The Joint Care Trust is a not-for-profit organisation which has been created by Dr Engela and Dr Martin.
Given the current state of health care in South Africa, it is obvious that there are significant discrepancies between private health-care and public health care. One of the major problems with public sector orthopaedic surgical management of patients is that a massive amount of the budget as well as the available theatre time is consumed by management of trauma cases. This leads to long waiting lists for patients who require elective procedures such as hip-and knee replacement surgery for arthritis.
While the skills required for performing these operations are present in abundance in the private sector, the shortage of part-time positions in the state sector, the lack of theatre time and facilities as well as budgetary constraints make it impossible for surgeons to volunteer for pro-Deo arthroplasty work in the state.
Another potential problem is the nature of the existing waiting lists, which, in our opinion, require streamlining as well as adjustment in order to change patient selection criteria. While this point is always emotive and controversial, we feel that patients should be stratified according to the urgency of their surgery (for example a patient who requires a revision procedure because she is at risk of fracturing her femur secondary to bone loss or a rheumatoid arthritic patients with a rapidly deforming knee) and secondly according to the potential societal knock-on effects of the surgical procedure (for example a young father with arthritis secondary to avascular necrosis, who stands to lose his job and therefore his ability to support his family if he remains consistently unable to work).
The logical solution for this problem is an establishment of a organisation which provides quality arthroplasty surgery to non-medical aid patients who are stratified (independent of the influence of the operating/referring surgeons) by means of a computerised waiting list, which is able to constantly re-stratify patients as per their relative urgency/need. This is currently being carried out at the Victoria Hospital Scoring Clinic. Patients are being referred there via the Victoria Hospital Orthopaedic Clinic, the False Bay Hospital Orthopaedic Clinic (which is being run by-weekly by Dr Martin), the GF-Jooste Orthopaedic Clinic as well as via the Cape Joint Surgery.
It has been shown conclusively in various scientific studies, that lower limb arthroplasty surgery on low-and intermediate risk patients can safely be carried out in secondary hospitals. While the Joint Care Trust is actively involved in seeking sponsorship of arthroplasty implants as well as consumables and theatre time in the private sector, the majority of arthroplasty surgery cases are currently being performed at Victoria Hospital (roughly 150 cases in the last three years). This is thanks to Dr Paul Rowe, who is a trustee and is in charge of the orthopaedic department at Victoria Hospital. Having recently secured sponsorship of arthroplasty implants from various implant companies with a commitment to increase the numbers annually, we are able to offer more patients surgery than ever before and we are now actively investigating possibilities for increasing theatre availability.
We feel that this plan is relatively easily reproducible and could be carried on in various other major centres in South Africa. In order to train surgeons to carry out the required procedures and in order to familiarise them with the workings of the Joint Care Trust, a University of Cape Town accredited teaching fellowship is being initiated in the next year under the auspices of the Cape Joint Surgery.
In order to provide this service to as broad a base of patients as possible, we urge any general practitioner (regardless of drainage area) to contact the Cape Joint Surgery ((021) 797 0947) regarding any potential patients. The secretarial staff will be more than happy to arrange an appointment at the False Bay Hospital Clinic, with a view to having a patient placed on the waiting list.
Both Dr Martin and Dr Engela extremely proud of the work that has been done in this regard already at the Joint Care Trust and feel strongly that, given the changing face of healthcare in South Africa this type of private-public sector joint initiative may well be workable model for inclusive patient care in the future.
