If you're in the luckiest one percent of humanity, you owe it to the rest of humanity to think about the other 99 percent
A charitable committee within the British Society for Surgery of the Hand who’s mission statement is:
"to use the BSSH resource to deliver maximum possible benefit for patients in need of hand surgery in low-middle income countries (LMICs)"
The committee develops and coordinates sustainable educational and surgical projects across the globe through various overseas projects:
Myanmar
Bangladesh
Sudan
Malawi
Ethiopia
Kenya
Sierra Leone
Tanzania
Uganda
Sri Lanka
Cambodia
Hand surgery is a multidisciplinary specialty. Good surgical outcomes are dependent on good postoperative hand therapy as much as the surgery itself. Many hand conditions can be successfully treated by hand therapists without the need for surgery. Therefore, most BSSH projects involve both surgeons and therapists travelling and working together to instil this essential MDT (multidisciplinary team) approach. We also actively encourage UK orthopaedic, plastics and hand surgery trainees to participate in these missions for their own learning, and to instil the culture of training others to propagate hand surgery as a sustainable global specialty.
Nik with his trainee Matt Jones, whilst in Kenya.
Below are various reports Nik has produced on the missions he has been been lucky enough to participate in…
Mission 1 - Myanmar, 2018 - Fact-finding
My first opportunity to get involved was the inaugural fact-finding mission to Myanmar in 2018. After 50 years of military rule and lack of any western influence and globally shared learning, Myanmar’s hand surgery training needs were completely unknown. With a team of orthopaedic and plastics hand surgeons from the UK, we spent a week visiting various healthcare settings speaking to surgeons, academics and students to identify potential areas where the BSSH may be able to help going forwards. As well as a fact finding mission, we also provided a 2-day educational course on hot topics in hand and wrist surgery to gauge response, interest and uptake. The mission was a success and close links were formulated in preparation for several future missions to address clinical and educational needs. It was clear their surgeons were already highly skilled and learning was definitely a 2-way process.
Nik Jagodzinski - Mission 1 - Myanmar, 2018 - Fact-finding.
Nik’s outpatient clinic in Yangon, Myanmar
Mission 2 - Sudan, 2020 - Hand & wrist fracture practical course
My second and third missions, both in early 2020, were to provide a hand and wrist practical trauma course that is currently available for trainee hand surgeons in the UK (Surgical Art hand fracture course), but adapted for LMICs to take account of their limited resources. Carrying several suitcases of dried out chicken bones wired together to make hands, along with 9 electric drills and hundreds of wires and tools on flights around the world posed its own challenges.
Hand fracture course, Sudan 2020
Firstly, we delivered the course in Khartoum, Sudan with roughly 30 delegates, all senior orthopaedic trainees. It was incredibly gratefully received with several senior surgeons providing feedback and high praise afterwards including comments such as “the best medical or surgical course ever to come to Sudan.” After the course, we spent a day seeing patients with complex hand and upper limb problems with local surgeons and therapists as an MDT meeting to help them solve their difficult conundrums. On our last day, we were incredibly honoured and humbled to receive an award from a senior Minister. Since this trip, I regularly provide clinical advice to surgeons in Sudan by WhatsApp and e-mail, because travel there is currently impossible due to the ongoing conflict.
Hand fracture course, Sudan 2020
MDT clinic in Sudan 2020
Mission 3 - Myanmar, 2020 - Hand & wrist fracture practical course
My third mission, just a few weeks later in early 2020, was to provide this same practical, chicken-bone hand trauma course to surgeons in Myanmar. This time, there were over 80 delegates who had travelled from all over the country for the course including trainees at all levels and established Surgeons and Professors. Alongside our surgical course, one of my Hand Therapists from North Devon, Henrietta Clay, also taught their physiotherapists some basics of hand therapy, a specialty that did not exist in Myanmar until then. Each course took many weeks of planning at home, several days to set up once there, and 2 days to deliver. Again, it was incredibly gratefully received and feedback was excellent. Despite a global Covid lockdown starting whilst we were teaching in Myanmar, we returned safely with our health intact and some excellent contacts for future potential missions.
Nik lecturing during hand fracture course, Myanmar
Unfortunately, due to the most recent military coups, civil war and political instability in both Myanmar and Sudan since our visits, further BSSH missions have had to cease for the time being. Unfortunately, many of the contacts and surgeons whom we worked with and helped to train have been lost.
Hand fracture course, Myanmar
Mission 4 - Kenya, 2023 - WALANT in Africa
This mission was born separately from the BSSH Global Partnership Committee, although they willingly supported and contributed significantly to its delivery once invited to get involved. I travelled to Kenya with Prof Don Lalonde, the undisputed pioneer and leader of WALANT surgery, who has spearheaded its teaching and dissemination globally for the last 40 years.
Grateful patient after WALANT wrist fixation course, Kenya
Joining our faculty were prominent WALANT surgeons from Malaysia and the USA. As well as presenting WALANT to the second International Congress for Innovations in Global Surgery (ICIGS), and to the Society for Surgery in Kenya annual conference, we put on a 2-day WALANT course for 40 established surgeons from 10 different East African countries who all travelled to Mombasa to learn WALANT. This consisted of a day of lectures and a day of live operating on patients in a small Governmental Hospital in Mombasa. Again, this was very gratefully received and helped forge 40 WALANT ambassadors who could further teach surgeons across Africa.
Nik operating during WALANT course, Kenya
Nik and his registrar, Matt, lecturing in Kenya
Mission 5 - Malawi, 2023 - The LION Project
Malawi is the 11th poorest country in the world and has few natural resources. Healthcare relies heavily on charity from around the world. Charitable work and funding from Norwegian surgeons have been instrumental in developing Orthopaedic and Trauma surgery in Malawi, but there are no hand surgeons as yet. The BSSH Malawi project is a slightly different project to their others in that it has a 5-year goal to train the first hand surgeons and create a hand unit that can self-propagate and become a centre for hand surgical training in Africa.
The BSSH have invested in a house, a family to run the house, security and a car in order to house a team of UK hand surgeons, hand therapists and trainees on a non-stop, rotational, charitable basis for a full 5 years. The old Kamuzu Central Hospital (KCH) in the capital city, Lilongwe, is overcrowded, run down and in dire need of expansion and modernising. The LION Unit (Lilongwe Institute of Orthopaedics and Neurosurgery) was designed, commissioned and built on the KCH site, once again by a Norwegian team, and would become home to a new BSSH Hand Unit. I was lucky enough to go for a month in the early stages of the project and worked at the old KCH before the LION Unit had opened for business.
Nik doing WALANT surgery in Malawi’s emergency department
As the volume of work far outgunned the surgical capacity, my teaching of WALANT surgery took on a whole new meaning. Without need for an anaesthetist or an operating theatre, my team and I were able to operate on dozens of patients in a small treatment room in the Emergency Department preventing the need for hospital admission. Several other patients could be operated on on the wards under WALANT technique using head torches when the operating theatres were full of more severely injured patients. More complex patients could be operated on in theatres during the evening and overnight under WALANT by the UK team when the over-stretched anaesthetic and surgical Malawian teams had gone home to rest.
Nik teaching surgical residents, Malawi
Although I have a lot of experience teaching in various parts of the world, becoming an integral part of a surgical team in Malawi and working every day for the benefit of local patients was a real eye-opener. It was humbling at how immense their workload is on a daily basis and taught me a lot about becoming as resourceful and efficient as possible in my own UK practice. As well as running hand clinics and operating on patients on a daily basis, we taught surgical trainees a hand surgery programme on a weekly curriculum led by the BSSH. We also held weekly video conference MDT meetings with surgeons and hand therapists from around the UK for unusual and difficult cases.
The new LION unit, Malawi, before official opening
It is a truly inspirational project that should sew a hand surgery educational seed to propagate across Africa and leave a legacy for the BSSH as well as creating permanent links for a 2-way learning process. None of this could happen without charitable donations from around the world. If you feel like learning more then please watch the video documentary, and consider giving, please visit: JustGiving.com
Nik’s BSSH and theatre teams in KCH, Malawi