BFirst trip to CURE International Children’s Orthopaedic Hospital, Bulawayo
Introduction
Having successfully undertaken a mission in 2024 (JM and DF) we were invited to again undertake a mission to the Cure hospital by Mr Andrew Hodges FRCS(Plast) {the resident Plastic Surgeon}and the Hospital Director Mr Jonathan Simpson. The plan again was to help with operating and teaching on a range of children with congenital and acquired differences of the hand. Jess Steele from Salisbury joined us this year.
We flew out to Bulawayo via Johannesburg and landed in Bulawayo on Sat 6th Nov. We were met with unseasonably heavy rain for the first 3 days but otherwise were delighted with warm days and sunny skies – when we were out of theatre! Accommodation had been organised with a very comfortable B&B and superb staff to look after us – Jamil and Jess also dab hands in the kitchen!
On the Sunday prior to the start of the very busy week we were again personally escorted around the Matopos National Park by Senator David Coltart, the Mayor of Bulawayo. This is a World Heritage park characterised by massive granite rock formations and rock art dating back to early man…and highly recommended for any visitors to Zimbabwe! We were entertained for lunch and a game drive at Farmhouse Matopos (www.farmhousematopos.com) the highlight being a pair of endangered white rhinos.
Clinic
Andrew Hodges had been accumulating cases for us to review with country-wide referrals and a total of 41 patients were seen in clinic on Mon 8th Nov. This day-long clinic was held together, with Andrew leading, visiting Plastic Surgery Registrar from Harare Rutendo Makiwa, Bhekinkosi Swene (Cure plastic surgery trainee) senior nursing sister and resident Orthopaedic surgeon Laurence Wicks popping in!. The patients were all children with hand problems including congenital anomalies, acquired birth trauma related problems and neglected trauma (Andrew does most of the burn-related work himself so we only saw one case of old burns). We also saw some follow-ups from last year’s mission.
Of these 16 were selected for surgery for the following 4 days in 2 theatres including 2 free flaps. In the latter part of the week we were joined by Tinashe Mutarisi, another Plastic Surgeon registrar from Harare.
Theatres
The operating theatres, anaesthetists and nursing staff were all of the highest standards and hugely facilitated what turned out to be a very busy but productive week. ‘Mr T’ was the go-to man for all major equipment issues. We had taken some latex-free gloves for Drew (Jess forgot to take hers!), Nieverts needle holders and assorted Vicryl Rapide suture material – otherwise all equipment excellent. Reminder next time – take some smaller K-wires!
The following operations were performed by the visiting team:
- *Left free fibula to radius (previously distracted Bane 3 radial dysplasia)
- Wind-blown hand with release and FTSG 3 digits
- Arthrogryposis with 1st web release and flap + intrinsic releases
- Arthrodesis DIPJ’s for burn Boutonniere contractures with FTSGs
- Pollicisation for Blauth type 4 in radial dysplasia
- Arthrodesis thumb IPJ and rotation osteotomy previous free toe transfer (from 2024)
- Centralisation for radial dysplasia type 4
- Macrodactyly bilateral feet – right central ray amputation x2, left great toe amputation and on-top plasty D3 to 1
- *Free ALT to forearm (previous Volkmann’s)
- Chondrodesis thumb + 4 flap z-plasty to 1st web + ¾ th web syndactyly release + FTSG
- Scar revision dorsal hand and neuroma removal
- Release 1st web, intrinsics transfer and sagittal band reconstruction (cerebral palsy)
- Zone 5 extensor + flexor reconstruction with grafts + median and ulna nerve grafting (2 year old saw injury)
- CP for wrist fusion + thenar muscle slide + extensor plication
- CP for bilateral thumb 4 flap Z-plasty, thenar slides, FTSG and chondrodesis MCPJs.
- CP 1st web 4 flap Z-plasty, chondrodesis MPJ and Huber transfer
Both free flaps were done and dusted by 6pm with no take-backs and good post-op recovery. Plans for free gracilis to at least 2 cases are in place for next visit!
The wards are delightful, spacious, well staffed and with accommodation for parents next to the children’s beds. There is a 1 bed HDU on the ward.
There is also a 20 bed dormitory to accommodate children + parents awaiting surgery as many of these families had travelled from all over Zimbabwe (Harare, Mutoko, Hwange, Mutare, Plumtree, Masvingo etc).
Aim
The aim of this trip was to teach and operate on a range of children’s hands to enable both Andrew, locally, and hopefully the visiting surgeons from Harare, to refresh and acquire a new skill set to help further children going forward. We believe and hope this was achieved in addition to obviously helping these children upon whom we operated on.
Feedback has been enthusiastic and the possibility of another visit is certainly on the cards. It would be good to teach the Harare registrars some more of the fundamentals of hand surgery which they confess is sadly lacking from their current curriculum due to theatre and expertise constraints in Harare.
We would like to thank Andrew and his wife and excellent Anaesthetist Sarah for their at-home hospitality; Jonathan Simpson, Sam Weston-Simons and Laurence Wicks (resident Ortho surgeons)and all the Staff at Cure Bulawayo for their kindness and hospitality during our visit – and of course the delightful children and their families.
Drew Fleming
Jamil Moledina
Jessica Steele
November 2025