[Ethiopian Herald] After receiving his Doctor of Medicine degree from Addis Ababa University Dr. Samuel Hailu chose to specialize in the field of General Surgery. Unexpectedly, he faced a car accident from which he sustained multiple bone fractures. This led him to realize some problems in Ethiopian Orthopedic care. As a result, he decided to specialize in Orthopedic Surgery at the Addis Ababa University. Subsequently, he traveled to Canada for further study to specialize in hip and knee joint replacement, along with the treatment of complex Orthopedic trauma. This specialized training was completed at the University of Toronto. He completed his training abroad and returned home 5 years ago.

At that time, he was the only hip and knee joint sub-specialist in the country. Hundreds of Ethiopians traveled abroad, paying large sums in foreign currency for joint replacement surgery. After he started delivering the service here, he was able to retain 10 to 20 percent of those who would have otherwise traveled abroad for joint replacement.

He is currently training more Ethiopians to perform these services, as well as training foreigners from various African countries. During his recent interview with The Ethiopian Herald, he has explained more about the treatment which is called “Surgery of the Century”.

[Ethiopian Herald] Could you elaborate on the situation of the problem in Ethiopia?

[Dr Samuel Hailu] One of the health problems that hinder the day-to-day life of the people and hold them back from economic activity is a joint problem that needs to be replaced. There appears to be a general unawareness in Ethiopia of local options, as many people go abroad for such treatment. We do not know how many people need joint replacement in Ethiopia, but according to statistics from Indian Embassy in Ethiopia, the Embassy issued a visa for 800 Ethiopians that needed joint replacement in a year’s time. No less number travel to Thailand, South Africa, and Europe. When we try to project the statistics from other countries to the population of Ethiopia it is quite clear that thousands of patients need the surgery every year.

[Ethiopian Herald] What are the main reasons people need a joint replacement?

[Dr Samuel Hailu] There are many reasons why people come seeking hip and knee joint replacements. By far, in my experience, the demand for a hip replacement outweighs that of the knee in Ethiopia by more than 5-folds. Some of the most common reasons people need a total hip replacement in our country are related to accidents, avascular necrosis (AVN) of the femoral head (death of hip ball bone tissue due to interruption of blood supply), osteoarthritis, and other types of arthritis. AVN occurs due to various reasons, but in our country, the main causes are steroids, alcohol, smoking, HIV, and as a sequel to accidents. In my observation, the most common reason for AVN in our setting is related to misuse (overzealous use) of steroid drugs. Steroids may have been ordered once by a physician, but many people tend to continue using it by getting a refill from a pharmacy without prescriptions.

[Ethiopian Herald] What are the main accidents that cause it?

[Dr Samuel Hailu] Simple falls and car accidents are the two most common injuries we see that result in fractures requiring joint replacements.

Hip fractures in relatively older patients occur as a result of simple falls while walking. Fractures occur as their bones tend to weaken due to osteoporosis; this age group is also prone to falling. Some hip fractures can be fixed and healed. However, some will not heal properly and hence hip replacement is the primary mode of treatment.

In the younger age group, car accidents are the main causes of fractures. When not treated timely and appropriately, they result in sequelae that need to be treated with joint replacement. Worksite injuries, assault, and gun-shot injuries are other causes of accidents we see in our country.

How is the delivery of the treatment and know-how in Ethiopia currently?

I am the first fellowship-trained sub-specialist joint replacement surgeon in Ethiopia. Before my return from Canada 5 years ago, foreigners used to perform the traditional joint replacement technique either as a campaign or in missionary centers. However, at a subspecialty level, I am pleased to pioneer the service using the most modern technique called “minimal invasive, muscle-sparing anterior total hip replacement”. In the past 5 years, we have been building our national capacity and providing an all-Ethiopian team for hip and knee joint replacement.

In my private practice, mainly at the Samaritan Surgical Center, I provide both hip and knee joint replacement surgeries. In the same center, we are working to serve those who would have otherwise traveled abroad to get these procedures done. We are able to apply the most modern techniques of hip replacement called anterior total hip replacement. It is minimally invasive, efficient, minimizes the risk of complications from the procedure, and enables me to do bilateral total hip joints replacements at the same time when needed. The rehabilitation process is facilitated as no muscle is cut, the pain is less and the power of their hip muscle is largely preserved. This is important for everyone undergoing hip replacement, but especially, the elderly following hip (femoral neck) fractures as this enable them to achieve the main goal of treatment in this age group- to get them up and going as soon as possible after fractures.

We are also working to make the service accessible to those who cannot afford private care; these surgeries can be provided free of charge at the Tikur Anbessa (Black Lion) Specialized Hospital. The hip joint prostheses are obtained through donations. Our goal is to provide up to 50 such surgeries annually but is limited to the number of hip prostheses provided by our donor. The donations are made by the Zimmer-Biomet company, based in the USA.

This collaboration has been greatly aided by our good friend Dr. Alexis Falicov. He is the champion who has been at the forefront of this effort, a good-hearted Orthopedic surgeon based in Seattle, USA. He has been coming to Ethiopia for 11 years and recognized the huge demand for hip joint replacement. In 2017, we jointly conducted a hip replacement campaign which enabled us to conduct 20 successful total hip joint replacements free-of-charge. Subsequently, Alexis has convinced the company to keep donating the hip implants for use at the Black Lion Hospital every year, and hence we are providing this service free of charge. We do not yet have knee joint replacement services in the Black Lion Hospital system.

The know-how in Ethiopia is still lacking and as a pioneer in the field, we have created social media platforms on YouTube (https://www.youtube.com/DrSamuelHailu); Facebook, Instagramand Twitter to create awareness in my fields of subspeciality. I am also on LinkedIn, this is where you noted my services and contacted me for this interview.

[Ethiopian Herald] How did you choose to study this discipline?

[Dr Samuel Hailu] After graduation from medical school, I was the victim of a car accident. I sustained multiple fractures and had to wait 16 days with a potentially deadly fracture before receiving my first surgery. It was then that I recognized the many problems and unmet needs for proper care. It became obvious that if I, as a doctor, had this much problem getting appropriate care, one can only imagine how much our farmers must suffer. This convinced me that I must serve my people.

So, I decided to study Orthopedics. As a trainee in the field, I had the opportunity to travel to the USA and to explore various subspecialties in Orthopedics and I realized how much I could help my people if I did two sub-specialties. I decided on trauma and joint replacement sub-specialties. These sub-specialties have enabled me to properly treat acutely broken bones, including complex pelvic and acetabulum fractures. When patients present late with sequelae of complex injuries, I can provide a reconstruction of their damaged joints with hip and knee joint replacement.

[Ethiopian Herald] How do you see people’s awareness of the problems?

[Dr Samuel Hailu] For the most part, awareness should be created at the community level. Many people, both in urban and rural areas, still initially visit traditional bone setters, for both joint problems as well as following fractures. These traditional practitioners what we call them locally Wegesha provide the service without having had any formal training. Before modern care, Bone setters were the main provider of this type of treatment. However, the problem lies when people visit these Wegeshas first and wait for too long to seek medical care until the injuries have badly damaged the cartilage and are too late for salvage of the joints. I saw a glimpse of the extent of the problem in Ethiopia when the campaign was first conducted here about 9 years ago. When people heard about the campaign by a visiting doctor from the USA at the Black Lion Hospital, more than 200 registered in less than a week.

The demand is very high, but many people do not know where they can get the service and continue to travel abroad, seeking what they perceive as advanced care.

At the moment the waitlist for hip replacement at Black Lion Hospital is around 1,000 and still, patients wait years before they get the care because of a shortage of material supplies.

Even though we provide quality care in a private setting, at Samaritan Surgical Center, many people are lured by agents and brokers, in the name of medical tourism, mainly to India, Thailand, Turkey, and elsewhere, adding to unnecessary expense and suffering.

We have to work more in creating awareness of the importance of getting these procedures done here locally. We provide minimally invasive surgery and this offers short hospital stay, quick recovery time, reduces complications, and overall cost of care. We also provide post-surgery care as postoperative care is as important as the surgery itself. The type of care each patient requires depends on the type of surgery as well as the patient’s health history and that requires a close follow-up with the patient.

[Ethiopian Herald] What about economic factors?

…..Part 2 will continue in the next blog.

By Zekarias Woldemariam
[Posted on Sep 05, 2020 by Ethiopian Herald]

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