Photo Comment - Surgical Workforce

Surgery at a district hospital in the north of Uganda. Anesthesia is provided by anesthetic officer, the patient is hand-ventilated though the operation, the primary cardiac monitoring is by precordial stethoscope. Surgical personnel work with limited instruments, protective wear, and draping is limited compromising sterility.

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During a mini surgical camp at a district hospital, multiple patients must undergo surgery in one room to accommodate the need.

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The numbers of nurses and equipment is limited, meaning that for patients such as this one who just underwent a laparotomy for a liver laceration sustained during a road traffic crash, post-operative monitoring is very limited or absent.

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The limited surgical and anesthesia workforce is one of multiple reasons why patients access care with already very advanced disease that requires more complex surgery or would be potentially curable at an earlier stage of disease. These pictures depict a patient with a massive goiter (first pic) causing airway obstruction, an advanced tumor of the distal femur (second pic) that had already spread to metastatic sites.

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Many injured patients do not have expeditious care of fractures and emergency trauma care, leading to complications such as this non-union of a femur fracture (now undergoing correction) (first pic); and this gangrene of the forearm and hand (second pic) in a child who had a distal radius fracture after a fall; this family first went to a traditional bone-setter, a common practice.

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There is a limited supply of physicians in Uganda, and most do not choose a career in surgical and peri-operative disciplines, for a multitude of reasons. Dr. Jane Fualal (right), a senior faculty general and endocrine surgeon at Makerere University, teaches senior medical students in the outpatient surgical clinic. The two medical schools in Uganda produce a combined 140 medical students/year.

Photos by Dr. Cephas Mijumbi, and Dr. Doruk Ozgediz

Consent was obtained from patients prior to any photographs and none of the patients in the photos are identifiable.