Thumbs up for Hand Surgery Unit five years on
- By Deborah Minors
When pioneering hand surgeons Professor John Fleming and Dr Walter Stuart decided to establish Africa'??s first self-contained hand surgery unit at Chris Hani Baragwanath Hospital, they could not have anticipated that R6-million in funding would cross their palms, enabling hand surgery to flourish in just over five years into one of Baragwanath's busiest surgical units.
A hybrid science of orthopaedic, plastic, micro and some neurosurgery, ‘hand surgery’ is a misnomer as the discipline is not confined to the hand; ‘hand and upper limb surgery’ is more accurate. Interest in specialist hand surgery evolved in the 1960s because of injuries during World War II.
In 1976, Baragwanath became the first hospital in the country to re-plant an amputated hand. A year later, the hospital conducted the first transplant of a big toe to replace a missing thumb, thereby creating a functional hand.
Head of the now self-contained hand surgery unit at Baragwanath, Dr Walter Stuart (MBBCH 1980) credits fellow Wits benefactor Professor Emeritus John Fleming (MBBCh 1962) as “the backbone of hand surgery at Bara and even in South Africa.”
“Professor John Fleming has been the main force behind the original unit since the early 1970s,” says Stuart of the former Chairman of the South African Society of Surgery of the Hand (SASSH). “Professor Fleming has guided the unit from a part-time position for more than three decades and has influenced large numbers of trainees in the discipline.”
Stuart himself was one such trainee. He served an orthopaedic fellowship at Wits in 1994 and a hand surgery fellowship in 1995. The SASSH enabled Stuart to serve fellowships abroad at the Pulvertaft Hand Unit - England’s first - and at the Wrightington Upper Limb Unit. Stuart returned to South Africa in 1997 intent on emulating the global trend towards self-contained hand surgery units.
“Following the evolution of hand surgery as a sub-specialty, an international trend developed for the creation of self-contained physical units for the practice of the discipline,” explains Stuart. In South Africa, the dominant mining labour intensive and working class society warranted the establishment of a dedicated facility. Mining houses recognised the need for such a facility due to the number of hand injuries in mining accidents.
“Tremendous interest was shown by the donors [in a self-contained unit] since they understood the relevance of hand injuries to a working class community and also the large numbers of hand injuries which occur in the mining industry,” explains Stuart.
African Rainbow Minerals, the Anglo American Chairman’s Fund, AVI, Gold Fields, Impala Platinum and Scaw Metals contributed two-thirds of the R6m funding raised. The Gauteng health department, which endorsed and contributed to renovations launched Africa’s first self-contained hand surgery unit on 4 February 2005. Operations began in April 2006.
The hand surgery unit currently performs up to 150 cases of reconstructive surgery a month. Hand and upper limb injuries result from trauma (knives, bullets, crushing) or through illness (osteo-arthritis, rheumatoid arthritis and infection). One-third of the unit’s surgeries is elective, a service other State hospitals struggle to supply. The unit is a direct referral centre for greater Soweto, most of southern Gauteng and the North West Province. It routinely treats patients from other African states
Hand surgery training at Wits falls under the School of Clinical Medicine in the orthopaedics department at Baragwanath and under the plastic surgery department at the Charlotte Maxeke Hospital. This crossover exposes postgraduate doctors qualified in orthopaedic or plastic surgery, to hand surgery, for which fellowships are available. Four Hand Fellows - two Kenyans and two from the UK - have served fellowships in the unit since 2006.
Since its self-contained status in April 2006, the unit’s average number of operations per month has increased from around 80 in 1997 to almost 170 in 2010. “The standard of hand surgery and service rendered to the community has improved year by year,” concludes Stuart. “Hopefully the gradual strengthening of the Hand Unit will continue and ongoing development and innovation will help to maintain and improve the service the facility is able to provide.”