The global shortage of healthcare workers is estimated to be at 4.2 million with approximately one million needed in Africa. Africa bears 25% of the global burdern of disease with only 2% of the world's workforce. For surgical disease the numbers are estimated to be similarly grim, but poorly understood due to a lack of research on the topic. The problem goes far beyond shortages of surgeons alone, and includes inadequate nursing and anesthetist staffing, as well as overall neglected health infrastructure.

Currently in Uganda there are approximately 75 Ugandan specialist surgeons and 10 physician anesthesiologists for a population of 30 million people. The training positions in the post-graduate programs are unfilled yearly due to difficulty recruiting and funding trainees. Given the immediate workforce shortage crisis, we hope to dramatically increase these numbers in Uganda by sponsoring Ugandan physicians wishing to pursue post-graduate studies in anesthesia and surgery. The annual cost of training for one surgeon or anesthesiologist is approximately $2,500 U.S.

In the short-run GPAS is addressing the workforce crisis by raising funds through grants and private donations for scholarships. Click here to read about the '2008-09 GPAS scholarship recipients. Simulataneously we will actively contribute to the training of these residents through consistent GPAS faculty presence at Mulago as well as through various GPAS training courses, such as the Advanced Trauma Care Course discussed below.

The long-run sustainability of this workforce expansion effort is dependent on multiple factors including philanthropic contributions, increased awareness of the workforce crises at-hand, and the recruitment of collaborators in nations of all income levels. GPAS also intends to promote sustainability of this project by sponsoring carefully selected trainees with a commitment to practicing and teaching in low-income settings. By offering these trainees opportunities to participate in and conduct independent research projects, we hope to provide a way in which they can obtain there own funding to contribute long-term viability.

Like many other developing countries, Uganda suffers from a severe trauma epidemic. The 1995 national burden of disease study showed that injury was among the top six causes of death in over half of the districts studied. (4) According to the WHO Global Burden of Disease Estimates in 2004, road traffic accidents are expected to increase from 9th to 3rd leading cause of disease burden worldwide, ahead of all infectious diseases.

Mulago Hospital, Uganda's national referral hospital, is located in the capital city of Kampala, which has an estimated population of 1.2 million people. The hospital handles many more injured patients than any other health facility in the country. In Uganda today, there is no organized trauma system, and specifically, there is no pre-hospital emergency system. Injured patients arrive at the hospital by any available transportation: car, bicycle, mini van, or police vehicle. Trauma systems in high-income countries have been shown to reduce medically preventable deaths by 50%. (11)

In most cases injured patients do not receive any form of emergency medical care prior to hospital arrival. For the foreseeable future, the resources to develop an ambulance-based system that can retrieve injured patients as in high-income countries do not exist.

The WHO has developed guidelines for Essential Trauma Care and Prehospital Care for low-income countries. (13, 22) Evidence from other countries without a formal emergency medical system suggests that the training of lay first responders can have a significant impact on the outcomes of injured patients. This model has been emphasized as one that should be considered in other resource-constrained settings. (6)

Building on recommendations made by previous studies, GPAS has begun a prehospital initiative which utilizes the existing informal prehospital system of Kampala (taxi driver, police, and citizens) as a foundation.

• To create an open dialogue between the relevant government and civilian organizations critical for establishing an effective prehospital system
• To provide pilot, first-responder training courses, and distribute low-cost, practical first aid kits to participants
• To monitor outcomes through emergency admission logs, discharge records, and field surveys
• To tailor the training courses as needed for expansion
• To encourage allocation of resources by local government

In 2008, GPAS conducted lay first-responders training courses in conjunction with the Ugandan Taxi Operators and Drivers Association (UTODA), the Kampala Police Department, Kampala Local Council, and the Injury Control Center - Uganda.

The six pilot courses in May 2008 provided training to a total of 300 first-responders from the police department, UTODA, and local government officials. Our curriculum has been designed with the input of numerous consultants (both health care professionals and lay persons from a wide range of countries). We received a grant from the Hellman Family Foundation for the initial training courses and provide each certified first-responder with a first-aid kit assembled by GPAS from local materials.

Since completion of the training programs, data were collected from injured patients brought to health care facilities by GPAS trainees. Visit our publications page or the prehospital project page to read the most recently published papers and data.

Currently we are seeking funds to expand training to include all Kampala Police and to facilitate collaboration with other local groups interested in prehospital systems development.

Click here to download references

Aim: To improve mechanisms for the supply and maintenance of donated and purchased biomedical equipment in resource poor environments, especially that used in the perioperative environment.

Description: It is well documented than many donations made to developing countries are comprised of inappropriate technology or hard to maintain equipment. This project, aims to establish a mechanism of maintenance and needs assessment for biomedical equipment in Uganda as a stop-gap until formal biomedical engineer, technicians and technician assistant courses are stablished. Initially this project will center on Mulago University hospital in Kampala.

Results: We have completed the preliminary needs assessment at Mulago, and have compiled an inventory list of medical equipment that includes descriptions of missing parts. Two biomedical engineering technician (BMET) rooms were established in the main operating theatres at Mulago. On multiple trips these rooms have been used by visiting BMEs to teach BMETs at Mulago on how to repair and maintain broken equipment. GPAS is currently building collaborations with various other organizations as well as faculty at Makerere University to push forward establishment of a biomedical technical college with the ultimate goal of a biomedical engineering diploma program at Makerere. We are also working with various international and local groups to develop novel online SMS-supported forums to support BME, BMETs ,and BMETAs throghout the developing world.

Health ICT and mobile health (mHealth) platforms are recognized as greatly underutilized tools with the potential to improve healthcare in resource-poor settings.

GPAS along with several partners is exploring new potential roles for mobile phone technologies in relaying test results, follow-up reminders, and educational materials to patients via SMS. The project resultsSMS.org will be completed by the summer of 2010, with more information found at resultsSMS.org.

"Harmonization" is the degree to which public health research or clinical activities share information and coordinate with each other to avoid duplication of efforts and maximize efficacy. The Paris Declaration (PD) (2005) and Accra Agenda for Action (AAA) (2008) outlined the critical need for higher levels of collaboration, transparency and coordination between research efforts, both at a national and international level. Lack of harmonization among researchers and healthcare workers poses a significant obstacle to optimizing the utilization of limited resources available for improving public health in low-income countries. This problem exists not only in resource-poor settings, like the proposed project site Kampala, Uganda, but also is present in healthcare settings in the developing world. In the public health arenas of low-income countries, the problems are compounded by significantly less communication between groups, more competition for fewer resources, and a large number of overlapping interests and funding sources. Hundreds, if not thousands of universities, NGOs, and other groups conduct healthcare-related projects at Mulago Hospital and Makerere University in Kampala, Uganda. The lack of communication among these groups leads to duplication of efforts, diminished benefits from collaboration, unnecessary competition for funding and hindrance of progress.

PubHealth.org is a project aimed to create an online mechanism to facilitate harmonization among healthcare researchers and providers in Uganda and to connect them with the international academic community. The site will include an easily and publicly searchable database of current and completed projects, outcomes or publications, as well as profile information about the groups or individuals working in the area along with their collaborators. In addition to providing a wealth of other information the site will incorporate several features including the ability for individuals to publish theses, research posters, and presentations. This feature will provide a free and much needed mechanism for the dissemination of unpublished research material in developing academic settings (theses, posters and presentations which contain invaluable data that are often never fully utilized). For more information on this project please visit PubHealth.org.

Aim: To introduce the use of ultrasound to providers and trainees at Mulago Hospital and to assess the utility of this intervention for trauma patients

Description: Ultrasound, a routine technology in the developed world, is scarcely available in Uganda. This project involves the training of Ugandan house officers and faculty in the use of ultrasound with a machine donated to Mulago. We believe the use of ultrasound in the care of injured patients at Mulago Hospital will improve diagnostic ability and decrease time to treatment, thereby saving lives.

Results: The pilot one-week training course was led by GPAS faculty in November 2006. In November 2008 the GPAS team led by Dr. Rochelle Dicker conducted another training program, commensurate with the training program given to US Surgeons, focusing on FAST. We conducted numerous practice sessions and to ensure sustainability of the project two Ugandan Surgeons were certified as FAST instructors to teach future courses. Images obtained and analyzed are continuously being sent to radiologists and GPAS faculty in the US for review of accuracy in interpretation. One of the senior surgical house officers at Makerere will be writing his thesis on the accuracy and utility of FAST at Mulago.

Aim: To assess the skills needs of providers in the casualty ward, of students, and surgical trainees in Mulago Hospital and to design appropriate training courses modified from Basic Life Support, Advanced Cardiac Life Support, and Advanced Trauma Life Support. These courses must have their curricula modified to the resource-limited context and the varied disease epidemiology of Uganda. Surveys will be conducted before and after the courses to assess course efficacy and the transfer of skills in these areas. We believe that essential skills training will improve the outcome of patients and the morale of trainees and health providers who will receive ongoing training.

Results: In collaboration with GPAS, the departments of Surgery, Orthopedics, and Anesthesia here at Makerere University offered an "Advanced Trauma Care" course on February 28 and 29th, 2008. The topics and content were adapted from the similar ATLS course offered by the American College of Surgeons. The faculty here had not previously run a similar course themselves, and it was well received by the students, and residents in orthopedics, general surgery, and anesthesia. This pilot course was funded by GPAS and we are currently seeking additional funding sources (including partial contributions by local government) to expand this program. Visit the GPAS Blog to read more about our training courses and the progress of this project.

Aim: To establish the utility of regional anesthetic techniques in the management of patients who present with trauma and obstetrical emergencies.

Description: Training sessions in regional anesthetic techniques will be performed with all levels of providers (trainees, medical officers and staff members). Data will be collected pre and post intervention (i.e. training session) to measure the effectiveness of the intervention. This information will be used to evaluate objective changes in patient care over the time course of the study. We believe the introduction of simple but effective alternative anesthetic techniques to reduce the reliance on general anesthesia will improve patient outcomes and reduce morbidity and mortality.<

Results: We are currently accruing data.