The Ecuador Initiative

Below is an email to our Medical Director Dr. Charles Price. The email is a summary of the recent Ecuador Mission and Outreach Program. IHDI assisted by providing a DDH Educational Module, harnesses and other educational materials (such as a hippy baby model).

Ecuador has been identified as high risk due to a number of factors including; traditional swaddling with the hips and knees extended and inadequate education of physicians and midwives to diagnose and treat hip dislocations during infancy.

We hope you enjoy the email:

Dear Charles.

Well we are back safe and sound from our recent Mission to Ecuador. Bob and I were checking in for our first flights home when the earthquake struck. We were about 600km away and at 8500 feet in altitude and it was still a good shake. Such devastation for the people of Ecuador. It will take some time for them to recover from this in so many ways. Our thoughts and prayers go out to these good people.

The group of 40 left Canada on April the 7th and returned on April the 14th.

We were able to accomplish 26 surgeries in 4 operating days. The large majority were high riding hip dislocations. This year we had 4 young females in their 20s who had severe enough symptoms to benefit from surgery and hip replacement after femoral shortening. All went well and we are always thankful when we don’t run into any significant post-op problems.

As you can imagine after 4 intense days in the OR everyone was very satisfied and happily tired.

The patients are always so grateful that it makes everything so worthwhile.

On the 13th Bob and I started our teaching tour. We started at the Med School of the University of Cuenca. Dr Thelmo Tapia was our host. We did a grand rounds on DDH with about 110 students and faculty in attendance.

Thank you very much for all the materials that you provided us with. They made the presentations much more entertaining and informative.

We had a good Q&A session after the presentation.

We learned during this session that each medical graduate is required to spend one year at the end of their training in the countryside in a community clinic. These are the young people that need to be reached.

After the Medical School we were able to attend 3 different Community Clinics over the next 3 days.These clinics are up in the Andes outside Cuenca and are exciting to reach. Thank goodness for all wheel drive. Each clinic is usually staffed by one young physician and one or two nurses. We found these professionals all to be very engaged and committed.

At each clinic the staff had made it known that we were coming and we were able to spread the word to another 275 individuals in those 3 communities. Again your videos and pamphlets were very helpful in our presentations.

There was always a very lively discussion at the end of our formal presentation and it was quite obvious that those in attendance were very interested in what we had to say. The topics that created the most discussion were how the diagnosis is made, what the treatment was and swaddling.

On our last day we had 60 people in attendance. There were 3 youngsters in that group who were being treated for DDH. Two were under 5 and had been diagnosed by X-ray around two to three months. Each was doing well with appropriate treatment. The third was an 18 year old who had not been diagnosed until after she walked. She had had 3 surgeries and was not doing well. She had a very high riding hip on one side and a very deformed hip on the other, possibly secondary to AVN. That was a sad situation and emphasized why we needed to have early diagnosis. We encouraged those in attendance to go out and spread the word and we are very certain that they will.

We also learned during these sessions that there is a policy in place in Ecuador that all babies at around 2 months are supposed to have an X-ray of the hips to look for dysplasia. Needless to say to doesn’t always happen but it is a start I suppose.

So we reached between 350 and 400 people with our message. Some medical professionals and some regular folks. A very small start but we are certain the word will spread at least in the province of Cuenca. We are somewhat encouraged that things do seem to be changing. There are those, like Dr Tapia, who appear committed to getting the word out about hip screening in the new born.

Bob and I feel that the IHDI perhaps in conjunction with POSNA could be very helpful at this stage in this effort. A collaboration between your Paediatric groups, particularly your spanish speakers, and the Ecuadorian paediatric orthopedic group would probably stimulate the Ecuadorians to take ownership of this. They should be the ones who take it to the ministry of health and develop with them an appropriate policy for hip screening in new borns and infants. We have been unable, in spite of trying for the last five years, in gaining access to the ministry of health.

As we discussed in our teleconference some months ago, better dialogue between medical missions would also be helpful. Out Reach programs such as ours could be established in other areas of the country.

Charles, this has been a very interesting experience for Bob and me. We feel that with the IHDI on board this has the potential to change a lot of lives in Ecuador.

All the best.

John