A step in the right direction: Anelisa Baiiso
Posted on 9 April 2019
“I think everyone in healthcare becomes involved in this industry for one reason: to do good,” says Dr Dirk Nell, an orthopaedic surgeon at Mediclinic Louis Leipoldt in Bellville, Cape Town. “So when this opportunity presented itself, we got excited. It had a snowball effect. Everyone just wanted to help.”
In 2017, Anelisa Baiiso was a student, enrolled in the social work programme at the University of the Western Cape. Though she walked with an awkward and uncomfortable gait, which caused her chronic pain, she joined the university choir. That’s when she experienced the first of a series of miracles.
“I went to watch a varsity choir competition at the Hugo Lambrechts Music Centre with a friend,” says Dr Nell, “and while they were singing, we noticed one of the lead singers had a very crooked leg. It looked like she found it awkward to stand. My friend asked me, You’re the doctor, can’t you do something about it? I said, Well, yes we can.”
Initially, Dr Nell imagined the help he could provide would entail no more than a small and relatively quick pro bono orthopaedic surgery. He contacted the choir leader and arranged for a consultation – which is when he realised the true scope of the project.
“I established that she’d suffered a fracture after a bad fall as a child,” Dr Nell explains. “Her growth plate in her right leg was damaged. That meant her leg didn’t develop properly as she grew up. Her upper leg was severely short, and caused her to walk with an unnatural gait. Because of that, her other leg became crooked, trying to compensate – it was bent at almost 50-degrees.”
Growth plates are pieces of soft tissue at the ends of a child’s long bones, found in the thigh, forearm and hand, among others. As we grow into adulthood, these areas develop into bone. Damage to these growth plates can lead to growth arrest – an injury that can stall proper development of the limb.
Dr Nell knew after one consultation that this was a bigger project than he’d anticipated. “There were two elements to this: straightening the crooked leg was fairly straightforward, but lengthening the right leg was more complicated. For that, we needed a lengthening nail.”
A lengthening nail, or intramedullary rod, is implanted directly into the bone of the affected leg. Remote-controlled magnets on the outside of the leg, together with magnets on the inside of the rod, are then used to lengthen the implant. Over time, the bone then naturally grows around the rod, effectively lengthening the leg.
An intramedullary rod is a noninvasive alternative to traditional distraction osteogenesis using external fixation lengthening treatments, and the best solution for Anelisa’s case. The challenge, says Dr Nell, was how to raise enough money to cover the costs.
This is where another miracle occurred. “I knocked on the door of an orthopaedic supplier, and he agreed to bring the implant into South Africa on a zero-commission basis. But that piece of equipment costs over R250 000, and comes from a company France. Then we heard that the supplier over there, out of their own, was willing to donate the rod. That was a surprise. That was when we thought, this can happen now. Let’s make this happen.”
Dr Nell says that donation kick-started a wave of generosity. “Everyone got involved. It was amazing to see. Radiologists play a huge role in a surgery like this – there are scans and check-ups every two days to ensure the line is growing correctly – and the guys were volunteering their time for free. There were nurses who came to me and said, I know you need anaesthesia drugs for this surgery, so I spoke to a rep I know, and for this patient, just this once, we’re going to get them for free.”
He says Mediclinic Louis Leipoldt jumped at the opportunity to extend expert care and first-class facilities beyond their traditional patient base, providing theatre time and unit amenities for free.
Anelisa underwent two surgeries. Dr Nell and his team broke her left leg and fitted her with an external frame, gradually correcting the shape of the leg. They then locked the brace in place to ensure the leg grew back correctly over the next eight to ten months. Once the left leg had healed, they removed the frame, and moved on to the second operation.
“An external frame is a huge burden for any patient,” says Dr Nell. “It’s heavy, it’s cumbersome – it gets in the way. So a rod that is implanted directly into the bone is a blessing.” It’s also highly effective: Anelisa’s leg was 11.5cm shorter than the other. The rod would give that leg an extra 8cm.
In total, the pro bono project was completed in 18 months. Today, Anelisa has only a slight limp. “Before, every step was a struggle. She was in a lot of pain. Now, it is way, way better than what it was – she’s walking.”