SINCERE, compassionate, self-effacing, and with a quirky sense of humour, Tracey Gibbs is the kind of woman who will fly off in her gardening gear on a Saturday morning rescue mission at a moment’s notice.
It was entirely in keeping with my impression of her to hear that she had recently tracked down a half-starved pup that was being mistreated by urchins in a dodgy area, extricated it from their clutches after heated negotiations, and then had the pavement special checked out by the vet before providing it with a loving home full of spoils.
She may be small in stature, but what Tracey lacks in size, she makes up for in terms of the size of her heart, tenacity and resourcefulness. These qualities are probably what suit her to the taxing role she acquired in 2018 as top dog of the femoral head programme in KwaZulu-Natal.
“This is the feel-good part of transplant and donation,” transplant co-ordinator, Tracey grins good-naturedly. “Nobody has to die to donate their femoral heads when they have hip replacement surgery, and most people don’t realise that the bone which is removed is just thrown away.”
Initially, the programme was run under the auspices of the Centre for Tissue Engineering and there were four hospitals under Tracey’s care. She was running the programme in Busamed Gateway Private Hospital, Busamed Hillcrest Hospital, Life Entabeni Hospital and Life Westville Hospital
Back then, they were being sent off to the Centre for Tissue Engineering. Vitanova-Bone SA later approached the KZN Cornea and Eye Association to assist with the programme in KwaZulu-Natal. A decision was duely made to split the country into coastal and inland areas.
She may be easy-going, but Tracey is clearly no slouch, “I continually have to do training for Vitanova-Bone SA, I supply the documents to the hospitals which they need, their books, their registers and their blood tubes.”
“Having started with only four hospitals, we’ve added Hilton, Umhlanga, Alberlito and Shelley Beach. Presentations have been done at St Anne’s and Kingsway hospitals, training is scheduled for this month – July. Once we’ve got all that up and running nicely, I’m going to move on to the outer regions, Richard’s Bay area and Empangeni, and then Northern areas, such as Ladysmith, Newcastle and get those hospitals on board too.
“I’m also working to get Howick involved. The doctors that are working at Life Hilton hospital, also do surgeries at Howick, so I’m going to get them to give me a hand in getting the programme running in Howick as well,” she elaborates.
Tracey’s aim is to enlist as many hospitals as possible, because there’s such an immense need for femoral heads. This is illustrated by the fact that as recently as 2018/2019, we were forced to import bone from overseas as South Africa did not have enough to produce the bone products needed for surgeries.
“You ask the patient the question, ‘Instead of throwing it away, would you like to donate it?’ Generally the response is that of course, they would like to do what they can to help,” says Tracey.
“In their own hip replacement surgeries, bone cement is used to set the prosthesis in place, so it’s basically paying it forward. You’re going to get some bone cement from someone who has donated their femoral head before, and you are then returning the favour by donating your femoral head.”
She relates the story of a recent donor who was so overcome by the idea of her bone helping others that she burst into tears, never before having realised this modern miracle of medical science was even possible.
“Currently, Vitanova-Bone SA requires at least 40 femoral heads a month from us in KZN and the areas down the coast towards Cape Town, so I was very happy that in June, I was able to send off 41 femoral heads. Our numbers are increasing,” she says animatedly.
But it seems that the Covid-19 pandemic has, once again, thrown a spanner in the works. “My heart just sank when I heard we were going back to Level Four.”
It must be gut-wrenching for co-ordinators like Tracey to see all their hard work thwarted by the virus as elective surgeries like hip replacements are again put on hold.
“The programme is a continuous effort, working every day at hospitals, checking what’s happening in theatres, finding out if the staff have asked the question – have they given the patient the opportunity to donate?
We also have to ensure the documents are filled in properly and that the bloods are done. Lancet has been very good, as they collect and spin the bloods for us at all the hospitals where the femoral head project is been done at no charge to Vitanova-Bone SA and obviously, no charge to the patient.
Blood samples are taken to be tested at Vitanova-Bone SA for a variety of infectious diseases, such as hepatitis B, hepatitis C, syphilis and HIV/Aids which might be transmitted to the recipient of the hip bone.
If the all-clear is given, the bone can be processed into paste, cut into wedges or matchsticks to be used as a sort of “scaffolding” in a bone graft for a patient in need. The recipient’s cells will, over time, colonise the support structure, remodelling and replaced it with host bone.
All the femoral heads collected in KwaZulu-Natal go to the main branch of Lancet Laboratories in Durban. “We have our own freezer there, so they collect the bone with the bloods from the hospital and send it to their lab and store it until I’m ready to go and pack it to send to Vitanova-Bone SA in Cape Town which I do once a month,” says Tracey.
If she has any queries, she says, Lancet are quick to help with anything she needs. “That’s one of the relationships you build along the way. I also provide Lancet with the cooler boxes and ice packs when they go into theatres to uplift the femoral heads and the bloods.
Tracey is justifiably proud of the fact that the region has managed to provide the outstanding figure of 41 femoral heads, but it falls to others to tease the information out of her, and ever-modest, she points out that a few of the femoral heads may be discarded because 80 years is the cut-off point for this type of donation.
“Still,” she shrugs, “the fact that our little hospitals in Durban have managed to get that quantity is a great achievement.
The two biggest hospitals contributing in KZN at the moment are Busamed Gateway and Life Hilton. The other hospitals are catching up.
“With the new regulations, it may be a while before I can go into the hospitals that have been hit hardest by Covid to try and resurrect the programme, but for now, I’m very pleased with the progress that we are making with the hospitals we do have on board, and I’m hoping we will continue to source even more femoral heads to provide the necessary product.
“We did have to import not so long ago, because we were short of bone. We don’t have that luxury any more though, because there’s a worldwide shortage of bone due to Covid. Surgeries like hip replacements weren’t taking place, so if we don’t turn this around and get those femoral heads in, we’re going to run into problems.
“We’re not going to have any product for surgeries like spinal fusions, operations for children with long-term TB in the spine, patients with bone cancer, tooth implants at the dentist, people who have car accidents or some sort of cancer in the jaw, and need surgeries to reconstruct their faces, patients that have had long-term problems and keep going back for further surgeries.
“Those things will all come to a standstill if we don’t get the product that is required for them,” warns Tracey, “and so I’m working my behind off, to try and ensure we get as many hospitals on board as possible.”
Tracey says she is only too happy to do the legwork and nurture this programme because it is “near and dear to her heart”.
“Patients will never be able to get their surgery without the bone product. Both my sister and brother in-law have had some sort of spinal fusions done and they wouldn’t have been able to have that kind of surgery without the product being available to them.”
She is dead earnest when she says, ”I don’t want to be the cause of any patient not being able to have their surgery because we weren’t able to get the femoral head programme running.”
But the situation we currently find ourselves in the latest lockdown regulations are bound to make hospital access sticky. It will be difficult for Tracey to operate as she would under normal conditions; going to the wards to see if there are problems where she can assist, or following up on documentation which may have been mislaid.
“We are definitely going to see a drop in the number of femoral heads now, so that is a concern,” she admits, “but we will forge forward and continue doing what we’re doing to make sure people know about the programme.
“They’ll continually be reminded about it, so when things do turn around and surgeries start reopening, I don’t necessarily have to go back and retrain.”
But even if she does have to retrain staff, Tracey remains adamant that she will do whatever it takes to ensure the programme moves forward in leaps and bounds.