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Winning Women: Healing hands

Feb 18 2018 09:26
Sue Grant-Marshall

Technology such as computers, iPads and cellphones are increasing the workplace risk of repetitive strain injuries. These affect our fingers, hands, wrists – any part of our upper limbs.

Hand and upper extremity specialist therapist Nicola Fellowes did her fellowship at the Texas Medical Center in Houston, US. It is the world’s largest medical complex, employing 50 000 people and stretching over 5 square kilometres. While there, she managed to surprise even those in the land of the superlative.

For she was the first non-American fellow to train there in her specialty. None of her collegial students had seen gunshot wounds or produced the research sample she gathered while working at three Johannesburg academic hospitals.

When patients were sent to her rooms at the centre, they would catch a glimpse of her before turning around and exclaiming “where’s the African?” she says chuckling.

“Hands and upper limbs are the most biomechanically complex and functionally relied upon part of our bodies,” says Fellowes. Almost one third of all casualty patients throughout the world present with upper limb problems, due to either trauma or disease.

Furthermore, our brain uses more motor and sensory processing for hand function than for any other part of our bodies.

These factors made Fellowes decide to specialise in the hand and upper limb, while doing cadaver dissection during her degree in occupational therapy (OT) at Wits University.

“Their complexity fascinated me,” she says.

However, at the time, in the early 2000s, there was no option for her to pursue her interest at postgraduate level in this country.

So the determined young woman decided, upon completion of her four-year degree, to apply for a Rotary Foundation ambassadorial scholarship so she could specialise in Texas.

She had to write medical conversion exams to do her fellowship there. Once completed, she was registered with the American OT Association, and recognised by their health professions board.

At the end of her fellowship, she was offered jobs in the US but returned to South Africa. “It was always my intention to fulfil my vision through a practice I’d already established here.”

That vision was different from anything she had seen in the US, and certainly in South Africa.

She decided to focus on accurate and in-depth assessment and diagnosis of all the components of upper-limb trauma or disease.

“Without it, the intervention process can never be fully effective and measured.”

She’s done so well at this that a couple of years ago she was invited to lecture at London’s famous Guy’s and St Thomas’ hospitals as a specialist in clinical assessment.

She explains the process with the story of a cyclist who’d come off his bike, resulting in crippling hand pain. An orthopaedic surgeon X-rayed his hand, found nothing and sent him away.

Three months later, he was still unable to ride, play his musical instrument or work on a computer.

Word of mouth led him to Fellowes where, for the first time he got a thorough history-taking and clinical examination focused on the details of his injury.

She suspected a hook of hamate fracture and sent him to Dr Roger Nicholson, a specialist hand surgeon who works with Fellowes. X-rays confirmed the fracture and Nicholson operated on it.

Fellowes successfully completed the patient’s post-operative hand therapy. The man might have suffered for years without their treatment. Today, he leads a full and pain-free life.

Fellowes has reached the stage where surgeons and other medical professionals send patients to her for diagnosis and assessment before surgery or other interventions are considered.

She often diagnoses disorders and diseases when patients present with unexplained hand or wrist pain problems.

She works with children born with congenital anomalies caused during the development of the foetus. She treats babies sometimes only days or weeks old with splints and mobilisation in preparation for the corrective surgery, which ideally takes place at around 18 months.

The shortage of such specialists sees Fellowes working from 7am to 7pm. Such work pressure is stressful, so Fellowes relaxes by rising at 4am on four days of the week to do Switch, a combination of cardio, yoga, boxing and other vigorous activities.

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