A SIGN for a New Generation

 Orthopaedic residents and consultants from Tenwek and Kijabe.  Dr. John is on the far left.  We are demonstrating the "squat and smile" photo, which Dr. Lew Zirkle, the founder of SIGN, likes to see SIGN patients perform to show they are healed!

Dr. John and I.

AP view of Dr. John's tibial SIGN nail.  The nail goes in through the knee, and travels down the intramedullary canal of the bone, across the fracture to just shy of the ankle joint.  The two screws go through holes in the nail to stabilize and hold the fracture.   

Lateral view.

Teaching ex-fix principles using PCV pipes simulating bones.

The entire group at the PAACS Basic Science Course, Brackenhurst Conference Center, Limuru Kenya.

During one call night in December, two weeks into the national doctors’ strike in Kenya, and with cases stacking up for surgery, I received a phone call from one of the 3^rd year orthopaedic residents.   “Dr. Galat,” he said, “you won’t believe this, but your resident, Dr. John Mandela, just injured his leg playing soccer.” “Really,” I said, somewhat concerned, as Dr. John was the only resident on my service at the time.   “He’s in casualty,” he said, “and it looks like he has an open (compound) tibia fracture.”  While heading to the hospital to see Dr. John, I chucked, musing at the irony of personally operating on my only resident.  “You just can’t make this stuff up,” I thought to myself, at the same time thankful for the opportunity to help.

I found John in casualty with a bloody splint on his leg, and, trying to lighten the mood, promptly informed him he was going to have to write all patient notes from his hospital bed.  Thankfully, we were able to take him to the operating room that same night to wash the open wound, and stabilize the fracture using a SIGN nail.  SIGN Fracture Care International is a not-for-profit company with a vision of “creating equality of fracture care throughout the world.”  They do this by providing nails to a network of SIGN surgeons in more than 300 SIGN programs in 53 developing nations.  To date, more than 180,000 patients have been healed using the SIGN intramedullary nail, and between Tenwek and Kijabe hospitals, we have treated more than 3,000 patients using this innovative nail.  Now, one of our own trainees has received the very nail he is learning to use to heal others. 

Recently, I saw Dr. John at the PAACS (Pan-African Academy of Christian Surgeons) Basic Science Conference, a two-week intensive course for 1^st and 2^nd year surgical residents from all over Africa.   I was amazed to see him walking without a limp, just 6 weeks from his date of surgery.   Without the SIGN nail, he would have still been in a heavy plaster cast, walking with crutches, and struggling to get around.  As I watched him interacting and learning with the other 50 residents, I thanked God for this new generation of surgical trainees who are dedicating their lives to helping others in need.  And the PAACS orthopaedic family is growing, as the Kijabe/CURE program will soon join Tenwek to make a total of 16 PAACS orthopaedic residents-in-training.  It is a privilege to be involved in the education of these young, bright, committed African trainees who will be part of the solution to the lack of surgical care in some of the most needy parts of the world. 

Dr. John will return to his training post at Kijabe next week, just two months from his injury.  I told him he failed his rotation on the Galat service, and will have to remediate!   Just kidding…we’ll all be glad to have him back.

Thanks for all your love and support over the years!