SMOPP: Swiss Mongolian Pediatric Project

Coincidence was the godfather of this aid project. A holiday trip to Mongolia and the stories of Mongolians that hip problems are very common among children and adults led to the project idea.
 
Both founders, Thomas Baumann and Raoul Schmid, have been working for years as instructors and users of Prof. R. Graf's method for the early detection and treatment of this most common congenital disorder of the musculoskeletal system. Together with a group of motivated doctors in Mongolia, they systematically began training, knowledge transfer and equipment deliveries in 2009. The first task was to overcome considerable resistance in order to correct the outdated notions of the nature and treatment concept of DDH (developmental dysplasia of the hip). Since then, the project has been concerned with the training of local doctors and quality assurance in diagnostics, the supply of equipment for ultrasound examinations, means of treating suffering and surgical therapy for the rarest, most severe forms of hip dislocation.
 
In a large study involving more than 8000 newborns, a DDH frequency of 1.2% was determined and at the same time the effectiveness of the simple abduction treatment with a Tübinger splint that can be used several times was demonstrated. The treatment did not last more than 6 weeks on average! Thus, the conditions for an aid project are virtually optimal: a serious, obstructive health problem which can be cured with a simple and harmless method. In a country without a social provision system, this not only means a direct gain in quality of life for those affected, but also a professional and thus economic future for them.
 
In the meantime, the largest maternity clinics in the capital and the central hospitals in all provinces of the country have the personnel and technical capacity to examine all newborns there for DDH.
 
Despite its mineral resources, Mongolia is a poor country with very limited resources for health care. At present (2017) and as a result of the fall in commodity prices, the state is virtually bankrupt. Nevertheless, the Ministry of Health has decided to carry out a nationwide screening of all newborns as part of a preventive programme. The time frame until 2020 was defined as the target for implementation. However, state financial support is not planned or expected. In the foreseeable future, SMOPP will therefore continue to focus solely on the problem and finance itself through donations and sponsoring.
 
Diagnostics
 
The method of early detection of hip dysplasia with ultrasound was defined more than 30 years ago by Prof. R. Graf from Austria and has developed considerably in the meantime also thanks to technical progress. The knowledge gained within the framework of the project and documented in studies allows us to use a classification system optimised for the bNewborn Screenig (see News/Research/Hip ultrasound in Mongolia), which not only considerably simplifies the training of local female doctors, but also the therapy.
 
In contrast to X-ray examinations, ultrasound is not associated with radiation exposure and allows reliable assessment of the hip joints at an earlier point in time, from the first day of life.
 
The examination is standardized and takes only a few minutes. The baby is bedded on its side in a positioning shell and strictly examined laterally with the aid of a sound probe holder. The stage of maturity or severity of the dysplasia can be easily measured. This is particularly useful for monitoring the treatment.
 
Treatment
 
The therapy concept is surprisingly simple. The vulnerable weak point of our hip joints is the roof of the acetabulum on the pelvic bone. This matures and ossifies until the end of puberty, but especially in the first 3 months of life. Pressure on the pantiled roof may hinder or prevent this maturation process. The principle of the treatment is the relief by spreading. The baby is fixed in a squat position with bent and slightly spread legs 24 hours a day.
 
The parents are instructed in how to use the splint and then carry out the treatment themselves. Ultrasound checks take place every 4 weeks until the splint is fully mature. As could be shown in our study, this can be reliably achieved in practically all cases on average after 6 weeks of treatment! Therapeutic side effects are not observed, the treatment is absolutely safe. The latter could also be proven by a study.