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Memorial Service for John Andrew Fixsen, FRCS, 1934-2014

The recent memorial service for John Fixsen, our urbane and distinguished consultant who carried the flag for SGAA in Afghanistan for many years, was a fitting tribute to a remarkable man. Modest, unassuming, and softly spoken, John bore his great medical knowledge lightly. There was often a mischievous twinkle in his eye, but he was deadly serious about his mission: for John the patient came first and last.

John FixsenJohn Fixsen

John Fixsen tests these baby boys for developmental dysplasia of the hip (DDH).

A pilot project in Samangan Province found 16 babies out of 80 sent for testing to have dislocated hips.

When we began working in Afghanistan in 1986, there were after years of revolution and war many hundreds of thousands of amputees and other disabled patients. Since then, year in year out, we have treated literally thousands of amputees, providing them with artificial limbs [prostheses]; and many more thousands of children suffering from polio, cerebral palsy, club foot and spina bifida - a disease of the spine. Our main activity now is to send out regularly our highly experienced consultants who were led by John. The work they have done, often in difficult conditions, without complaint, has been enormously valuable. We are immensely grateful to John, who would have been 80 this year. His companion on many trips, a leading physiotherapist, Mrs Jeanne Hartley, currently representing SGAA in Afghanistan, sent this moving tribute, read out at the service by her husband, Peter, in the 11th century St Bartholomew the Great church in the City.

John Fixsen – 23 October 2014

I am sorry not to be with you all in London today to pay tribute to John. I thought long and hard about whether I could, or should, go without him to Afghanistan, but I know he would have wanted me to go ahead - so here I am, trying very hard to do him proud.

John and I had known each other for over 40 years but for the last 11 years we have paid twice yearly visits to Afghanistan, a country we have both come to care about deeply. John first came to Afghanistan in late 2002, a year after the Taliban government had been overthrown. In the summer of 2003 I bumped into him early one morning in Great Ormond Street. The conversation went something like this: “I’ve just been to Afghanistan,” said John. “ Oh” said I, “I would love to do something like that”.

John decided that I had “volunteered” in inverted commas and soon after I found myself with him in Afghanistan as one of the consultants supporting the work of Sandy Gall’s Afghanistan Appeal, set up 30 years ago to provide physiotherapy, orthotics and prosthetics to the many Afghans, adults and children, disabled by many years of war, illnesses such as polio and congenital conditions such as clubfoot.

John’s contribution to the people of Afghanistan was immense, and in particular to the children: by encouraging, supporting and inspiring the few Afghan orthopaedic surgeons who had an interest in children’s orthopaedics, by generously giving them his full attention in discussing cases in clinic, by teaching and supporting them in theatre and by providing text books and instruments. He viewed each clinic as an orthopaedic trainees dream come true – everything in the text book was there!

His ability to perform surgery in very basic and often chaotic conditions, keeping his good humour and teaching at the same time, is now an Afghan legend. He also encouraged and helped to arrange for one Afghan surgeon to spend a year training in India and he would have been delighted to hear that last week, Dr Rahimullah, told me that he had carried out open reductions on 60 children’s hips – that’s a lot of children, mostly girls, who will not limp anymore, who will be able to go to school, and importantly in this society, who will be able to marry.

Perhaps John’s most lasting legacy will be his involvement in the introduction of the Ponseti programme in 2005 and more recently the baby hip screening programme in the north of the country where DDH appears to be very common.

Preventing disability by correcting a child’s club foot - over 1,000 patients have received successful treatment - or preventing hip dislocation by simple treatment in a harness – is surely an amazing achievement.

But John was an amazing man. He was a true and dear friend over the years, encouraging and supporting me. It is strange to be here without him. I miss our working together during the day, just enjoying being with the children and their families and our evenings together chewing the fat over a “medicinal” whisky – John regaling me with tales of sailing, Devon, the family, skiing etc, etc, and me trying to get a word in edgeways.

The large number of tributes that have been sent from his Afghan colleagues stands testament to the high regard, esteem and love they had for John. Over the past 2 weeks people have looked at me and then said where is Dr. John and it is sad news I have to break to them. Two days ago a family had travelled for 4 hours to the clinic in Taloqan as they had heard the “foreign doctors” were there. They had come to thank John for the surgery he had performed on their son 5 years ago – now a very active 8 year old. With tears in their eyes they said “he gave our son a life – he can now walk”.

Today in Taloqan we will gather together to remember John and the difference he made to so many in a country he grew to love.

Tashakor Dr John. Khoda bubakshesh.

Thank you Dr John. Rest in Peace.

Physiotherapy Consultant’s Report. April 2013

Objectives of visit:

  • To review paediatric physiotherapy services.
  • To review Ponseti treatment and DDH screening.

DDH PILOT PROJECT.

The DDH project in Samanghan seems to be running well and very successfully. Many babies have been identified with risk factors and have been referred to the physiotherapy clinic for testing. Nearly 50 babies have been found to be positive for DDH and have had, or are undergoing, treatment in a Pavlik harness to stabilise the hip joints. This is an impressive finding and means that these babies (mainly girls) will, hopefully, grow to walk without a limp and all the associated physical and social problems that can accompany life with a disability, particularly in a developing company.

Dr Rahimullah (Orthopaedic Surgeon, Mazar) has now been to Samanghan. His involvement in the project is extremely important, to review X-rays at the end of the harness treatment to determine the outcome – some babies may need further treatment such as a closed reduction and frog plaster – and also to assess walking young children who are limping because of undiagnosed DDH and select those who are amenable to hip reconstruction surgery. His contribution is vital to the project and funding should be made available to recompense him for his time and involvement.

Funding for X-rays and to pay for travel expenses for poor families is also vital – we were told that some families are not able to complete their babies’ treatment because of financial problems. This appears to be a particular problem in Aibak.

The Female Physiotherapy Supervisor gave an excellent over view of the project to date and is to be congratulated, along with Ashraf (Male Physio Supervisor) for their commitment and hard work. It is obvious that liaison with midwives and medical staff has raised awareness of DDH and the posters seen around the hospital and in the clinics is an effective means of getting the message to visitors and patients to the hospital. The data generated by the records kept on the DDH patients will be useful for reporting to potential funding bodies but it is also important that a record is kept of ALL babies tested for DDH. It is essential that the number of babies tested, whether positive or negative are recorded as this shows the amount of work actually being carried out by the physiotherapy staff. MEANWHILE: In Taloqan, physiotherapists have also been testing all babies, who come to the clinics, for DDH – these may be babies in whom the mothers have concerns but also siblings of paediatric patients and babies born to SCA staff. In this way 436 babies have been screened with 47 found to have DDH – 46 were treated in a Pavlik harness – one child was too old for harness management. They have also noted an increase in referrals from Rustaq where the midwives have been appraised of the risk factors and are referring babies to Taoloqan for testing. Well done!

If the DDH project is to be expanded then consideration should be given to a similar publicity campaign in the Taloqan/Kunduz area but, of course, funding will need to follow this to ensure that costs identified as essential in the pilot project are ring fenced to support costs, such as travel, X-rays, fabrication of harnesses etc. As in Aibak the services of an orthopaedic surgeon is crucial.

CLUBFOOT CLINICS:

As ever in each centre the ‘clubfoot’ clinic days were extremely busy. Technical and assessment skills were variable, as was record keeping. I would like to suggest that bringing staff to Kabul for training sessions/master class may be the best way forward to maintain high standards throughout the clinics.

Nich Woolf, Paramedic for Festival Medical Services

Report on Resuscitation Training, Mazar and Kabul April 2013

The first visit to Mazar-i-Sharif in 2011 delivered 150 Kgs of equipment and supplies and provided resuscitation training to medical staff in the public hospital. The objective was to improve the safety of surgery in response to a report by Dr Ray Allen pointing out the risks faced by visiting consultants from SGAA.

Click here to view the full report

Fundraising Dinner with Sandy & General Sir David Richards

SGAA held a fundraising dinner at Cliveden House on Monday 1st October 2012. Read more

Supporting the Afghans step by step

Charles Moore travelled to Afghanistan with Sandy Gall to see the charity in action.You can read The Telegraph article Charles wrote about his visit here.

Afghanistan 10 years on

John Fixsen FRCS has written an article which appears in the Winter edition of the British Orthopaedic News (BON).

News from Afghanistan – August 2012

The next two years are going to bring great changes to Afghanistan.

The United States and NATO plan to withdraw their troops and hand over responsibility for security to Afghan forces by the end of 2014. The Taliban insurgency remains a serious threat to the government in much of the country and many Afghans are nervous that the departure of foreign troops will create greater instability.

The departure of nearly 100,000 foreign troops and the end of their reconstruction programmes is expected to cause an economic recession in Afghanistan and the end of the heavy military presence in Afghanistan is already changing the political dynamics in the country. President Hamid Karzai is drawing to the end of his second term as leader of the country and elections for a new president are due by May 2014.

In preparation for the withdrawal the United States signed a strategic partnership agreement with Afghanistan in 2012 assuring the Kabul government of longterm strategic assistance for Afghanistan. The US administration has said it will retain an element of US troops after 2014 to train and mentor Afghan security forces, and provide a counter-terrorism element in the country. Western donors also pledged $16 billion of assistance over four years for Afghanistan at a conference in Tokyo in July, provided the Afghan government does more to combat corruption in its ministries.

Nevertheless the challenges are great and Afghanistan has already shown a new volatility as it enters the transition period.

The Taliban has been pushed back in southern Afghanistan by the surge forces sent in by President Obama in 2009 and 2010, yet it remains a security threat throughout the Pashtun southern and eastern belt of the country, and in pockets in the north. As Taliban forces lost territory, they turned to assassinations and bombings in the cities and have targeted senior leaders, and strong opponents of the Taliban, including close allies of President Karzai.

Groups of insurgents have also staged complex attacks on targets in Kabul, attacking with suicide bombings and then following with assaults by gunmen on foot. Militants besieged the American embassy for hours in September 2011 and attacked an Afghan lakeside hotel in June 2012, killing 20 people. A number of other attempts have been made, indicating that the militants consider the attacks an effective tactic.

The Afghan government has continued to offer peace talks to the Taliban, despite the killing in a suicide attack of the head of the Afghan peace commission, Professor Burhanuddin Rabbani in September 2011. US government officials have also met with Taliban officials in exploratory contacts to work out a plan for the Taliban to open a representative office in Doha, Qatar. Talks appeared to stall for some months, but a Taliban official attended the Tokyo conference, indicating the process is continuing.

Bright spots for Afghanistan are that health and economic indicators continue to improve and an ever larger pool of students are filling schools and colleges. Afghanistan has joined in Olympics fever, sending a team to London which includes a female athlete and Afghanistan’s first ever Olympic champion, Rohullah Nikpai, bronze medal winner in Beijing in Taekwondo, who is carrying hopes for another medal in London.