Mseleni Hospital, KwaZulu-Natal
It is 9.15am and Wilson Mhlongo is being prepared for an operation to replace the ball and joint of his right hip, which are eroded by arthritis. He winces, his eyes screwed up in pain, as Dr Kobus Viljoen tries to find a space between his vertebrae to insert the huge needle of the spinal anaesthetic injection.
Dr Victor Fredlund, assisted by Viljoen, will perform the two-hour operation. As the hospital has no anaesthetist, Mhlongo will be awake throughout the procedure.
Mseleni District Hospital, a 190-bed hospital on a sandy hill between Sodwana and Kosi bays in far northern KwaZulu-Natal, is an unlikely site for this relatively high-level orthopaedic operation.
But there is such a high incidence of arthritis in the area that it has become known as Mseleni Joint Disease (MJD), and even people in their 20s need new hips.
”The cause of the arthritis here is still something of mystery,” says Fredlund. ”Poor diet could have played a part, but there may have been an infection or a toxic substance in the food or water that affected a large portion of the population.”
Preliminary studies seem to have ruled out genetics. While a lot of people in the community still have MJD, there is definitely a decrease among the younger generation, he says.
Whatever the cause, the result is pain and difficulty for those who have MJD — especially as walking long distances through thick sand is part of everyday life.
Mhlongo is only 51, yet he has the stiffness of an old man, with little mobility in his joint and a lot of pain when he moves around.
According to the hospital referral system, Mseleni patients should be sent to Ladysmith regional hospital for hip replacements.
But, says Fredlund, patients had to wait for months in the town before being operated on. Fredlund had organised for a surgeon to come to Mseleni to perform hip replacements over weekends, but he was killed in a plane crash. So Fredlund decided to do the operations himself.
In the cold, pale green operating theatre, Mhlongo is laid on his left side and his body is bound in green cloth. Only his right hip is exposed. That gets painted with antiseptic and covered in cling wrap.
A nurse places an arm rest across Mhlongo’s body and straps his right arm to it. Thankfully, it forms a screen that will prevent him from seeing the operation taking place.
Once the anaesthetic has taken, Viljoen dislocates Mhlongo’s hip. At 10am, Fredlund makes the incision, cutting as deep as his knuckles.
From then on, the theatre resembles a carpentry shop, with the short Fredlund shadowed by his tall assistant. By 10.20am, Fredlund has sawn off the flattened ball of Mhlongo’s hip joint with an electric saw.
With much hammering, gouging, chiselling and sanding, the doctors clean out the cup socket that holds the ball in the hip joint to prepare for the new plastic cup.
Mhlongo gives a muted cry, but is comforted by the nurse at his head, who is monitoring his vital signs. He shivers.
The scrub nurse hands Fredlund the new cup and the theatre sister mixes some human cement. By 10.50am, Mhlongo has a new plastic hip cup.
Then comes an even noisier part, as Fredlund drills down Mhlongo’s femur to make space for the artifical ball, which comes attached to a long spike.
Fredlund cuts a plug from Mhlongo’s hip ball and jokes about recycling parts. Then he pushes the plug into the hollowed out femur. The sister mixes more human cement. This gets syringed into the femur hole and followed by the spike of the ball prosthesis.
Mhlongo speaks quietly to the nurse about going to church on Sundays.
Fredlund hums a little as he cements the new ball is in place.
At 11.25am there is a creaking sound as the two doctors re-connect Mhlongo’s leg and hip, the new ball and cup joining for the first time. The operation, which purists believe should not be done at a district hospital, is all over bar the stitching. In a day’s time, Mhlongo will be on his feet and starting physiotherapy. Fredlund and Viljoen, who do two hip replacement operations every Wednesday, prepare for the next patient.
Fredlund, a deeply religious man, seems to relish challenges. He and his wife, Rachel, came to Mseleni from Britain in 1981. Although they only intended to stay a few years, they have been here for almost 25 — and have home-schooled three children. In the late 1980s, frustrated at having to treat diseases caused by dirty water and a lack of sanitation, he simply organised for the hospital’s water pipes to be extended, first to the local school, then in a 10km radius. Taps were attached at regular intervals for local residents. He also helped to start a toilet-building project.
After years of running Mseleni — at times being the only doctor — Fredlund has handed overall management to Thema Mqadi and now oversees only the clinical work.
Mseleni is a perfect example of a hospital doing its best with limited resources. Its excellence is cemented by years of Fredlund’s unique determination and his relentless recruitment of foreign doctors, for it seems few South Africans will stay in the remote hospital. Sadly, the health department’s new human resource policy states that foreign doctors can work in South Africa for a maximum of three years. This effectively shuts out the Fredlunds — and their missionary zeal.