I arrived in Uganda at the end of November 2015 and spent my first two days in Kampala with Dr Kayube while my luggage caught up with me from Dubai. This was a great opportunity to find out more about the important work he does installing and maintaining the IT systems of an increasing number of hospitals throughout the country. By maintaining contemporary accounts, stock levels, and being able to audit fully, hospitals have been able to improve patient care, increase resources, and become increasingly self reliant. Sometimes having to make a 14 hour round trip just to help with a single PC and often taking dozens of calls throughout the day, Dr Kayube has an incredible commitment to this work, and yet still finds time to be a great host to visiting UK doctors without any luggage!
The term ‘General’ Surgeon is still used in the UK but the spectrum of work undertaken in this area is usually limited to bowel, liver, and stomach procedures in adults. Therefore despite having worked in the field of general surgery for a number of years in the UK the breadth of work undertaken by the doctors working in Kilembe Mines Hospital was greater than anything I’d seen before.
What would be the work of several specialist teams in areas of Obstetrics and Gynaecology, Urology, Endocrine, Hepato-Biliary, Maxillofacial, and Plastic Surgery in the UK was undertaken in a single day by the doctors working at Kilembe.
In any operating theatre I have worked in, the biggest factor affecting how well it functions is not the equipment or the number of surgeons but how well the whole team communicate and work together and the staff at Kilembe are a great example of this, eating and relaxing together without boundaries of severe formality between doctors and other staff.
When doing a Caesarean section and finding twins instead of a single child, the theatre staff stepped in to become extra midwives and when I was operating on a major facial injury in the middle of the night while an emergency obstetric case was ongoing in the room next door every member of the team seemed to be in two places at once, such as holding a torch over my shoulder for lighting while at the same time helping with the anaesthetic.
Nearly 3500 people die every day as a direct result of traffic accidents with injuries accounting for 9% of all deaths every year worldwide. Major trauma certainly makes a considerable contribution to the workload at Kilembe both from the roads and the mineral mines which employ a large number of the local population and I was able to share some of the training I’d had here in the UK with the team in Kilembe. An example of this was when a patient needed an emergency operation for compartment syndrome. This is the swelling of the muscles in an arm or leg usually because of a broken bone that is severe enough to squash the blood and nerve supply to the limb and can require an amputation or even be fatal if left untreated. The patient we saw on the ward clearly needed her leg operating on to release the pressure (a fasciotomy) and the doctor doing the ward round with me hadn’t done one before so we took the patient to theatre and I operated from one side and explained the process before he did the other and learnt how to do this important procedure.
One of the areas of my work I’ve always enjoyed is the practical problem solving required in emergency surgery and creative thinking on my feet was certainly something I was required to do in Kilembe from time to time. One memorable example being when a patient who had fallen off a Bodaboda (taxi motorbike) came in with trouble breathing I was about to show the doctor on call that night how to put a drain into the patients chest to get rid of the air and blood that had built up only to discover there wasn’t the equipment needed to do this in the hospital. Yet being used to such scenarios the team in Kilembe all came up with ideas and foraged for spare equipment until we had made a drain system from sterile water bottles, catheter bag tubing, and lots of sticky tape! The patient went home three days later without any problems.
I was fortunate enough to be in Kilembe when they had their annual Christmas party which gave me a great opportunity to socialise and celebrate with the whole hospital invited, from the medical superintendent to the porters and cleaners. After a doctors versus nurses football match (4-1 to the doctors) there were a series of speeches made by local politicians, business representatives, and the Bishop of Kasese. All gave thanks to the staff for their work over the year and it was clear the importance of Kilembe Mines Hospital for the local population. The most succinct summary of the impact of the work done there came from the local pastor who explained that during the weeks the work of the hospital had been limited, during previous years of flooding, he had performed many more funeral services than normal. Like all good Christmas parties the celebrations ended with lots of fantastic food and dancing well into the night.
Back in the UK I have kept in contact with the staff in Kilembe and we are working towards improving outcomes from major bleeding, which continues to cause potentially preventable deaths worldwide by combining the recent advances in this area with the resources available there to produce sustainable practices that save lives. I hope to return to Uganda regularly in the many years ahead to continue to share experience and knowledge with the staff there that will be sustainable in improving the care for patients.