Standing Tall

The first thing one notices about 16-year-old Noxolo Makhaza is the sparkle in her eye. But until October 2022, it would likely have been her curved spine.

Scoliosis, a condition frequently associated with the adolescent growth spurt, twists the spine and causes uneven hips and shoulders as well as an asymmetrical chest wall. ‘The children’s presenting complaint is often the way they walk: they walk skew and they are very self-aware, so they wear big jackets and jerseys,’ says Dr Alberto Puddu, orthopaedic spinal surgeon at Grey’s Hospital in Pietermaritzburg, South Africa.

Aside from causing chronic back pain in later life, the spine’s contortion can deform the chest cavity, preventing the lungs and heart from developing properly in extreme cases. However, for a young teen, the change in appearance can be just as devastating.

‘I found it difficult to run or jump and I had pain when I slept. But most of all I always wanted to change the way I looked,’ says Noxolo, who was diagnosed in October 2021. Since she was a state patient, there was no guarantee when her spine could be corrected.

Grey’s Hospital is the only governmental tertiary facility for a catchment area of more than 4.5 million people. Although it has the necessary expertise and facilities for specialised procedures, it has to prioritise emergency and life-threatening cases. ‘It is a logistical problem. When you get one slate a week for all spinal surgery cases and there are emergencies, the scoliosis operations get pushed back,’ explains Alberto. ‘Theatre time is one challenge, the other is time in ICU. We can schedule a patient for theatre but if there is no ICU bed available afterwards, the surgery gets cancelled.’

For both surgeon and patients, it is demoralising when treatment is delayed – in some cases for up to four years. Scoliosis is ideally treated while the spine’s curves are more flexible and more easily corrected; treatment for adults is more challenging.

Spinal surgery for the condition is a long and complicated operation that entails putting metal rods and screws into the vertebrae. It requires a theatre with skilled nurses and excellent post-operative care. So Dr Alberto Puddu reached out to our nearby Pietermaritzburg Hospital for assistance. The solution to clearing his surgical backlog: a PPP between Mediclinic and Grey’s Hospital.

Mediclinic provides the theatre and bed in ICU or high care, as well as covering the costs of consumables and nursing. ‘It is very important to me that the client has the best care,’ says Meshach Naidu, Hospital General Manager at Pietermaritzburg Hospital. Coming from a nursing background, he knows the impact attentive, client-centred care can make on clinical outcomes. In the case of the scoliosis patients – seven in 2022, with a balance of 19 scheduled in 2023 – one-on-one postoperative care ensures their pain is effectively managed.

For us, the goal is to help clear the waiting list of young scoliosis sufferers. ‘We want to give with purpose and leveraging our expertise and resources to address the surgical backlogs in public hospitals is the right thing to do,’ says Bob Govender, Industry Affairs Executive for our operations in Southern Africa. This is not the only initiative to benefit state patients: in 2022, our facilities in the geography carried out 169 pro bono surgeries, ranging from cataract procedures to cleft palate operations. 

Lancet Laboratories supports the scoliosis initiative with testing, while several anaesthetists donate their time and expertise. ER24 provides transport back to Grey’s Hospital once the individual’s pain is under control. After a few days of recovery in the state hospital, the person starts walking again. ‘These kids are amazing; they bounce back quickly and within a week they will be discharged. It is very rewarding to work with patients like these who have no other resort,’ says Alberto.

‘When they come to their follow-up consults, the children are walking upright and full of confidence, the girls are wearing tank tops. Noxolo, who was our very first case operated at Mediclinic, is dancing now,’ he says.

At first glance the risks of such a complex operation would seem to outweigh the benefits of better self-esteem, but the fall-out from scoliosis extends beyond appearance. Kids who are teased at school will avoid attending and can develop serious educational difficulties. ‘A previous patient of mine was failing at school, but now she is in the middle of her class. The surgery did not improve her brain, it just gave her an opportunity at confidence.’

‘For me, it has been very touching to be able to contribute and see the person living a good life,’ says Meschach. ‘The children that we are doing the surgery for are our future – they could be the next nurses, physiotherapists, doctors. I feel so blessed that we are able to play a part.’