Aim: To increase the number and skill of anesthesiologists and surgeons in Uganda

Description: 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.Currently in Uganda there are approximately 75 Ugandan specialist surgeons and 10 physician anesthesiologists for a population of 30 million people. Historically post-graduate training positions have gone unfilled yearly due to difficulty recruiting and funding trainees. 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 mentoring and encouraging prosepctive trainees with interest in surgery or anesthesia, and by providing tuition scholarships for select trainees who express committment to working in Uganda after training. Click here to read about the GPAS scholarship recipients. Simulataneously GPAS actively contributes 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.

Since initiation of this program enrollment in surgery and anesthesia training at Mulago has quadrupled.

In 2011 we began an additional component to this program by providing a Chief Scholar position to one graduate in surgery and anesthesia. This position provides funding and privledges for the Chief to contribute to teaching and mentorship of current trainees as well as provides time and support for research interests.

Next Steps: We are currently working closely with other Universities, private donors, and the Ministry of Health in Uganda to explore ways to ensure long-term support to increase the quantity and quality of training in this critically underserved area of public health.

Aim: To create and monitor the impact of a prehospital trauma system in Kampala, Uganda

Description: 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.

Results: 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 initial 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.

With a contribution from the Laura Case Trust and a partnership with Medical Teams International, in September 2010 we began training of trainers in the Kampala Police Force. In the wake of the tragic bombings in Kampala during the 2010 World Cup and in preparation for the 2011 presidential elections, the Kampala Police recruited 5500 new cadets with the goal of training them all in first aid by 2012.

Next Steps: Along with our partners (MTI, Kampala Police, and LCT) and the leadership of GPAS Chief Scholars Arthur Kwizera, Andrew Kintu and Alex Elobu, we continue to move forward with prehospital training and welcome collaboration on this project. We are specifically in need of hands on training skills materials as well as funding for training of trainers courses as well as follow-up.

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 has centered on Mulago 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 has supported establishment of a BMET training program at Kyambogo University, the first of its kind in Uganda. At present we are working to help recruit visiting BME/BMET trainers for the university and for the technical training site - Mulago Hospital.

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 in 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 with subsequent courses funded through private grants.

Next Steps: We currently have plans to refine the course based on feedback from prior trainees. GPAS Chief Scholars will oversee teaching of the course annually and are working to package teaching materials into a module for use in similar settings elsewhere.

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.

Next Steps: We are currently accruing data and looking for volunteers interested in retrospective analysis of cases at Mulago.

Aim:To determine the frequency and cause of difficult airway scenarios at Mulago Hospital

Description: Difficult and emergent airways are anectodatlly more frequent at Mulago than other similar hospital settings. We hope to determine why this may be the case in an effor to identify appropriate and feasible measures to lessen this life-threatening problem.

Next Steps: Currently we are open to researchers interested in working with our researchers in Kampala to help answer these questions.

Aim: To gather and anlyze data on surgical disease burden in Uganda (specifically drowning, motorcycle injuries, pediatric surgical disease, referral cases from upcountry sites) and use the analyses to identify potential interventions

Description: As discussed above,injuries represent a signficant proportion of the surgical disease burden worldwide though data directing intreventions is lacking. We are working to establish databases and retrospectively review exisitng data to help identify potential interventions for these problems.

Next Steps: Currently we are open to researchers interested in working with our researchers in Kampala to help answer these questions.

Aim: To improve access to adequate and current educational materials for trainees in surgery and anesthesia in Uganda

Description: We are currently trying to develop and test several teaching tools for use at Mulago. These include an online curriculum for surgery and anesthesia, using Makerere's existing Moodle eLearning platform. We are also working to create a module for our ATLS-like course already taught at Mulago, for use at other sites. Another project underway is the creation of taching videos for surgical and aneshtesia skills (airway workshop, machine checks, ATLS-like skills, and more).

Next Steps: Currently we are looking for individuals with interest in medical education and preferably who have experience and skills with basic computer programming (though not required). These individuals would work closely with GPAS Chief Scholars in Kampala and other GPAS faculty to help develop these tools.