Seek early care for spinal cord ailments

It all started in December 2008 with extreme back and neck pain for Aline Uwitonze. The 44-year-old resident of Kicukiro Sector in Kicukiro District dismissed the ailment as a mere ‘dislocation’ due to poor sleeping position. However, it wasn’t long before one side of her limbs started becoming numb. Walking or lifting anything became a difficult task, forcing her to abandon chores. Uwitonze continued with aromatherapy, occasionally having her body massaged but this was not helping. Her condition continued to deteriorate. She lost sensation completely, including the ability to feel heat and cold. One time she stepped on a burning charcoal without noticing until her 9-year-old daughter came to her rescue. Soon she became completely immobile, developing devastating signs and symptoms like loss of bowel or bladder control, relying on a wheelchair for movement, and needing help to bathe. In May 2009, with funds pooled from relatives, Uwitonze was able to get admission to King Faisal Hospital, where she was diagnosed with spinal cord injury. Uwitonze underwent repair surgery and recovered in the next eight months. What is spinal cord injury A spinal cord injury — damage to any part of the spinal cord or nerves at the end of the spinal canal — often causes permanent changes in strength, sensation and other body functions below the site of the injury. Spinal cord injuries are caused by road accidents, falls, violence, diseases like arthritis, cancer, inflammation, infections, or disk degeneration of the spine. “If I didn’t have helpful relatives, I think I would be dead now,” Uwitonze says tearfully. Uwitonze is not sure what could have caused her condition but suspects a taxi-moto accident she had about six years ago could have had a hand. Extent of threat Uwitonze is one of the many Rwandans who are increasingly becoming victims of the ‘silent killer’. Although no national survey has been carried out to show the degree of threat spinal cord injuries have on the population, Dr Emmy Agabe Nkusi, a neurosurgeon at King Faisal Hospital and Rwanda Military Hospital, Kanombe, says the number of spinal cord injury cases registered in his clinic have been increasing over the years. “In 2009, we carried out surgery an average of only 25 patients, but last year alone, we did surgery on about 100 people,” he says. However, the increase is engineered by increased awareness programmes by the Ministry of Health about the condition as many people are encouraged to go for screening. Ignatius Kabagyema, the coordinator of pre-hospital emergency care services at the Ministry of Health, says road accidents are a major cause of spinal code injuries. For instance, between 2013 and 2014, out of 2275 injured in road accidents, 220 of them were suspected to have spinal cord-related injuries. And of the 492 who were injured as a result of other causes such as violence and falls, 57 of them were suspected to have spinal-related injuries. Dr Fred Fundi Gatare, the director-general of Rutongo Hospital in Rulindo District, whose hospital neighbours tin minefields, agrees that accidents are major cause of spinal cord injuries. Challenges The country still has infrastructural and human resource challenges. For instance, currently, there are only four orthopedic and three neurosurgeons. The University of Rwanda is the only institution that offers training in the above fields. King Faisal is the only public hospital that offers spinal cord injury surgery, the rest offer services like occupational, physio and psycho-social therapy. According to Dr Nkusi, although all types of spinal cord ailment care can be accessed locally, the service is still prohibitive for those without health insurance. Surgery ranges between Rwf2 million and Rwf8 million. Efforts Dr Theophile Dushime, the director-general of clinical services at the Ministry of Health, says they are currently partnering with the Rwanda National Police in fighting common causes of road accidents like speeding, in an effort to reduce spinal injury cases. Dr Nkusi says they are currently lobbying government and other stake holders to establish a one-stop centre for people with spinal cord ailments. “Investment is also being made in human resources too, for instance five new orthopedic surgeons and three neurosurgeons are currently undergoing training both locally and abroad,” he says.