Surgical Outreach to Kapchorwa, Uganda

On Feb 18th, 2008, a group of surgeons from UCSF, including Dr. Doruk Ozgediz (Asst. Adjunct Professor of Surgery), Dr. Alexander Ayzengart (PGY4 in General Surgery), and Paul Shen (MS IV), embarked on a surgical outreach visit organized by the African Medical and Research Foundation (AMREF). The initial invitation came courtesy of Dr. Jane Fualal, a consultant faculty general surgeon and endocrine surgery specialist at the Mulago Hospital in Kampala, Uganda. We were to accompany Dr. Fualal to the district hospital of Kapchorwa, located in a small village in the valley of Mt. Elgon on the eastern border of Uganda. Dr Fualal had made multiple prior visits to this remote hospital and had excellent working relationships with the hospital staff.

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At the time of this invitation, our group was actively involved in teaching, patient care, and collaborative research projects with the Department of Surgery at the Mulago Hospital. Due to the gradually strengthening bond between the faculty and residents from our two departments, the degree of our involvement went far beyond mere short medical volunteerism and, over time, has developed into a long-term collaboration. Needless to say, we were happy to contribute to this growing relationship in yet another way.

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On the day of our departure to Kapchorwa, and not knowing what to expect on site, we collected a few boxes of medical and surgical supplies, piled everything into a large mini-van, and headed out to meet Dr. Fualal at the district hospital. After 6 hours of bouncing around on the rural roads of Uganda (imagine potholes sprouting bigger potholes!), we were being greeted by dozens of patients, curious on-lookers, and members of the operating theater staff. However, our meet and greet was short lived, as we were scrubbing on our first case within an hour of arrival. Dr. Fualal, who arrived in Kapchorwa by plane a few hours ahead of us, has been busy evaluating and triaging many patients lining the halls of the hospital, in order to create a manageable operating plan.

Within the span of 2.5 days, we performed close to 25 operations - all under the conditions rivaling the most hardened of any surgical field hospital, where the lack of running water, working surgical lights, and functioning instruments created an additional element of difficulty. Most of the procedures consisted of subtotal and partial thyroidectomies, aimed at providing relief to the patients with gigantic goiters that developed due to widespread iodine deficiency. However, since surgical care has always been hard to come by in many district hospitals of Uganda, and Kapchorwa was no exception to this rule, our operative log covered a multitude of problems that required surgical intervention (anything from large salivary gland tumors to chronic appendicitis).

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True to the surgical etiquette practiced worldwide, we made it a point to see all of our patients after each operative day. Despite all of the challenges mentioned above, most operations went as smoothly as expected, with all patients doing well on their 1st postoperative day. Just imagine stepping into a large room full of people that are gingerly nursing their neck dressings and actively sharing their experiences and worries with any neighbor willing to listen! This was one of the many cultural differences that stirred and shocked our senses on the daily basis while in Uganda.

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So, was it all work and no fun, all the time? Of course not! At the end of our stay in Kapchorwa, we found a little free time to visit the valley of Mt. Elgon and to track on foot to the top of Sipi falls. It is difficult to do justice to the beauty of Uganda's countryside in mere words... let me direct you to our photo section, so you can judge for yourself!

Take care, Alex Ayzengart.