Advanced Trauma Course in Uganda, surgical outreach and new publications

Update from Doruk...

I spoke with Doruk yesterday about his recent activities at Mulago and in the district hospitals. He is in the midst of running an ATLS-like (Advanced Trauma Life Support) course for the residents and medical students. He organized the two-day course and recruited Makerere Faculty to teach. The first day went well and ran from 815 am (only 15 minutes behind schedule!) until 7pm. It was scheduled to end earlier but there were so many questions and so much enthusiasm from the residents and medical students, many stayed late to continue teaching. Pretty good indicator of the quality of the course, I'd say.

Earlier in the month, Doruk and 4th year resident Alex Ayzengartwent on an outreach trip to one of the district hospitals. More on that to come from both of them, but here's a brief note from Alex..

'things here are going well - we went on a surgical outreach trip to Kapchorwa (on the border of Kenya, way east) - and that was amazing! we did 25 cases or so in 2 days!! most of that time, there was no running water and we had to use sunlight as our only illuminating aid!'

Also of note, the February 23rd issue of The Lancet published a comment written by Makerere Faculty and UCSF faculty entitled 'Africa's neglected surgical workforce crisis' (see link: doi:10.1016/S0140-6736(08)60279-2 ) This was followed by the February 26th issue of World Journal of Surgery entitled 'The Neglect of the Global Surgical Workforce: Experience and Evidence from Uganda '
(see link: doi:10.1007/s00268-008-9473-4)

Kudos to all involved!!!!

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.