The Orthopaedic Trauma Patient Experience: A Qualitative Case Study of Orthopaedic Trauma Patients in Uganda

Abstract

The disability adjusted life years (DALYs) associated with injuries have increased by 34% from 1990 to 2010, making it the 10th leading cause of disability worldwide, with most of the burden affecting low-income countries. Although disability from injuries is often preventable, limited access to essential surgical services contributes to these increasing DALY rates. Similar to many other low- and middle-income countries (LMIC), Uganda is plagued by a growing volume of traumatic injuries. The aim of this study is to explore the orthopaedic trauma patient's experience in accessing medical care in Uganda and what affects the injury might have on the socioeconomic status for the patient and their dependents. We also evaluate the factors that impact an individual's ability to access an appropriate treatment facility for their traumatic injury. Semi-structured interviews were conducted with patients 18 year of age or older admitted with a fractured tibia or femur at Mulago National Referral Hospital in Kampala, Uganda. As limited literature exists on the socioeconomic impacts of disability from trauma, we designed a descriptive qualitative case study, using thematic analysis, to extract unique information for which little has been previously been documented. This methodology is subject to less bias than other qualitative methods as it imposes fewer preconceptions. Data analysis of the patient interviews (n = 35) produced over one hundred codes, nine sub-themes and three overarching themes. The three overarching categories revealed by the data were: 1) the importance of social supports; 2) the impact of and on economic resources; and 3) navigating the healthcare system. Limited resources to fund the treatment of orthopaedic trauma patients in Uganda leads to reliance of patients on their friends, family, and hospital connections, and a tremendous economic burden that falls on the patient and their dependents.

“Life is at a standstill” Quality of life after lower extremity trauma in Malawi

“…Our findings are supported by a study of orthopedic trauma patients in Uganda where the authors identified social, economic, and health care system factors affecting injuries [11]. Economic loss was common, which also had implications for the Ugandan patients' families because most were breadwinners with multiple dependents.…”

“…Structural or environmental factors like accessing care and navigating the health system played a role in injury care in Uganda, however, transportation and terrain were the major obstacles mentioned in the present study [11]. Traditional medicine was a common alternative to hospital treatment in Nigeria and preferred among some Ghanaians, but we did not observe the same utilization patterns or attitudes toward traditional medicine in our study [10,12].…”

“…However, the literature focuses on quantifying mortality and describing the epidemiology of injuries [7-10]; few studies explore the non-fatal aspects and outcomes of injuries [11,12]. To date, little qualitative research has explored the post-injury experience from the patient perspective against the background of poverty and limited resources in Africa.…”

Is safe surgery possible when resources are scarce?

“…Populations in these regions are predominantly rural,4 and the few dollars required for a bus ride to the hospital are often an insurmountable barrier to care 5. Those patients that successfully navigate through the barriers to access surgery in low-income countries are frequently greeted with lengthy queues, overcrowding and poor facilities as well as shortage of trained personnel 6…”

Impact of battery-powered orthopedic drills on the practice of orthopedic surgery in a resource limited country

“…However, due to the lack of or a limited number of powered orthopedic drills, they tend to wait for days to have surgery or they do not have it done at all. 5 There have been attempts to overcome this challenge of unavailability of drills with the use of fabric and surgical chuck adapters that can be sterilized, coupled to industrial hardware drills. However, the challenge still remains throughout the world due to the inability to commercialize this laudable innovation.…”