Septic conditions of all types are on the increase and common in lower income countries. Bones and joints are frequently involved in children resulting in osteomyelitis and septic arthritis. In tropical communities infection within muscle (pyomyositis) is uniquely prevalent. Tuberculous and mycotic infections complicate the picture. If not treated early and effectively, serious long term impairment and disability results. It is the responsibility of medical officers at district level to treat musculoskeletal infections as early as possible.  When pus is present, antibiotics alone are ineffective. Surgical procedures such as draining of abscesses and sequestrectomy need to be done.

The course

Instructing upper limb incision, Tanzania 2012. Photo © R. Lett

The Essential Osteomyelitis (EOM) course is part of the CNIS Safer Surgery and Obstetrics in Africa Program and is based of Section 5 of the Essential Surgical Skills (ESS) course.
The purpose of this course is to train medical officers at district level in the essential surgical techniques necessary to control musculoskeletal infection and prevent serious disabling impairment.

Drs. Norgrove Penny and Ronald Lett piloted the EOM course under the auspices of the Injury Control Center -Tanzania (ICC-T) in Dar es Salaam March 8th and 9th 2012. Two Tanzanian surgeons from Muhimbili Hospital were assistant tutors. The course included the management of both acute and chronic osteomyelitis and septic arthritis. Using models developed by the instructors specifically for the course, simulated deep soft tissue and bone abscesses were drained and sequestrae (dead bone fragments which prevent healing) were removed. 15 general surgery and junior orthopedic residents completed the 2-day course, which was held at the Muhimbil Orthopedic Institute. Two X-ray reading sessions where highly popular with the participants.

Dr. Norgrove Penny teaches Osteomyelitis pilot course, March 2012. Photo © R. Lett

CBM is one of the largest disability organizations working in low income countries and CNIS is proud to collaborate with them. The successful treatment of osteomyelitis, which largely affects children, is one of the greatest orthopedic contributions to quality of life. We look forward to replicating this course with CBM in Dar es Salaam and other centers in Tanzania.

“The students in this course were enthusiastic and indicated that they learned a lot of useful skills. We initially felt the course might be too basic for first-year surgical residents, but it was evident that these basic skills were very much needed. The local faculty felt strongly that skills training was vital early on in the training program.”

Dr. Norgrove Penny, Orthopedic Surgeon, Victoria, BC and CNIS volunteer surgical instructor