Also by

Dr Ahmad Al Safi

Native Medicine in Sudan, sources, concepts & methods (1970) Tigani El Mahi, Selected Essays (1981) ( : مختارة مقاالت الماحي (1984التجاني Women’s Medicine: the zar-bori cult in Africa and beyond (co-

editor 1991) التداولية ) الهيئات وإجراءات قواعد إلى (1999المرشد Traditional Sudanese Medicine, a primer for health care

providers, researchers & students )1999) الحديثة ) التنظيمات وإجراءات قواعد إلى (2007المرشد السودان ) في والطمبرة (2008الزار Abdel Hamid Ibrahim Suleiman, his life and work (2008) Ahmed Mohamed El-Hassan, his life and work (2008) Daoud Mostafa Khalid, his life and work (2009) El Hadi Ahmed El Sheikh, his life and work (2010) Mohamed Hamad Satti, his life and work (2011) ً أعمق أطباء أجل من الحكيم، ً وأكثر لمهنتهم فهما ببيئتهم وعيا

(2013) أهلهم وأحوال Ahmed Abdel Aziz Yacoub, his life and work (2014)

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Author Ahmad Al SafiBook Title Abdel Rahim Mohamed Ahmed, his life & workFirst Edition 2014Deposit No. 664/2013ISBN 978-99942-69-47-1Copyright© Sudan Medical Heritage FoundationDistribution Sarra for Information Services Tel +2491221674Cover design Ahmed Hussain

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Abdel Rahim Mohamed AhmedHis life and work

(1923-2010)

Milestones in Sudanese Orthopaedic

ByDr Ahmad Al Safi

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Contents

Acknowledgements.......................................................6Abbreviations & Acronyms..........................................7Preface...........................................................................8Abdel Rahim Mohamed Ahmed...................................14Introduction...................................................................15

Early years.................................................................18Career........................................................................19Societies & international links..................................21Family.......................................................................21Mentors, predecessors & contemporaries.................22Mr. Abdel Hamid Bayoumi.......................................22Mr. Ibrahim Mohamed El Moghraby........................23Julian Taylor..............................................................26Marriot F Nicholls.....................................................26Other founders...........................................................27

Medical Specialization in Sudan...................................28Relations between SMS & KSM...................................29Orthopaedics in Sudan..................................................29

The clinical scene......................................................29Orthopaedic services.................................................30The Oxford-Sudan Programme.................................30Initiation of OSP.......................................................31

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Reciprocal training....................................................34OSP Training in Oxford............................................35OSP & Auxiliary staff training.................................35Termination of OSP..................................................35The Training of the Orthopaedic Surgeon................36World Rehabilitation Fund........................................38Sudan Orthopaedic Rehabilitation Programme.........38Aid for the Disabled..................................................40Khartoum Cheshire Home.........................................41The National prosthetic and Orthotic Centre............42

Written Contributions....................................................44Published papers............................................................44Unpublished papers.......................................................44Photo Gallery................................................................46Biographer’s Profile......................................................55References & notes.......................................................57

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Acknowledgements

Acknowledge with gratitude the verbal and written contributions of the many friends, schoolmates, associates, coworkers, and students of Mr. Abdel Rahim Mohamed Ahmed. Indeed, I am

indebted to Mr. Abdel Rahim himself for sharing with me his documents, and spending lengthy hours documenting his rich career. The interviews with Mr. Abdel Rahim finished few weeks before his death.

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Abbreviations & Acronyms

DKSM Diploma of Kitchener School of MedicineFMOH Federal Ministry of HealthFOM, UOK

Faculty of Medicine, University of Khartoum

KCH Khartoum Civil HospitalKSM Kitchener School of MedicineKTH Khartoum Teaching HospitalMCS Master in Clinical SurgeryMD Medical DepartmentMOH Ministry of HealthMRC Medical Research Council, United KingdomNOC Nuffield Orthopaedics Centre at OxfordOSP Oxford-Sudan ProgrammeRACM Royal Army Medical Corps SMS Sudan Medical ServicesUCK University College of KhartoumUK United KingdomUOK University of KhartoumWHO World Health OrganizationWRF World Rehabilitation FundWTRL Wellcome Tropical Research Laboratories in Khartoum

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Preface

he idea of compiling this series of monographs originated after I finished collecting the scattered works of the late Prof. Tigani El-Mahi (1911-1970). In two volumes, I edited and published in

19811his articles, which he wrote in Arabic and in 19842 those, which he wrote in English. The warm reception those two volumes had encouraged me to continue similar work on more pioneers albeit in a different way.

TWork started during my fruitful expatriate period in Saudi Arabia (1989-2004), and took fresh momentum after I came back to Sudan, when I realized that this type of work could have more far-reaching value than mere documentation. I realized that allusion to several pioneers of the medical profession is anecdotal and reflected misinformation and superficial impressions at best. Given this dismal situation, health care providers, researchers and students are faced with a dearth of reliable sources on the bookshelves. Resource books are alarmingly few and historical writings notably deficient. Sources rest mainly in grey literature, which by definition is not readily available.

For sure, we are not doing enough in the field of documentation. Although we say that health care providers, researchers, and students should be informed about the history of this profession, sources of information are few. History is not written or taught systematically in all health institutions. The few medical schools that started courses in this field still lack authentic sources to help them in their job.

Personal contributions and outstanding achievements of the pioneers of Sudanese medicine were not documented or highlighted. A more positive approach should be taken to correct this deficiency. There are lessons to be learnt by posterity from the legacy of their predecessors, how they lived, behaved, and worked. A fresh look at the lives of the pioneers may provide an opportunity, I presume, for re-enacting the

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merits of these great men and women, and a chance of emulating their successful stories and bringing those stories back to life in one way or another.

The history of the medical enterprise in Sudan should be documented. This should be a priority, not only because it is something worthy of our immediate attention; but also because it is the one part of our medical culture, which has been totally neglected.

Now, after so much work by several generations, so much experience and big sacrifices, it is high time for this profession to substantiate what it has gained thus far and put it on record, for surely one good document is worth a billion spoken words.

I took this matter seriously by launching a major documentation project entitled “Sudan Health Trilogy” for which I solicited the help of teams of co-workers, fieldworkers, and editors.

In addition to performing its chief function, that of recording faithfully the lives and work of the main actors in the medical scene, the Trilogy also hopes to provide authentic information. Often we find ourselves uncertain as to whether or not a particular act or technique has been widely accepted or related to a certain person. How can we be sure? This Trilogy should help us here. By consulting the appropriate part of this work, we can obtain the information we need on the milestones of different disciplines of Sudanese health care delivery. The danger in thinking that history starts with us, that nothing has been said or done before about the issue in question, or lay hands on what is not ours are obvious caveats. This is the raison d’être for launching the project of this Trilogy.

There has always been coexisting generations working together, and there has always been a generation gap in the medical profession, and in every other profession to be more accurate. The younger generations have grumbled about the way their elders behaved, and the way they treated them, and have repeatedly deviated from the set norms,

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sometimes in obstinate and intentional rebellion. Traditions, culture, moral definitions change, and generations interact. Wise interaction and even frictions narrow the generation gap and reproduce yet another generation hopefully wiser and more mature.

In Sudanese medicine, the elders wanted the young generations to excel. The young generations deserve this and are worthy of access to the highest echelons of the profession if they are well educated and coached in the skills of their trade.

The patrons, who were brought up in classical biomedicine and lived the agonies of the birth of the current medical system in the country, would not tolerate deviations from the set norms easily. At one time, there were few notable figureheads in each discipline in Sudan. That was understandable and natural, because those were the formative years, the age new medical disciplines emerged, newer sub-specialties born, and foundation of Sudanese medical practice laid down. With the proliferation of sub-specialties, tens of new comers from all over the world joined the service carrying with them new skills, knowledge, and vision. The patrons had to accommodate and surrender some of their monopoly, sometimes reluctantly. Conflicts and professional jealousies reigned for a time. However, life went on and so did the profession.

The wide generation gap that has been enforced over the last two decades was unfortunate and should be bridged. The apprenticeship tradition, the hallmark of medical practice, teaching and training, has suffered badly and the professional unit is breaking up due to a multitude of social, economic, and political factors. Hundreds of resourceful medical scholars were forced into exile or unnecessarily alienated, and as ‘nature abhors vacuum’, the young filled the void, with inevitable loss of proper professional control and proper management.

If the younger generations are to be the natural heirs of the profession, they have to educate themselves better, they have to explore and analyze the medical past thoroughly before setting new norms and

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standards. They must speak the language of modern medicine and embrace all its goodness.

We cannot bring the past back and we should not, but we ought to learn from the incidents in its trail. In this instance, the epigrammatic phrase of Sir Winston Churchill ‘the longer you can look backward, the further you can see forward’ may be appropriate. The young generations should explore the past and learn from it before they take their decisions. They should be tolerant and reverential towards the old generations. This will assure that some wisdom is shared, and harmonious living replaces discord and grumbling. I thought this series of works would help to bridge this gap, salvage lost wisdom, and obviate eminent dangers.

Our past is long gone; but our history continues, it cannot be ignored; it is alive, it is continuous, it is active, and needs to be recorded and preserved. This current work is one chapter in the Sudan medical story. It is a reminder of the excellent work that has been done so far to build the health system of the country.

Conservation and development of the medical system and heritage needs to be written down in social history as well as stories of achievements. We need to build a sound health care system, maintain modern medical schools, research laboratories, libraries, and museums. These institutions, which were once intact and functioning, are endangered, mal-functioning or lost.

We need to record the history of this profession more thoroughly before it is too late. We might wake up soon to find out that we have no recollection of our past. Details of this degenerative process have been listed in an earlier monograph.3

This series of monographs, however, is written specifically to raise the awareness of readers in the academic community in the health profession about the milestones and important stations in Sudanese health care development, and help them to be better health care

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providers. They would be, I am sure, if they were better educated about the contribution of their predecessors.

History of medicine is the history of men and women's lives. It is but the biographies of great men and women. No great man or woman lives in vain. There is probably no history, only biographies. This series of monographs is a humble attempt towards documenting the lives and work of some notable Sudanese scientists. It aims to provide concise documentation of the lives and work of the men and women who have shaped the health care services in Sudan. It focuses on individual contributions and through them sheds light on the milestones of health care services in Sudan.

The individuals featured in this series, fulfilled the criteria I set to identify a pioneer. The pioneers in the context of this work are Sudanese men and women, who have established new institutions, founded new disciplines, researched the field, or made new discoveries and techniques, those who laid down new traditions and models of admirable behaviour. They taught, trained, and mentored, and more importantly, provided guidance and encouragement to several generations of young and aspiring physicians and scientists.

They are without exception, meticulous clinicians, arduous teachers, imaginative trainers, and hard-working researchers. They maintained unimpeachable professional integrity, upheld strict medical ethics, and consolidated sound medical traditions in a rich service career. They all worked with purpose, with principles, with culture building, and strengthening people. In every situation, they looked for better management, efficiency, perfecting techniques, practices, and processes.

Their contribution as scientists or physicians to science and life has been exemplary. They searched for continuous improvement in their lives and in the institutions in which they worked. They have been constantly involved in the pursuit of fact and truth about everything in life. That is why they were also notable social workers, sportsmen,

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poets, musicians, political and social leaders, writers, and competent administrators.

Studying the lives of these individuals clearly shows that the path to success and distinction requires hard work, confident persistent toil, and professional zeal. Nothing happens arbitrarily through luck, or due to quick fixes.

Our work in this field is an attempt towards understanding what happened in the medical profession, our role in it and what should be done in the future. I hope this series proves to be useful and fulfills its goals.

This volume profiles the life and work of Dr Abdel Rahim Mohamed Ahmed, the orthopaedic surgeon. Among these pioneers, Dr Abdel Rahim Mohamed Ahmed has been typical. He did his job as expected in terms of quality. His performance has been solid, fully proficient in all aspects of job content and expectations. That is why he won the admiration and respect of his peers, colleagues and associates. However admirable his qualities as a man, it is his contributions as scientist that have been the chief concern in this monograph.1

1 This monograph is based on Abdel Rahim Mohamed Ahmed resume, list of publications, grey documents, written statements, and personal communications with him and his associates and coworkers.

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Abdel Rahim Mohamed AhmedHis life and work

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Introduction

he story of orthopaedics in Sudan will not be properly understood without insight into the contributions of the time honoured bonesetters (basirs), and those of Abdel Rahim

Mohamed Ahmed. The basir mended bones over centuries, and Abdel Rahim Mohamed Ahmed put the foundation for modern orthopaedic practice.

TA basir (basira for a female, plural. busara) is a person skilled in any craft but it is mostly related to midwifery, and bone setting, as well as animal healing and boat making. The word derives from basara (artisanship). Its Arabic etymological root ‘to see’ indicates insight, wisdom, experience and technical competence. A basir sets broken bones, treats sprains, contusions, dislocations, and advises on matters relating to pain and disabilities in body joints. Basirs massage wrynecks and ailing muscles. Frequently, they advise customers to take special foods to speed up the healing of fractured bones. Popular recommendations include eating turmus (Lupinus termis), dates, and chicken. They also prepare and prescribe medicines. Jean Buxton described bonesetters in the Mandari tribe as practiced people who set broken bones, sprains, and dislocations by tying them firmly with creepers, often to wood splints. Hot poultices are placed on swellings; incision may be made at the point of a break, and the bones pushed together.4 Ostrich oil is the treatment of choice for muscle contracture, over which it is rubbed and then massaged for a few weeks until the stiff joint relaxes.

Some basirs circumcise boys, and perform cupping and cautery. An atitt among the Raik Dinka is a bonesetter who sets broken bones, trephines skulls, and may be a spear-haft straightener. Other basirs make artificial limbs for the handicapped. Ali Wad Ghiyama of Katotab village was a basir in the widest sense. He was a skilled

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bonesetter, and an experienced and resourceful innovator in other fields. He made artificial limbs that were thought to be lighter and more competitive than imported ones. He was also a healer of man and animal, an astrologer, a renowned diviner, and a poet, to mention just a few of his talents.

Bone setting is a typical craft that runs in families, learnt through apprenticeship to older basirs who are senior members of the family. Basirs such as Al-Badri of Al-Abassiya (Omdurman), Ahmed Wad Talab and El Toma Bit Rahama of Kannour (between Atbara and Berber), Asha and Mohamed Simbawi of Mahmiya, Wad Mukhtar of Al-Saggana and Wad ‘Agib of Al-‘Azozab (Khartoum), the late Mustafa Ahmad Bati of Omdurman (Wad Bati), and his daughter Zeinab (Bit Bati) have been the most famous.1 The craft usually passes from grandfather, to father to son. Mustafa, however, inherited the craft from his uncle Arbab Bati, and handed it over to his daughter Zeinab, who has been practicing up to a very late age.

Zeinab Mustafa Ahmad Bati, known as Bit Bati (1923-2006) of Omdurman has described how she learnt the art and how she practiced. She said she learnt bone setting as a gift from God (wahbiya min Allah), and through watching (bi al-shawf) her father practicing. Then, whenever her father was away, she used to act on his behalf managing easy cases. Although she treats people li wajh Allah (for God’s sake), she will accept their gifts gladly.

She classifies a bone or a muscle injury as radkh (a contusion), fakak (a dislocation), and kasr (a fracture). The method she follows in setting bones is universal among Sudanese bonesetters. She first manipulates the fractured bone until it is set in good alignment, and then pads the site with cotton gauze or cloth. Next, she applies tabb or jabiras

1 People often cite the fictional woman, Al-Basira Um Hamad as an example of a foolish and stupid basir or basira. Once, a calf put its head into an earthenware jar and failed to pull it out. The calf’s owner sought basira Um Hamad for advice. She ordered them to cut the animal’s throat. They did that, but the head was still inside. She then ordered them to break the jar to retrieve the head!

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(splints) made of palm fronds, and tightens them. Finally, she bandages the injury. The tie should be firm enough to hold the fractured parts in place, but not too tight to stop al-dawra al-damawiyia (blood circulation).

Bit Bati has treated all types of fractures including compound injuries. She says that she applies sulpha compounds to ‘treat’ bleeding, and refers infected cases to hospital. She attributes infection to either neglecting the wound, or due to the intervention of an incompetent bonesetter. She does not mention any other medicines, but her father used to use harjal (Solenostemma argel). She said that children’s fractures heal in a week or so, and those of grown-ups take longer. She is also aware that children’s fractures are difficult to handle because they are intolerant to pain. She uses no banj (anaesthesia); the only analgesic available to her, she said, is al-sabr (endurance).

Bone setting does not only run in families but may run in a whole tribe. The Bisharin tribe is known to be a tribe of bonesetters, men, women and even children are experts in bone setting. The bait el qarab of the Bisharin is a noted family of bonestters.

In spite of reported and unreported complications in traditional practice, people seek traditional healers regularly and confide in them. They respect them, and revere and worship many. Healers throughout the country have given people continuous social and psychological support, and offered them help in different spheres of life. People also know the system’s limitations very clearly and often choose intelligently which healer to consult, and, whenever there is a modern facility, a clinic or hospital around, they could well visit it first in acute or urgent cases. As a rule, people continue to be committed and faithful to their traditional recipes and practices, though aware that healers make mistakes, some of which are fatal and unpardonable. However, in the local mind, these mistakes are part of life’s eventualities.

Complications of varying degrees have followed surgical interventions, and bonesetters have set bones wrongly. As a rule, bonesetters are

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ignorant of the exact relation of nerves, vessels, bones, yet manage all sorts of fractures-multiple, compound or those that need special handling such as supracondylar, and spine fractures. They have caused, in the process of setting bones, contractures of hand muscles with subsequent deformity and loss of function. The successes of basirs are widely circulated, but their failures rarely mentioned. Their interventions have frequently been accompanied by complications, some of them very serious indeed. These include Volkmann’s contracture of the extremities,1 mal-union or nonunion of fractured bones, and gangrene of limbs has occurred after tight bandaging, rendering amputation of fingers or limbs necessary.

Early years

Dr Abdel Rahim Mohamed Ahmed was born in El Ghaba El Shimaliya, Ugri El Dabba on 3 October 1932(3). He spent the first four years of his life in Al Ghaba Khalwa under Hagg Baloul. His entry into formal government education was a mere coincidence as there were only two primary government schools in that area-one in Wadi Halfa and the other in Berber, and these were only known to the elite. He spent his elementary schooling in Dibaira, north of Halfa, before joining Halfa Intermediate School. Later, he joined Wadi Saidna Secondary school followed by Kitchener School of Medicine (KSM). Schooling was supported by a college scholarship of 10 Sudanese Pounds a year to be given in three-month instalments. In current money, this seems to be too little an amount; but it carried out a lot of pride as it was a compliment to all science students and was a good relief to a poor student. He graduated with DKSM in 1958 together with 19 others including Gaili Karrar the first surgeon to be appointed in the Sudan Medical Corps and first Orthopaedic Surgeon there.2

1 A contraction of the fingers and sometimes of the wrist, with loss of power, developing after severe injury in the region of the elbow, improper use of tourniquettes, or splints.

2 The batch included:

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Career

After acquiring the Diploma of Kitchener School of Medicine (DKSM) in 1958 with a prize in Medicine, Dr Abdel Rahim joined the Ministry of Health (Sudan) as house officer (1958-1959) and medical officer (October 1959-60). Having passed the primary FRCS in Khartoum, he was appointed House Officer and then Registrar in surgery under Mr. Abdel Hamid Bayoumi. This period proved to be extremely formative in terms of the surgical experience he gained, the knowledge he acquired, and most importantly the mentorship he had from Mr. Bayoumi. In addition to surgery, he was exposed to proper medical ethics and manners, and high level moral integrity.

In the UK, having passed his second part of FRCS (England) in about six months, he started to look for a job in his field of interest. He had several offers; but his life gift came in a cable from Professor Trueta asking him for an interview for a job in the Nuffield in Christmas 1960!

He was Surgical Registrar (November 1960-March 1962), and Senior House Officer in Hammersmith Hospital, London (April 1962-March 1963). In 1962, he was awarded the Fellowship of the Royal College of Surgeons of England (FRCS). He did Training in Accident and Orthopaedics in Oxford (1964-1966), a Smith and Nephew Fellowship in Plastic and Trauma Neurosurgery in Oxford for one year in 1966, and a six-week WHO Fellowship (Prosthetic-Orthotics) in Denmark in 1973.

In Sudan, he was assigned surgeon in Kassala, Sudan (May 1963-March 1964). He was Accident and Orthopaedic Registrar, Nuffield Orthopaedic Centre (1966), and Consultant Orthopaedic Surgeon, Khartoum (1967-1972). He was Senior Consultant to the Ministry of Health, and Head of the Accident and Orthopaedic Department, Khartoum Teaching Hospital (1973-1990).

Following voluntary retirement in 1990, he was Fellow-Accident and Orthopaedic Department, medical school. He continued in private

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practice in accident and orthopaedic surgery, part-time postgraduate tutor in orthopaedics, examiner in anatomy for the Second MB BS, and surgery for the final MB BS in the Faculty of Medicine, University of Khartoum. He was examiner in anatomy for Part 1 Surgery and Part 2 MD (Surgery), University of Khartoum, and for the Degrees of MB BS and Master in Clinical Surgery (MCS). He also did WHO short-term consultancies in Accident Prevention and Emergency Medical Services in the Middle Eastern Region.

The immediate posts he carried out before his retirement included Senior Orthopaedic Surgeon to the MOH, Head, Accident and Orthopaedic Department, KTH, Part-time under- and post-graduate teacher, Faculty of Medicine, UOK.

The immediate post commitments were many including:

In charge of the National Prosthetics-Orthotic Centre, Khartoum

Director, Joint Ministry of Health-World Health Organisation Rehabilitation Programme

Member of the National Council for the Welfare and Rehabilitation of the Disabled.

Chairman of the Committee for the National Council for Accident Prevention.

Chairman of the First National Conference on Road Traffic Accident prevention.

Director, Joint Ministry of Health-World Health Organisation Programme for Accident Prevention.

Societies & international links

WHO

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Temporary Consultant: Consultation on Traumatology and Orthopaedic Training, Geneva, 1985.

Temporary Consultant: Inter-Country Consultation on Accident Prevention-Baghdad, Iraq, 1988.

Temporary Consultant: Inter-Country Consultation on Integrated Safety Promotion and Accidental Injury Control, Doha, Qatar, 17-22 March 1990.

Short Term Consultant in Accident Prevention and Emergency Medical Services in the Middle East Region: 1990 to date.

President, Sudan Association of Surgeons (1988-1990).

Member of the British Orthopaedic Association.

Member World Orthopaedic Concern

Member, Middle East-Mediterranean Orthopaedic Association.

Honourary Member, Egyptian Orthopaedic Association.

Family

Dr Abdel Rahim Mohamed Ahmed is blessed with four daughters and one son Ihab who is currently a vascular transplant surgeon.

Mentors, predecessors & contemporaries

Mr. Abdel Hamid Bayoumi

Early general surgeons practiced orthopaedic surgery and some of them excelled in it. General surgeons laid down the foundation of the future discipline and gave it the necessary support. Any narrative of orthopaedic surgery in Sudan will not be complete without reference to

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the surgical work of the pioneers namely Abdel Hamid Bayoumi and Ibrahim Mohamed El Moghraby.

Mr. Bayoumi laid down the foundation of Sudanese surgery. He helped several surgeons to train, and endorsed the budding of orthopaedic surgery as a separate discipline.

Mr. Abdel Hamid Mohamed Saeed Sayid Bayoumi (13 March 1911- 24 January 2004) is rightly the father of surgery in Sudan.1 He was born in Merawi on 13 March 1911. He completed his elementary schooling in Merawi and secondary school in Khartoum before joining KSM in 1934.

After graduation, he worked in Omdurman, Khartoum North, Port Sudan, and Torit, in which he spent 5 years during which he learnt the Baria language. He then worked in Abu Usher and Wau to land in 1945 in Khartoum as Surgical Registrar with Mr. Bartholomew, the Senior Surgeon.2

In 1947, he was sent for postgraduate studies in the UK where he spent two years in Edinburgh after which he acquired the FRCSE, and later the FRCS Glasgow. He returned to Sudan in 1949 to take up the Omdurman surgeon post vacated by Mr. Bartholomew. In 1953, he was promoted to senior Surgeon and lecturer in surgery in MOH in place of Mr. Bartholomew, thus becoming the first Sudanese Senior Surgeon.

Mr. Bayoumi worked as surgeon in MOH for 30 continuous years (1935-1965) before he retired. In 1984, he was made Professor in the FOM, UOK, and worked in that capacity until 1999. During that period, he made substantial contributions to the teaching of anatomy

1 I am deeply indebted to Dr. Magdi Bayoumi (son) and Abdel Aziz Bayoumi (brother) of the late Mr. Abdel Hamid Bayoumi for providing most of the information on Mr. Bayoumi in this section.

2 Mr. F. Bartholomew joined SMS in 1932. He got his Edinburgh FRCS while working in Merawi. He worked in Omdurman Hospital (1937-49) as surgeon and director. He died in UK in 1952.

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and expanded the department considerably.

All the Sudanese doctors who graduated from KSM since 1928 performed surgery as general practitioners using chloroform and ether for anaesthesia and spinal blocks. Professor Abdel Aal Abdalla Osman in an excellent article entitled “Milestones in the History of Surgical Practice in the Sudan’ documented the first cases of surgery performed by Sudanese doctors. He said:

“It is of interest to note that the first Sudanese graduate to perform a planned non-barber surgical operation in KCH was Ali Bedri. According to KCH Operations Registry, it was an excision of madura in a fourteen-year-old patient named Ali Khidir done under chloroform on the third of May 1928.” 5

On practicing surgery, his repertoire of the surgery he performed was limitless. He would start his daily list of operations with tonsillectomy, followed by thyroidectomy or cholecystectomy, then LSCS and ending the list with setting bones. He used to give his own anaesthetics with the help of the theatre attendants.

Mr. Ibrahim Mohamed El Moghraby

Mr. IM El-Moghraby (1913-1993), DKSM, D Chir., D Orth., FRCS, FICS, PhD (Hon) had his secondary education at Gordon’s Memorial College, Khartoum, and joined KSM and qualified at the age of 21 in 1935. He was top of his class throughout his school career and won the Anatomy and the Physiology prizes in 1932. He passed his final examinations with distinction and won the Waterfield prize in Surgery and the school prize in Medicine.

He joined the SMS and finished his internship at KCH. He was then posted as medical officer to several districts of Sudan. As a Medical Inspector in Wadi Halfa, he conducted the Gambia Mosquito Campaign and fought a Typhus epidemic.

In 1939, he was chosen to be the first Sudanese Surgical Registrar and

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was trained by the late Mr. T.S. Mayne.1 In 1946-1949, he left to Egypt on his own and attended postgraduate courses in Kasr El Aini Medical School, King Fouad University in Cairo. He obtained a Diploma in General Surgery and a Diploma in Orthopaedic Surgery. He then trained at his own expense in UK for the Surgical Fellowship at Guy’s, St. Mark’s, the National Orthopaedic and the Marsden Hospitals, and Institute of Urology, London.

In 1952, he became the first Sudanese and the first graduate of KSM to obtain the English Fellowship. He took part in research projects on metabolic response to trauma, and fluid balance in Prostatectomy patients at the Royal Infirmary, Liverpool, under Professor Charles Wells. In 1953, he returned to Sudan, was posted to Wad Medani, and became the first Sudanese Consultant Surgeon to take over the Blue Nile Province from the British.

Mr. Moghraby rapidly developed the Wad Medani Hospital and made it the leading surgical centre of the Sudan, and it gained the recognition of the Royal Colleges for training for the final Fellowship examinations. He gained nation-wide fame for the treatment of football injuries and was the pioneer of modern orthopaedic surgery. He wrote extensively on the surgical diseases of the Sudan and became an authority in the surgery of massive Pyloro-duodenal Fibrosis (Syn. Shaigi Syndrome), Bilharziasis and Portal Hypertension in the Sudan. He also conducted notable research in Mycetoma (Madura foot) in collaboration with the London School of Tropical Medicine and Hygiene, supported by a grant from the MRC (UK).

In 1965, he was transferred to Khartoum to become the Senior Surgeon to the MOH until his retirement in 1969. He was succeeded by Mr.

1 FS Mayne obtained his medical degrees at Queens University, Belfast and FRCSE. He was posted to Sennar in place of O’Shaughnessy on his retirement in 1929. He had had considerable surgical experience when he succeeded Grantham-Hill in Khartoum in 1933. He continued as Senior Surgeon and Lecturer in Surgery until 1944 when he was forced to retire due to illness. (Squires, Herbert Chavasse. The Sudan Medical Service: An Experiment in Social Medicine. London: Heinemann Medical Books, 1958: page 53.

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Ahmed Abdel Aziz.

Among other achievements as a Senior Surgeon, he championed the cause of the Omdurman Military Hospital until it gained recognition for the final Fellowship training in general surgery and ophthalmology by the Royal College. He then devoted his time to teaching both under and post-graduate students in surgery, anatomy and pathology. He was an examiner in anatomy, pathology and surgery for the MB Diploma and the local Masters in Surgery (MS), Khartoum University.

He was instrumental in the compilation and production of the first issue of the Sudan National Formulary. He was the President of the Sudan Association of Surgeons for two terms of office. He was a founder member and first president of the Sudan Section of the International College of Surgeons (Chicago) in 1972. He was awarded a honourary PhD from the Gezira University in 1989. He founded the El Nilein Trading Agencies for the import of pharmaceuticals and surgical instruments and equipment. He also had notable activities and contributions outside the medical field. He was the chair and member of the board of directors of some of the leading companies of Sudan (The General Insurance Company, Sudan Plastics, the Nile Cement Company, National Footwear, etc.).

Julian Taylor

Professor Julian Taylor (19??-1961), CBE, MS, FRCS of the University College Hospital, London, joined the UOK in 1957 as Professor of Surgery. He pioneered the development of surgery in Sudan, and inspired and helped several Sudanese to become surgeons. In 1960, he persuaded the Royal College of Surgeons of England to establish a yearly examination for the Primary Fellowship held in Khartoum. Successful candidates, of which the percentage is high, work for a year as registrars in Khartoum Civil Hospital and then travel to England for further training and sit for the Final Fellowship. Professor Taylor was the first to start a scheme of sub-specialization to be expanded by Professor Nicholls who replaced him in the post of

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Surgery in KSM.

Marriot F Nicholls

Sir Marriott Faulkner Nicholls (1898-1969) studied Medicine at Clare College, Cambridge, and St. George's Hospital, London, qualifying in 1923, and three years later, he gained his Fellowship. In 1932, he became M.Chir., and joined the consultant staff of St. George's. His interests in surgery were wide and before the Second World War, he was consultant surgeon to the Royal Chest Hospital, the Belgrave Hospital for Children and the Royal National Orthopaedic Hospital. At St. George’s, he was in charge of the genito-urinary department. In spite of these commitments, he became Dean of St. George's Medical School in 1936, a post he held for 20 years, interrupted by service in the RAMC, in which for a period he was in charge of a surgical division in Africa and later consultant surgeon to the 14th Army in South-East Asia. After retiring from the Deanship, he became the first director of the newly formed surgical unit at St. George's Hospital. At the age of 64, he started a new surgical career as Professor of Surgery in Khartoum, Sudan. He was appointed CBE in 1946 and KBE in 1969. He will be remembered for his tactful administration, for his encouragement of the young, for his clinical teaching, for his foresight and purposefulness, and perhaps most of all for his zest for life.6

Other founders

Those who contributed to the foundation of orthopaedics in different cities, in civil hospitals or teaching hospitals, in the Medical Corps or in private practice in the second half of the twentieth century are many. They include Kamal Zaki,1Abdel Salam Saleh Eisa, Adam Fadlalla,2 El

1 Graduated from FOM, UOK in 1959. Specialized in orthopaedics in Oxford, UK. He died on 29 April 2007.

2 Graduate of Cairo University in 1955, FRCS in 1965. He joined FOM, UOK in 1970 on secondment from MOH. On retirement in 1994, he was temporarily appointed in UOK until his death in 29 November 2005. He was particularly interested in paediatric orthopaedics.

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Gaili Karrar,1 William Aziz, Abdel Dayim Kashan, Babiker Hamour, Kamal Arabi, Amir Mursal, Abuzaid Atta Elmannan, Hussain Hassan Sid Ahmed, Richard Hassan, and Abdel Monem Elshafie.

1 Graduated from FOM, UOK in 1958. He was the first surgeon to be appointed in the Military Corps. He died on 21 November 2005.

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Medical Specialization in Sudan

SMS started postgraduate three-month training exposures in the UK before the First World War. The first doctors to make use of this scheme were Dr Ali Bedri and Hussain Ahmed Hussain, who were sent to Hammersmith and Moorefield in the UK respectively in 1937.

A new scheme ushered in the era of specialization and sub-specialization of Sudanese doctors in the different branches of medicine. In 1946, the SMS stated its scheme of postgraduate specialization abroad. The first doctors to be sent to UK were Mansour Ali Haseeb who specialized in Bacteriology and Hussain Ahmed Hussain who trained as Ophthalmologist. On the retirement of AR McKelvie, Hussain Ahmed Hussain replaced him to be the first Sudanese Ophthalmologist.1Dr El Baghir Ibrahim (1914-1976), a graduate of KSM, was the first Sudanese to obtain the Diploma of Ophthalmology (DO) of London, and the third Ophthalmologist to be appointed in SMS.

Early specialization and sub-specialization have been a national concern and an inevitable outcome of the national pride that accompanied the localization of all disciplines and administration.

Doctors were sent abroad by MOH or FOM to specialize in the different disciplines. Few, for example Dr Bakheit Mohamed Omer (FRCSE) who specialized in surgery, and Dr Ibrahim Mohamed El Moghrabi (FRCS) who specialized in addition to surgery in orthopaedics, left for postgraduate studies abroad on their own expense and initiative.

1 Dr AR McKelvie, Glasgow graduate, arrived in Sudan in 1928 to be the first ophthalmologist to work in Sudan.

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Relations between SMS & KSM

On its inception, KSM was part of SMS and as such depended for its academic staff on doctors seconded from SMS.1 WTRLK staff (later SMRL staff) taught medical students pre-clinical subjects while clinicians from Khartoum Civil Hospital (KCH) took over teaching of clinical subjects and carried out postmortems. In September 1951, KSM was incorporated in the University College of Khartoum (UCK) and when the Sudanese parliament conferred full university status on UCK, KSM was made a faculty and named Faculty of Medicine, University of Khartoum (FOM, UK). In 1949, the Ministry of Health (MOH) emerged to replace the SMS.

Orthopaedics in Sudan

The clinical scene

Dr Abdel Rahim Mohamed Ahmed described the prevalent orthopaedic problems in the Sudan of his time. Early expatriate orthopaedic surgeons namely O’Connor encountered and listed the diseases in the sixties of the twentieth century. The diseases included tuberculosis, poliomyelitis, osteomyelitis, spastic disease, neglected trauma, congenital malformations, and tuberculosis including spinal tuberculosis, Pott’s paraplegia, thoracic, lumbar, hip, knee, elbow, and ankle lesions.

In the Nuffield Orthopaedic Centre at Oxford (NOC) scheme, this variety of disease enriched the experience of the young expatriate staff. The elderly consultants contributed with their vast experience in planning, organization and teaching both in the UK and in other developing countries. They were conversant with local disease pattern, then extinct in Europe, yet prevalent in the days of the earlier twentieth century.

1 In 1924, the Medical Department was replaced by the Sudan Medical Service. Dr OFH Atkey was appointed as first director.

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Orthopaedic services

Bone surgery was part of general surgery and performed by general surgeons. Indeed, all orthopaedic surgeons were general surgeons who specialized later in orthopaedics.

The Oxford-Sudan Programme

As a direct result of a request from a representative of the Sudan Government and the UOK to the Nuffield Professor of Orthopaedic in Oxford for assistance in establishing Orthopaedic Surgery in Sudan, a secondment scheme was launched and called the Oxford-Sudan Programme (OSP).7

The initiative of the NOC came from Professor M. Nicholls, later Sir Marriot Nicholls, then Professor of surgery at the medical school, University of Khartoum. He felt the pressing need for the improvement in both orthopaedic education as well as the care of the injured, diseased and disabled patients. Himself a urological surgeon, his department already had the services of a plastic and a cardiothoracic surgeon.

At Professor Nicholl's invitation, Professor Joseph Trueta arrived in Khartoum soon after Christmas 1962. His discussions with the senior staff in the University of Khartoum and Ministry of Health culminated in the agreement creating a link between the NOC on one hand and the University of Khartoum on the other. The objective was to create, as soon as possible, accident and orthopaedic services for the whole country, starting in Khartoum. The methodology was:

1. To support teaching and training at both under- and post-graduate levels.

2. To train national medical and paramedical staff that will form the nucleus for future expansion of a countrywide accident and orthopaedic services.

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Initiation of OSPFrom 1962 to 1964, under the aegis of Professor Joseph Trueta, BT O’Connor1 was seconded to the Sudan as the first Senior Registrar in the launching of the Oxford-Sudan Programme. Dr O’Connor took up his post on 21 July 1962. In an article entitled “The Girdlestone Tradition: Inauguration of Orthopaedic and Traumatic Services in the Sudan,” Dr O’Connor described the inception and progress of that pioneering programme. He said:

“The initial request by the Sudanese was for an orthopaedic surgeon to be employed on the usual five-year contract basis. Professor Trueta, recognizing the evils and futility of such a scheme which invariably exiles a young surgeon to far-flung outposts "for the term of his natural life", insisted upon a two-yearly secondment plan. This was accepted and Professor Trueta enlisted the co-operation of his medical colleagues at the Nuffield Orthopaedic Centre. With their support in hand approaches were made to the Oxford Regional Hospital Board and the United Oxford Hospitals, and with the untiring and earnest efforts of Sir George Schuster, Lord Franks, Sir Charles Ponsonby, Mr. E. W. Towler, and Dr. J. 0. F. Davies, successful overtures were made to the Ministry of Health to support the scheme and to appoint a third senior registrar in order to implement it. As a result, an exciting and challenging secondment scheme was born. The Sudan's request for assistance in establishing orthopaedic services came at an extremely opportune time in the history of British surgery. Visionaries in the profession have long recognized that surgeons contracted to underdeveloped countries gain unique and valuable experience to a degree no longer possible in Europe. Unfortunately, it is equally true that such surgeons when they return to the United Kingdom they found that they were denied fair assessment for posts against colleagues often younger and less experienced. Most of the profession agreed

1 Brian Thomas O’Connor, MS., M. Ch. Orth., FRCS, FRACS (1929–1999). Nuffield Department of Orthopaedic Surgery, University of Oxford.

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that this was both parochial and unjust, but no-one offered a solution. The obvious answer lay in secondment-a scheme which offers the seconded surgeon unique experience in surgery and administration plus security upon his return, whilst at the same time affording the underdeveloped country concerned the best possible assistance and eliminating the necessity to rely upon the services of adventurers and misfits. There has also been an increasing political awareness of the responsibilities we owe to underdeveloped countries as is evidenced by the formation of the Ministry of Overseas Development. Thus, it was not difficult to persuade the Ministry of Health to increase the Senior Registrar establishment in Oxford by one, and to persuade the Ministry of Overseas Development to assist with a financial grant towards instruments. As a result, there are now three senior registrars in the Oxford establishment: one in the Accident Service of the Radcliffe Infirmary, one in the Nuffield Orthopaedic Centre and one in Khartoum. The latter is seconded for two years and it is proposed to continue the secondment until a sufficient number of Sudanese orthopaedic surgeons have been trained to form a nucleus for the entire country.”8

In fulfillment of the agreement, Dr Abdel Rahim described the two-way traffic arrangement that emerged:

a. The NOC seconded, for a two-year period, one of its three senior registrars to the post of a senior lecturer in the medical school. Those surgeons were of such seniority that each one of them attained the consultant post on their return from Khartoum The first senior lecturer, B.T. O'Connor, undertook his responsibilities in July 1962. His forceful and dynamic personality, together with the support of Professor Nicholls and Mr. Abdel Hamid Bayoumi, the senior surgeon, enabled him to create a full-fledged orthopaedic unit, with its own theatre, casualty, outpatient, and ward facilities. The theatre, the wards and their equipment mirrored that in Oxford. On the job training of the medical staff, the theatre attendants, and the nurses was an

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important step in the initiation of a safe orthopaedic practice. It was indeed a great tribute to Brian O'Connor (later Professor O'Connor in the prestigious Oswestry) and his subsequent colleagues that so much was accomplished in such a short time. However, for their latter part of the period the tenure of the Oxford surgeons was reduced to one year as they were called back for their consultant posts. Eventually, and with the return from Oxford of the national trainees the secondment scheme was terminated to be replaced by one of visiting consultants.

b. Visits to Khartoum by the Nuffield Professor and NOC Consultants were short ones and administrative in nature. They meant to ensure that the programme is running smoothly, and give advice on improvements and report to the University and to the Ministry of Health. The momentum of these visits was given a further boost with the arrival of Professor Robert Duthie to the Nuffield Chair following Professor Trueta’s retirement in 1966. Professor Duthie's keenness was exemplified by his several visits to Khartoum, his strenuous efforts to avail paid posts for the Sudanese trainees in the NOC and in the Oxford Region: Reading, Southampton and Banbury. This was particularly helpful in facing the mounting difficulties for accessing posts by overseas trainees due to the changing pattern of postgraduate training in the UK.

c. The return from Oxford of the earlier national trainees overlapped the presence of the Oxford senior registrars who enriched their experiences in the very different pattern of local orthopaedics. By 1975, the secondment arrangement ended resulting a reasonable number of national surgeons to teach and run services in Khartoum and in some other provincial towns. The scheme, however, was replaced by one of Visiting Professors, very senior people, retiring or recently retired eminent surgeons who stayed for three to six months. They contributed with their vast experience in planning, organization and teaching both in the UK and in other developing countries.

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They were conversant with the local disease pattern, now extinct in Europe. Their presence and interactions during the lengthy outpatient and operating sessions, particularly in areas such as poliomyelitis, spastic disease, bone and joint tuberculosis, neglected trauma and congenital malformations was inspirational to both the visiting professor and the young national surgeon. They belonged to the orthopaedic giants of their days: Edger Somerville, Arthur Eyre- Brook and Dennis Wainwright.

Reciprocal training

The NOC Assistance programme (OSP) consisted of a two-way traffic: Oxford to Sudan, and Sudan to Oxford. Dr Abdel Rahim Mohamed Ahmed was the first recipient of the NOC training programme. He described eloquently how he got the news:

“It was one of the coldest winters in decades when the present writer was climbing the snow clad Headington Hill making his way towards the Nuffield Orthopaedic Centre (NOC) in Oxford. That was just before Christmas of 1962 and the journey was in response to a telegram dated 21 December 1962, stating "advise telephone Professor Treuta, Oxford 64811 to make appointment for early interview." A postal letter of the same date received subsequently explained the urgency as "Professor Trueta is leaving for Khartoum in about two weeks’ time and he would like to interview you before he goes". The writer was totally oblivious of Professor Treuta 's journey, and having passed the FRCS diploma the previous month had applied for a number of orthopaedic posts including that of Oxford. His government scholarship would last him for another fifteen months.”9

OSP Training in Oxford

Training in Oxford started soon after the initiation of the programme. All the trainees had obtained the FRCS diploma and spent some time as

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general surgeons in their country. The programme commenced with the first year in the accident service of an Oxford Regional Hospital, mostly Reading or Northampton, to be followed by one year in the NOC. They held the posts of registrar or senior house officer with their heavy commitments of those days. The trainees were encouraged to spend a few months in a sub-specialty related to orthopaedic trauma such as traumatic neurosurgery, including head and spinal injuries, plastic and hand surgery.

By the end of this phase of the Programme nearly twenty surgeons had returned to the country, and apart from the Three Towns, including the University, orthopaedic units were established in the major provincial towns of Atbara, Port Sudan, Gadarif, Medani and EI Obeid.

OSP & Auxiliary staff training

The establishment of proper orthopaedic services in the country necessitated the upgrading of the supporting staff, including nurses, physiotherapists, and radiographers. One-year fellowship was awarded to at least twelve nurses to specialize in theatre, ward and after-care techniques. Likewise, three radiographers spent a similar period in orthopaedic radiography. Physiotherapy posed a more difficult problem as local training was confined to the assistant grade. Six post GCE were awarded three-year scholarships, only three of whom were able to obtain the Certificate of Chartered Physiotherapists and only one returned to the country. Later one fellowship was availed to a pathologist to study musculo-skeletal pathology.

Termination of OSP

In about eight years, the life span of the NOC programme, five orthopaedic surgeons: Mr. O’Connor, Mr. Denman, Mr. Fekerzli, Mr. Neeser, and Mr. JS Ferguson in this order have come to Khartoum from 1962 to 1970. Five Sudanese orthopaedic surgeons were thus trained in Oxford in reciprocity.10

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The spontaneous cessation of the programme was due to a number of factors, chief among which was the difficulty of availing paid posts for trainees as a result of the major changes in the structure of postgraduate training in the UK, and in particular for overseas students. The partial government sponsorship for training abroad became increasingly difficult. On the other hand, the University of Khartoum postgraduate degrees namely Master in Clinical Surgery were by then so well established that other disciplines had to follow by necessity. The controversy on the questions on locally based orthopaedic training as opposed to training in developed countries had raged for some years. The senior visiting professors did not fail to draw attention to the drawbacks of the programme, one clear evidence of which was the migration of a big number of the Oxford trained surgeons. By the time the access to postgraduate training in the UK closed, the University of Khartoum degree in accident and orthopaedics was well established.

The Training of the Orthopaedic Surgeon

While he was Head Department of Orthopaedic, KCH, Dr Abdel Rahim had his views on the training of orthopaedic surgeon.11 He noted that the trainee orthopaedic surgeon had to train and work in the less privileged condition dictated by the state of development of his country. He also note that every effort must be made to give a comprehensive training representing orthopaedics as technically advancing science both in theory and practice. It is unlikely that all training centres in the developing countries are so equipped and staffed as to present an up-to-date picture of orthopaedics, itself one of the widest specialties and intimately connected with many others.

Surgeons in developing countries are aware of the workload thrown onto them, and the priorities they have to consider, but in matters of surgical judgment and execution, the standard must in no way be inferior to that practiced in the developed part of the world.

It is thus essential that trainees in orthopaedic surgery in developing countries should spend some time, at least one year, working in more

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advanced centres. Not only is the trainee exposed to the growing ends of knowledge, but also he meets more teachers, new ideas, and different techniques and altogether gains a fresh and perhaps a welcome critical attitude. Such an attitude is particularly important in orthopaedic surgery where the treatment of a certain condition can vary between masterly inactivity and the initiation of the most elaborate surgical interventions and rehabilitation programmes.

The disease pattern and the practice of orthopaedics will certainly be different, but the principles remain the same. Equally important is the fact that the trainee’s active involvement in this advanced setup gives him an insight into the organization, the administration and delivery of service, an experience that is much needed in developing countries.

This period of work in the more advanced centres may form an integral part of the training programme and hence must be carefully planned preferably by a liaison scheme between the concerned institutes in the developing and more developed countries. The trainee’s work there should bring him in contact with the routine practice in both accident and orthopaedics as well as with the ongoing academic and relevant clinical and research activities. Time should be allowed at the end of the training programmes for brief visits to some other major and specialist centres e.g. hand, spinal, plastic and neurosurgical centres.

In this way, the trainee is exposed to another programme against which he can judge his merits and shortcomings and naturally will try to bridge the gaps in his skill and knowledge. Moreover, on his return to his centre, these new ideas and techniques will be further disseminated to the benefit of many others.

Obviously, the biggest obstacle that faces the fulfillment of such an aim is a financial one, many developing countries unable to afford scholarships. It is here that centres in the developed part of the world can come in with much needed help, by assigning training vacancies and scholarships on their training programmes to candidates from the developing world. It is here too that our meetings can assume a more

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positive role by recommending and fostering such relationships.

World Rehabilitation Fund

In a letter addressed to the president of the World Rehabilitation Fund, Mr. Abdel Rahim Mohamed Ahmed in his capacity as Senior Orthopaedic Surgeon, Ministry of Health, expressed his and his country’s sincere thanks and gratitude to the support this organization was giving to Sudanese orthopaedics. He expressed his gratitude for all the invaluable help WRF had rendered to Sudan. He stress however, the role played by the prosthetist orthotist Mr. Juan Monros through the numerous and most constructive visits he made to Sudan. He mentioned that Mr. Juan Monros has left an indelible mark in this field, and that it was WRF, too, that started the training of four Sudanese technicians in courses sponsored by WRF at Kampala and Beirut. He added that he was happy to say that these four young men presided over the Sudan’s ambitious programme of prosthetic orthotic service.12

Sudan Orthopaedic Rehabilitation Programme

Mr. Abdel Rahim Mohamed Ahmed, the senior orthopaedic surgeon, Khartoum Civil Hospital, described the Sudan Orthopaedic Rehabilitation Programme, its problems, early strides in the field of prosthetics and orthotics and the plans for a countrywide coverage in this field.

He noted that crippling disease is rife, and that it lashes hard at childhood since poliomyelitis is endemic throughout the country, and that the incidence of cerebral palsy was many times that in the developed world due to obvious perinatal and tropical causes. Bone and joint infections add a further toll, and skeletal malformations present late and constitute a big challenge.

Thousands of amputees overwhelm our budding service. Madura Foot, a tropical fungal infection, is prevalent in the central part of the country. Surgeons often are presented with the advance disease where

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amputation is the only merciful answer. Road traffic accidents and industrial injuries, often presenting late or inadequately attended to add to this pool.

He said that the Sudanese health authorities had been aware of these problems. The last five years plan provided for the start of a rehabilitation service and the field of prosthetics and orthotics was given top priority. The first national prosthetics and orthotics centre was opened in May 1974. The buildings layout of this centre is very ambitious and carries a great potential for the future. There are three blocks for the different workshop departments each with an area of five hundred square meters together with a full adjoining outpatient block. The overall enclosure provides ample space for future building for medical and industrial rehabilitation.

The equipment consisted of basic machinery, hand tools and a certain amount of prefabricated components, which were acquired from Hangers and Company Ltd. of UK at a cost of £ 22,331 in 1972. This was to cater for an initial phase, which depended on prefabricated components. A sum of £ 10,000 is being raised locally to acquire further machinery, which will enable the centre to move into the next phase when local timber and steel can be utilized.

The workforce consisted of four technicians, all with twelve years of basic plus three years of technical education. They were trained abroad each for eighteen months. Two were trained in the WHO Regional Training Centre for Technical Orthopaedics in Tehran, and the other two in Roehampton and stanmpne in London. Two senior foremen had three months training courses in Cairo. The workshops are also manned by skilled labourers.

Mr. Abdel Rahim summed up the Ministry of Health plans in this field. He quoted the inaugural speech of HE the Minister of Health of the Centre in May 1974. The plan includes:

1. A short phase of resort to prefabricated components. 2. An eventual phase of dependence on locally available materials.

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3. Research into simple methods of fabrication and cheaper materials to produce durable prostheses and orthoses suitable to our largely peasant community.

4. The establishment of smaller satellite centres in all provinces manned by technicians trained in the National Centres, which will also produce the necessary prefabricated components.

5. The creation of units for medical and industrial rehabilitation.

This phase needed expert help, training and guidance in modern fabrication techniques, and production management, equipment and materials.

Aid for the Disabled

Mr. Abdel Rahim was also interested in preventive orthopaedics and helping the disabled. In an unpublished paper entitled “Aid for the Disabled: available facilities, present and future needs,” he noted that rehabilitation of the physically handicapped is usually relegated a secondary role in the face of enormous medical and social needs. Such an approach is dangerous as it submerges the issue until it reaches unmanageable proportions. Most authorities agree that whatever the size of the country’s resources, a rehabilitation programme must be intimately blended with its socio-medical structure early on.

Although not all rehabilitation problems are solvable by mechanical means, it is a well-known fact that the speedy provision of a suitable artificial limb or other appliance goes a long way towards allaying the physical handicap. This is an area where, from the pure economic principle, cost-effectiveness, a high priority must be accorded to the provision of such mechanical aids, especially that the onus on such aids, by the nature of injury and disease pattern in the Sudan are either children or adults in the prime of their lives. It is with the provision of artificial limbs, braces and other special appliances that the note is concerned.

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He noted that lack of knowledge of the magnitude of the problem makes it difficult to plan for a nation-wide service for amputees, children, adolescents and adults afflicted by poliomyelitis and other crippling diseases. Comprehensive national social surveys of the prevalence of physical disability are desirable though difficult. The demand will certainly increase with the increase in the incidence of injury at work and or roads, unchecked crippling diseases especially poliomyelitis, and the increasing public awareness`.

Khartoum Cheshire Home

By 1992, there were 270 homes in 49 countries founded by Leonard Cheshire (1917–1992) International.1 These homes provide different rehabilitation services to disabled children free of charge. There are currently two Cheshire Services in Sudan providing both residential care and outreach/community based rehabilitation programmes. These services cover needy areas and displacement camps and offer physiotherapy, orthopaedic workshops, surgery, and educational and creative activities such as handicrafts.

The services work in conjunction with a number of partners including the Christoffel Blinden Mission, the Broader Horizon Institute in Atbara, Sudan north and western Sudan Union of the Disabled. Khartoum Cheshire Home (KCH) was established in 1973 as local voluntary organization. This rehabilitation centre assesses children with mobility impairments, refers, gives pre- and postoperative care and treatment, and provides physiotherapy services and mobility devices to children with physical - mobility impairment. The centre has 34 beds for post-operative care. The admitted children get education during their stay in the rehabilitation centre to prepare them to join schools once they are discharged.

Those who helped in the foundation of the KCH include Mr. Adam

1 This section is a reconstruction of information obtained from different sources. Professor Samir Shahin contributed substantially to this section.

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Fadalla, Mr. Abdel Rahim Mohamed Ahmed, and Dr. Ahmed Abdel Mageed. KCH is managed by and Executive Committee of 12 to 15 members, and traditionally headed by the British Ambassador in Sudan. The Department of Orthopaedic, Faculty of Medicine, University of Khartoum covers all clinical activities of KCH. Around 1500 children are seen in KCH, 330 children are operated on every year, and an additional 3000 children are given mobilization aid. The departments of KCH are:

Physiotherapy including hydrotherapy. Orthopaedic workshop unit for orthotics production. Surgery. Outreach unit and community based rehabilitation.

The National prosthetic and Orthotic Centre

Artificial limb making made a modest start in the early 1940s through personal initiative in the workshops of the Mechanical Transplant Department. This is dedicated to the service of the amputees of the Sudan Defence Force during the Second World War. The service gradually expanded to include civilians. The Senior Surgeon to the MOH became actively involved in prescription and supervision of the fittings with the initiation of orthopaedic surgery in Khartoum Hospital. In the early sixties the workload on this small unit became greater and it was imperative that the MOH takes over. The Centre was officially inaugurated in May 1974.

The buildings of this Centre are situated in the Industrial Area in Khartoum some three kilometres from Khartoum Civil Hospital. They consist of a complete outpatient block and three adjoining blocks, which served as workshops and the third a service/administrative block.

The technical staffs consist of four technicians who are graduates of Khartoum Senior Trade School. The course in this school included 12 years of general and 3 years of technical education. After a two-year on-the-job training in the Old Unit, technicians are sent on 18 months upgrading courses to London and Tehran. Staff also included four

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senior foremen with many years’ experience of whom two had three months upgrading courses in Cairo, senior skilled labourers, specializing in metal, wood and leatherwork.

The machines were basic hand and bench tools and light machinery, which were bought from Hangers Ltd, UK. This leaves the Centre dependant on the import of some prefabricated components in the initial phase. The use of plastics has already been introduced and is proving to be very satisfactory in both prostheses and orthoses.

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Written Contributions

Published papers

1. Abdel Rahim Mohamed Ahmed. Patterns and Problems of Poliomyelitis in the Sudan. Sud. Med. J. 1971; (9)4:2-5.

2. --. Social Implications and Medical Priorities: Orthopaedic Training Reviewed in This Context. In: The Commonwealth Foundation Occasional Paper No. XX111: April 1974.

3. --. The Evolution of Prosthetic and Orthotic Services in a Developing Country. In: The Commonwealth Foundation Occasional Paper No.

3 Ahmad Al Safi. Abdel Hamid Ibrahim Suleiman, his life and work. Sudan Currency Printing Press, Khartoum, 2008. 96 pages.

4 Buxton, Jean. Op. Cit., page 314.5 Abdel Aal Abdalla Osman.6 Obituary by AHMS. In memorial of Marriott Faulkner

Nicholls. K.B.E., M.Ch., F.R.C.S. (1898-1969)7 O’Connor, BT. The Girdlestone Tradition: Inauguration

of Orthopaedic and Traumatic Services in the Sudan. Page 390.

8 O’Connor, BT. Op. Cit. Pages 371-391. 9 Abdel Rahim Mohamed Ahmed. Orthopaedics in the

Sudan: Unpublished paper. Undated.10 Abdel Aal. Op. Cit. Page 150.11 Abdel Rahim Mohamed Ahmed. The Training of the

Orthopaedic Surgeon: The Need to Work in Other Centres. Unpublished paper. Undated.

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XL1: May 1977.

Unpublished papers

Papers read at national and international conferences.

1. The Radical Surgical Treatment in Pott’s Paraplegia: A Review of Eighty-Five Personal cases.

2. The Outcome of Total Synovectomy in Chronic Non-Tuberculous Swelling of the Knee.

3. The Management of the Motor Deficit in the Cerebral Palsied Child.

4. Patterns, Problems and Priorities in Child Orthopaedics in the Sudan.

5. The Evaluation of an Orthopaedic Training Programme in a Developing Country.

6. Amputation and Prosthetics: A Review of 248 patients.

7. The Training of the Orthopaedic Surgeon: The Need to Work in Other Centres. Unpublished paper. Undated.

12 Abdel Rahim Mohamed Ahmed. Letter to president of the WRF on June 3, 1976.

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Photo Gallery

Figure

الخرطوم، جامعة الطب، كلية 1958خريجو

اليمن الخلف من من ابتداء الشمال إلى اليمين من األطباء :

ه عبد يوسف –عمر سمرة –مأمون ابو الرحمن –محمد عبد النيل حمد يوسف – العزيز أمين –عبد حسن كرار –ابوبكر على –الجيلي أحمد

معتصم –الطيب المجيد –محمد عبد الختم شريف –سر عبد –حسن المبشر سليم –الله يوسف –حافظ الله حسن –عبد أحمد –محمد

القدال سالم –أحمد الرحمن محمد –عبد الرحيم كرودين –عبد –دكتور آدم ماكقوان –دكتور مورقان –مستر دين –بروفيسور بروفيسور

دالي –سمث ماكفيل –بروفيسور محمد –بروفيسور الجليل عبد

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Biographer’s Profile

Professor Ahmad Al Safi

MB BS, DA FFARCS, FRCA

Ahmad Al Safi is a Sudanese anesthesiologist, researcher, administrator, and writer. He is known in the medical field as a medical biographer, and noted for his role as founder of institutional research in the history of medicine, and health heritage, and that he broke new grounds by establishing unique non-governmental high skills medical training. Ahmad Al Safi has an extensive record of accomplishment of activities in working with and in groups for four decades. He founded or co-founded several organizations – governmental and non-governmental, and held executive offices in many.

Ahmad Al Safi has been honoured by the Sudanese Writers Union (SWU) in December 2013 in recognition of his valuable contributions in studies of the Sudan’s health heritage, and for his scholarly publications in these virgin fields. The Union applauded his remarkable contributions in improving knowledge and enlightenment in academic work in Sudan. In February 2014, Professor Ahmad Al Safi was elected President of SWU.

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