Services

Reconstructive Surgery for Crippled Children

Many children in the community Selian serves are crippled and have no access to corrective surgery or rehabilitative care. Some are born with congenital deformities and many more become crippled through drinking water with a high fluoride content. Skeletal fluorosis causes grossly bowed and painful legs.

At Selian skeletal fluorosis (click here) is among the top five causes of crippling in children. In some nearby villages as many as 20% of the children are affected.

The most severe cases of skeletal fluorosis are referred to Selian for corrective surgery. Selian surgeons together with Orthopedic Surgery volunteers operate on approximately 200 of these children annually. The cost to the hospital is only $100 per child and the surgery restores these children to wholeness and allows many to walk again. It is truly a remarkable ministry of healing and prevention. Children come into the hospital unable to walk and then walk out under their own power.

Selian provides a wide range of reconstructive surgery options to our community. This includes not only orthopedic surgery for children crippled by congenital deformities and acquired deformities such as skeletal fluorosis, but also burns and trauma. Visiting volunteer orthopedic surgeons operate at Selian at least six weeks each year. For example, a visit (March 2004) by orthopedic surgeons Dave Palmer from the United States and Jackson Murila from Kenya resulted in over 100 operations on crippled and disabled children at Selian in a single week. This important work continues with support from the Help for the Disabled team here in Arusha and with the financial support of Compassion Canada. In total Selian surgeons and volunteer surgeons operate on over 300 major orthopedic cases annually!

Equally important is the reconstructive surgery done by volunteer plastic surgeons. The repair of cleft lips and palates as well as the grafting of complicated burns is a wonderful ministry to those who have already suffered so severely from their trauma.

There's a silent and tragic epidemic rampant in the poor countries of the world. It is not much discussed because it affects primarily women who are poor. It is an epidemic that turns mothers into outcasts.

Imagine a mother who lives deep in the bush when she goes into labor at home, perhaps with the help of a traditional midwife. If the baby is too large to pass through the birth canal, the baby's head exerts enormous pressure on the vaginal, rectal and bladder tissues which then die and results in leakage of urine or stool through the vagina (a vesico-vaginal or recto-vaginal fistula). The child usually dies in the process.

The joy of an expected child is replaced with a new problem: the continual leaking of urine and/or stool. It is impossible for her to stay clean. Her husband may banish or divorce her. Her family may send her away or keep her at distance from the family hut because of her smell. She is now "unclean."

Selian began the first center for fistula repair in northern Tanzania and the center also serves the southern third of Kenya. The surgery is difficult and requires special training and experience. Drs. Sweke and Kisanga both perform 100s of fistula repairs annually. Dr. Sweke undertook special fistula repair training at the well-known Fistula Hospital in Addis Ababa, Ethiopia.

The AIDS epidemic is devastating Tanzania. Selian has been responding to the epidemic since 1986 and the effort has grown dramatically in the past few years. The program now consists of a wide range of comprehensive services and preventive activities. The individual components of the program include:

1. AIDS Education and Awareness Raising: These efforts have continued to expand into new areas with concentration on the training of local church leaders, school educators, peer groups, traditional leaders and high risk groups within the community.

2. Voluntary Counseling and Testing (VCT): VCT is now available at three Selian sites. The largest is at the Arusha Town Clinic, second is Selian Hospital in Ngaramtoni, and the third is in the Health Center at Mto Wa Mbu. These Selian clinics provide VCT to over 1000 patients per month.

3. Prevention of Maternal to Child Transmission of HIV (PMTCT): This program began in 2002 and expanded in all subsequent years. Eighty-five percent of women in the antenatal clinics agree to be tested for HIV. HIV-positive rates are fortunately low with about 13% testing positive and requiring treatment for PMTCT. Further expansion of this program is planned for 2004.

4. Medical Care and ARV Treatment for HIV Patients: In 2003 Selian began treating AIDS patients at the Arusha Town Clinic with anti-retroviral drugs (ARVs). The Selian ARV clinic will began providing free ARVs in 2004 with funding from USAID and the Clinton Foundation. The clinic cares for over 1000 patients living with AIDS.

5. Home Based Care and Hospice Care: Selian continues to reach out into the community of patients with AIDS and other diseases to provide home based care, training for family members in home care, and to provide for end of life hospice care in the home. As of February 2006 the team is providing this care to over 1000 patients in their homes.
To see a hospice slideshow, click here.

7. Support of People Living with HIV/AIDS:Selian continues to be the patron to and a primary supporter of the support group known as ALPHA+ or Arusha Living Positively with HIV/AIDS. This is the largest support group in Arusha with over 120 members and they regularly meet at Selian's Uzima (Wholeness) Center in Arusha. Many members participate in community AIDS education programs.

8. Orphan Care: Orphan care and Care to Children Affected by AIDS (CABA) remains a top priority for Selian. The program is designed to keep orphans in their villages by providing direct support for orphan care and education.

Clinical Officer Frida Njotto, right, is Selian Hospice's medical
officer and nurse-midwife Paulina Natema is
the hospice administrator.

The ministry of hospice care continues to expand. The hospice program began in 1999 and was the first hospice in Tanzania. The program is home-based and the hospice team does home visiting to provide palliative and spiritual care to those who are terminally ill. Most hospice patients have AIDS (65%) or advanced cancer.

The program has expanded into many surrounding villages and congregations where volunteers are being trained to provide hospice care to those in need in their communities. In addition to the hospital staff and clergy, there are 130 lay volunteers who have been trained in home hospice care.

The hospice team was able to invite other church hospitals from Northern Tanzania to attend an introductory workshop on hospice care in 2002. This then gave rise to Selian Hospice becoming a training center for other hospitals in hospice care! In 2003 this training introduced the Selian hospice model to nine hospitals including three in Kenya. Plans are now to expand the training to include all of the Evangelical Lutheran Church in Tanzania hospitals and other faith-based medical facilities as well and this is being implemented under the direction of Dr. Kristopher Hartwig.

Contiuing Medical Education for clinical officers, physicians and nurses is another of the exciting ongoing efforts at Selian Lutheran Hospital. Developing and supporting our staff through higher education is a basic goal of the hospital. Currently, Selian has 16 staff in advanced study and an additional six that are being sponsored for other Diocese Health Department positions. This means 10% of Selian staff are receiving advanced education. For example, during 2003, further studies included:

1 Surgical Residency
1 OB/GYN Residency
2 Clinical Officers (COs) Upgrading to Medical Doctor
1 Medical student
2 COs upgrading to Assistant Medical Officers
3 Clinical Officer students
4 Nurses upgrading to Nursing Officer
2 MCH (maternal & child health) Aides upgrading to Public Health Nurses
1 Nurse Assistant upgrading to Nurse Midwife
1 Radiographic Asst upgrading to Radiographer
1 Lab Technician upgrading to Diploma technician

Regular continuing medical education (CME) for staff occurs three times weekly. These three weekly meetings are: a general CME for all staff; a special CME for Clinical Officers; and a special CME for nursing staff. There are formal lectures as well as weekly case reviews. Staff from other government dispensaries in the area are invited to attend. Lecture topics include the full range of medical and surgical problems typically encountered within the hospital.