets, but when she was four years old, we saw Dr Frielingsdorf and he diagnosed her with Blount’s disease.”

This is a rare form of bow-leg deformity at or just below the knee joint. It is caused by an abnormality of the growth plate in one or more of the leg bones. Growth plates are located at the ends of a child’s long bones and help determine the length and shape of the adult bone. Treatment entails numerous operations to correct the deformity.

Blessing has a twin who was walking and playing and running with ease, which made her struggles even more obvious.

“Dr Frielingsdorf explained that Blessing would need operations every year to try to straighten her tibia and make sure it was in alignment. But travelling to South Africa for Blessing’s numerous surgeries was not an option,” Chawa  says. “It’s too far from family. I couldn’t stand leaving my husband and other twin at home. And then we were told we have to be there at least six to eight weeks each time. Staying away from home, with no emotional support for that long was going to be so difficult. Plus, there was the expense to consider.”

When Dr Frielingsdorf told the family Professor du Toit would be able to perform the necessary surgery at Mediclinic Windhoek, the relief was palpable. And after more than five surgeries, Blessing is now as active as any other teenager.

Ernst, Darryl and Henriette and Damian Nuab.

The Nuab Family are equally grateful for Dr Frielingsdorf and Professor du Toit’s outreach partnership. When their first son, Darryl, started walking at eight months old, Ernst and Henriette Nuab noticed he had a significant limp. Doctors diagnosed him with hip dysplasia and suggested a closed reduction surgical procedure to correct the abnormality. This entails realigning the bones to optimise hip joint congruity, by positioning the leg bone where the socket is supposed to be. The hope was that over months the socket would start forming over the bone and the leg would remain in place. Darryl was in a cast from his rib cage down to both his ankles for four months, but unfortunately the closed reduction was unsuccessful.

Darryl was then referred to Dr Frielingsdorf and Professor du Toit, who determined that an open reduction would be suitable. In this surgery, an incision was made in the front of the hip to open the hip joint. Professor du Toit then removed tissue from the hip joint to make the ball of the hip fit into the socket better.

Dezne Colmer, Patient Experience Manager at Mediclinic Windhoek, says, “This paediatric orthopaedic supportive programme is a fantastic initiative by Dr Frielingsdorf and Professor du Toit. Families have no more worries about the financial and emotional support aspects of doing the procedures in South Africa. Numerous families’ lives have been changed for the better because of their dedication.”

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