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How to reduce spike in cases of low back pain, arthritis in Nigeria, by Alimi

By Guardian Nigeria
15 December 2022   |   4:30 am
•Recommends healthy diets, regular exercises, medical checks, seeking professional help to beat motion ailments, sudden death •Says NOHIL provides total knee/hip replacement surgeries with results comparable to global standards Dr. Mustapha Faiz Alimi is a consultant orthopaedic surgeon and Medical Director of National Orthopaedic Hospital, lgbobi, Lagos (NOHIL). Alimi in this exclusive interview with The…

•Recommends healthy diets, regular exercises, medical checks, seeking professional help to beat motion ailments, sudden death
•Says NOHIL provides total knee/hip replacement surgeries with results comparable to global standards

National Orthopaedic Hospital Igbobi

Dr. Mustapha Faiz Alimi is a consultant orthopaedic surgeon and Medical Director of National Orthopaedic Hospital, lgbobi, Lagos (NOHIL). Alimi in this exclusive interview with The Guardian ahead of the 77th anniversary of the hospital, among other things, made recommendations on how to address the rising cases of low back pain, neck pain and arthritis in the country. He, however, said the hospital also offers surgical solutions, conducted the first total knee/hip replacement surgery in Nigeria and has flourished in providing adult reconstruction and replacement surgeries with results comparable to what is obtainable anywhere in the world. CHUKWUMA MUANYA writes.

Recent reports indicate rising cases of low back pain and neck pain as well as the attendant abuse of painkillers like opioids in Nigeria. Why? What is the burden? What are the implications?
THE burden is heavy. For example, today is Friday, one of the clinics holding today is the spine clinic and it is running as we speak. When you get there, you will see the load of patients and most of whom, are low back pain patients. Low back pain can become complicated with difficulty in walking, with difficulty sitting or neck pain is also complicated, but you see the clinic is busy. The burden of low back pain in Nigeria is heavy and low back pain itself is multi-factorial.

First of all, if you are bipedal, that is you have two legs, you stand on two feet, and then you are at risk of low back pain. But the other factors that worsen it are ageing; as people get older there is degeneration of the spine, so back pains come. But these are factors that you cannot control because everybody wants to grow old. There are other factors like lifestyle. So, for low back pain, you are talking about factors that you are born with and factors that you acquire. If you live a sedentary lifestyle, you are at higher risk of low back pain than someone who lives a very active lifestyle. If you are obese, you are at higher risk than someone who is not. What happens is that most people in urban areas are sedentary. Yes, we get tired but most of the people you see tired have not walked up to one kilometre that day and yet they are so exhausted. So, wherever you practice sedentarism there will be low back pain. The problem with low back pain now is that it generates more low back pain if you are not careful. How? For those who do not have an idea of how to manage low back pain, they will make matters worse. Low back pain can be countered with increased activities, weight control, lifestyle management, like reduction in alcohol consumption, reduction in smoking, then you investigate. You have what we refer to as red flags in low back pain- infection, tumours that is either benign or malignant tumours (cancers) or trauma (injuries). Before you trivialise low back pain you must rule out those three things.
How about using painkillers to suppress it?

Low back pain is not the reason for abuse of painkillers. People abuse painkillers for several reasons. Of course, patients who have low back pain do take painkillers. Don’t forget that painkillers come in several forms. It is not all painkillers that are tablets or injections. Some are topicals that you apply over the painful areas. Most of the painkillers that we use are non-steroidal anti-inflammatory drugs and they are not opioids for patients who have primary low back pain. Even when opioids are used, they are advised, and regulated. Generally, I don’t think the abuse of opioids in Nigeria is because of pain, I think people just take it as social drugs to make them feel good.
In the light of rising security challenges in the country, more patients are turning up with trauma and open wounds. How are you addressing this issue?

We have the capacity to address trauma from many angles. Now, we are talking about physical capacity for patients who have physical trauma, that we have immense capacity to address either fractures, whether it is open or closed fractures, whether it is loss of limb or whatever, we have the capacity to manage trauma. Then there is a psychological trauma, we have in-house psychologists and psychiatrists who can address that, who have the capacity to talk to patients, to address their issues, to psycho-analyse them, to evaluate them, to advise on what the patient will need to do. So, we have the capacity to address trauma from bio, pyscho and social angles completely. We have a vibrant social service unit as well that participates in the management of these patients.

There was a study published late last month that showed that 25 per cent of adults aged between 40 and 69 suffer tears and wears; and athletes having osteoarthritis or rather motion problems. How true is this and can it be addressed?

What the study is saying is that 25 per cent or about 25 per cent of sports men and women who grow as old as 50 to 69, one in four will have osteoarthritis. Now, in the population that are not sports people (athletes), l can assure you that not less than that too will have osteoarthritis if they grow old enough. Primary osteoarthritis comes from wear and tear, and any joints that you use well, everyday, every time and you grow old enough will reach that limit that wear and tear will set in. So, I don’t think it is about sports people; sportsmen and women have their own challenges. But I don’t think that osteoarthritis is common in sports people more than it is in ordinary people. So, whichever way it is, as orthopaedic surgeons we will continue to encourage sports, increase activity because the human body is designed to move. Our responsibility is to make the human body stable, functional and mobile. We don’t want to work towards incapacitating or reducing mobility either by suggesting or by encouraging a sedentary lifestyle.

What is your message to Nigerians on the need to improve mobility and reduce sedentary lifestyle, so as to prevent these orthopaedic and mobility challenges?

My advise to Nigerians is number one, live a healthy life in terms of what you consume. Consumption means what you eat or what comes into your body. Two, be very mobile. The secret to movement is movement. Failure of movement results in no movement, very importantly. Three is eat very healthy. Four, checks regularly, especially if you are beyond the age of 40. Five, seek for professional help. Don’t speak to quacks, don’t listen to people who say they said and they said.

Seek for help. Orthopaedic facility and services are available widely, especially in this town. National Orthopaedic Hospital is a big centre for orthopaedic services but is also available in Lagos hospitals, it is also available in Lagos University Teaching Hospital, and it is also available at Federal Medical Centre.

So, these services are widely available, people should use them. It is also available in private practice; use them. Seek for clarification. If there is a problem, sound an alarm early so that that problem can be controlled, minimized and it does not become something that is incapacitating. That is my message to Nigerians.

Are there conditions that you cannot address that Nigerians will have to travel abroad to access treatment?

Most of the orthopaedic problems, 95 per cent can be addressed here. We have a fantastic operating theatre with seven specialized suites for services. Even for premium patients, patients who feel they don’t want to sit down with everybody, we have a premium facility in the hospital. We are ready and our personnel are trained both locally and internationally. There is no Surgeon in this hospital that has not been outside the country for training. So, if it is in terms of capacity, specialized facility we do have and premium services, we do offer it. Our records are completely electronic. Our patient services are paperless and we are modernising so that we can meet the need of modern Nigeria.

Igbobi Orthopaedics at 77, do you have anything to celebrate?

Of course, we have a lot to celebrate. Now, if you look at the evolution of the institution, we started as a rehabilitation centre. From rehab of Second World War veterans, we now became an orthopaedic institution and gradually it fell into the hands of Lagos State. Initially, it was Royal Orthopaedic Hospital then it became Lagos State. Later, the Federal Government took it over as National Orthopaedic Hospital.

The National Orthopaedic Hospital, lgbobi, Lagos is a tertiary health institution established on December 6, 1945 to provide orthopaedics, traumatology and burns, plastic and reconstructive surgical services to all Nigerians and neighbouring countries.
Over the years, the Hospital has expanded its scope of services to other sub- specialties such as arthroplasty, arthroscopy /sports medicine, paediatric surgery, oncology, spines, complex trauma, limb lengthening and deformity correction.

We have evolved as well as orthopaedic services. Now, if you look at it, orthopaedic services evolved from orthopaedic surgeons, but over the years we found out that Orthopaedic Surgeons cannot work alone and need the support of other specialists such as Plastic Surgeons, Haematologists, Chemical Pathologists and Microbiologists as well as Histopathologists. The Hospital has a robust laboratory and we have established a robust Plastic Surgery Unit. Patients who do surgery may require either prosthesis or orthosis, so we have a Prosthetics and Orthotics Department as well as a School that can train Prosthetists and Orthotists.

Orthorsis and Prosthetists design and fabricate medical supportive devices and measure and fit patients for them. These devices include artificial limbs (arms, hands, legs, and feet), braces, and other medical or surgical devices.

Patients will require orthopaedic cast, so we have Orthopaedic Cast Unit. Orthopaedic Cast Technicians will require to be trained, so we have a school that trains them. Our patients will require orthopaedic and accident & emergency nurses, they will also require to be trained and so we have a school that trains them. As the hospital evolved, we realised that we have to run sub-specialisation orthopaedics. So, we now have sub-specialty orthopaedics.

Right now, in the last seven years, we have ran at least seven sub-specialties. We have a spine unit where they can fix the spine from the base of the skull. They perform trauma cases, degenerative cases, infections, deformity and tumours. We also have arthroplasty units.

Arthroplasty is a surgical procedure to restore the function of a joint.
It is a very robust unit; we have about seven surgeons there who can replace hip, knees and other joints. This is performed here everyday. We also have units that deal with the orthopaedic challenges in childhood; we call them Paediatric Orthopaedic Surgeons. So, they can handle events or challenges that children have, they can address it. They manage patients from day old to 14-year-old patients. Then we have developed or arthroscopic unit that is sports medicine.

Arthroscopy is a minimally invasive surgical procedure on a joint in which an examination and treatment of damaged joint is performed using an arthroscope, an endoscope that is inserted into the joint through a small incision. They do surgeries around the knee without having to open the joints. So, they use pinholes to look into these joints and they can do the surgeries. We also have the most robust and effective musculoskeletal oncology unit. They run their clinics regularly, in fact they are at the theatre today as we speak. They deal with cancers and other tumours of muscles and bones, replacing the joints, excising the tumours, administering chemotherapy and doing other things for these patients. Then our most recent unit is our microvascular unit, where patients who have suffered injuries or patients who need surgeries that will require repair of blood vessels, some of their parts are replaced.

We have patients who have hands severed and they are reattached if presented on time. At the microvascular unit, we repair with tendons, we repair the ligaments, we repair anything that is ‘dead’ and the blood vessels. They have been doing these things successfully.

As part of the mission of the Hospital to serve as an advocacy centre for injury control and disability prevention in all areas of our specialty, the Hospital is committed to creating awareness about health related matters with a view to reducing the rate of mortality in Nigeria.

What are the landmark and significant milestones or achievements of NOHIL from inception till date?

In a bid to meet the health needs of Nigerians and curb medical tourism, the Hospital has expanded its scope of operations. The major three areas of strength of the hospital include: orthopaedic services; trauma services; and burns and plastic reconstructive surgical services.

Over the years, the Hospital has continued to develop in orthopaedic care through training and acquisition of capabilities in sub-specialties of orthopaedics such as: arthroplasty (total hip and knee replacement); arthroscopy/sports medicine; spine surgery; paediatric surgery; and oncology.

Can you throw more light on arthroplasty?

The Arthroplasty Unit of National Orthopaedic Hospital, Lagos provides specialised services in the area of adult joint reconstructive surgeries (arthroplasty), one of its kind in the whole of West African sub region. We are pleased to inform you that the first total knee/hip replacement surgery conducted in Nigeria was performed by the Hospital. The Hospital has flourished in providing adult reconstruction and replacement surgeries with results comparable to what is obtainable anywhere in the world. The Arthroplasty Unit has seven well-experienced surgeons who have received training in various part of the world. The specialists’ expertise spans primary, complex primary and revision adult joint reconstruction surgeries. The Arthroplasty Unit also engages in the teaching of young orthopaedic surgeons in Nigeria who have interest in the subspecialty.

We provide both surgical and non-surgical services for a host of spinal deformities. These include: traumatic spine; degenerative spine (neck pain, low back pain); correction of scoliosis; spinal tumors; spinal instrumentation; and numbness and weakness in the legs and hands. The Unit comprise of five dedicated Surgeons with wide experience in two units.
What about children? Is there specialised care for children with orthopaedic issues?

The Paediatric Orthopaedic Unit provides services to children with musculoskeletal problems such as limb and spine deformities, fracture and bone or joint infections. The unit regularly organises International Paediatric Orthopaedic Workshops that are widely attended by Nigerians.
The unit runs a clubfoot clinic where patients with deformities are reviewed and serial manipulations and casting are carried out based on the diagnosis of the patients.

Do you have training programmes?
In line with the vision of the Hospital to be a centre of excellence in the provision of comprehensive healthcare delivery and training in orthopaedics, trauma and burns and plastic reconstructive surgery, the following training schools were established. Residency Training Programme – Training programme for medical doctors who aspire to specialise in orthopaedics and trauma or burns and plastic surgery.

There are two schools under Federal College of Orthopaedic Technology (FECOT): School of Prosthetics and Orthotics – Prepares and trains students in the skills of making artificial limbs and supportive Orthotics splints. School of Orthopaedic Cast Technology: Trains students in orthopaedic casting techniques. Post Basic Nursing Schools (PBNS): Training programme for nurses who aspire to specialise in orthopaedics and trauma or accident and emergency.
In addition, the Hospital’s Training Schools, Education, Research and Statistics (TSERS) coordinates all other in-house seminar/training activities for staff of the Hospital. TSERS has a dedicated team of staff Educators and Administrators with varying clinical knowledge and experience within the various specialties that provide specialised learning opportunities to the students.
he TSERS Department oversees the activities of the training institutions and programmes. They facilitate the training, implementation, and evaluation of on‐going comprehensive education programmes running within the schools.

What are your plans for the future?

One of the achievements of the Hospital is the full automation of Hospital service that is a paperless system as obtained in the western world today. Full computerisation of all activities starting from the Head records offices to the clinics; pharmacy and all care giving units of the Hospital with modern medical equipment to facilitate timely and accurate medical care to our clients.

In summary, it is the vision of the management of this great institution to bring it to a world-class Hospital in Sub-Sahara Africa comparable with western standards in terms of healthcare to our clients, using modern equipment in a congenial environment to curb medical tourism.