Report on Royal Berkshire Hospital Surgical Team’s camp in Naggalama, Uganda, October 2015.
The RBH Surgical Team undertook a 7-day surgical camp in St Francis Hospital, Naggalama. The team comprised Mr. Tom Dehn (retired consultant surgeon), Dr Maurus Rimmer (semi-retired consultant anaesthetist), Dr Angela Nicklin (anaesthetic trainee), Dr Jenny Isherwood (surgical trainee) and Mrs. Sarah Wilson (theatre sister from Wycombe General Hospital).
We flew to Kampala via Qatar where we stayed overnight and took the opportunity of purchasing some locally sourced medical supplies (drugs and surgical instruments). The drugs and instruments were manufactured in India and were considerably cheaper than similar products purchased in the UK. The drugs appeared to be of good quality; the instruments were not as good as EU-manufactured ones but were quite adequate for the purpose.
On day 1 we settled into the hospital accommodation (two bedrooms with beds that would not be sold by John Lewis!) and arranged the surgical and anaesthetic supplies we had brought from the UK.
The washing facilities in the accommodation were adequate although hot water was infrequent and cold water somewhat less so. We shared the accommodation with two Germans; these ladies did not undertake any nursing duties since they were distributing hospital equipment collected by a German charity. Additionally, two Danish medical students ate with us.
The purpose of the camp was to undertake approximately 60 hernia operations over 5 days. The African black male is particularly predisposed to developing hernias, especially groin hernias. Since there is little provision in Uganda for elective (planned) surgery, patients just learn to live with their hernias. These can be extremely uncomfortable, especially since many of the patients are subsistence manual farmers and there being little mechanised farming in the country.
Over the 5 days we performed 43 hernia surgeries, 25% of which were on children between 3 months and 7 years of age. The adult hernias were operated under spinal anaesthetic and the children under intravenous anaesthetic since there was no availability of anaesthetic gases.
Of the 43 hernia operations, 3 minor complications occurred – all wound haematomas (bleeding) none of which required interventional treatment. From subsequent contact with Sr Grace, the local and highly efficient theatre sister, none of the patients has returned with any postoperative problem.
We were very gratified with our results since we worked in an environment far from the facilities of the NHS: for example, there is no oxygen available, no blood or blood products, no reliable radiology, the local surgical instruments are diabolical (TD was handed a pair of scissors of which 80% of the length of one blade was broken off!).
The quality of the ward nursing was a far cry from the NHS.
We were, however, disappointed that the caseload was not what we had been told to expect.
Prior to the camp we informed the hospital administration that we were bringing the majority of our own surgical and anaesthetic supplies so that our camp would not denude their own scant resources. These supplies included operating gloves for all the theatre team, all surgical swabs, sutures, hernia meshes and dressings as well as anaesthetic drugs and needles necessary for 70 cases.
We had hoped that the hospital management would have reduced the cost to the patient from the 70,000 Ug shillings (£12.00) that was being charged to take into account the minimal cost incurred by the hospital for theatre consumables.
Regrettably this was not done and by day 2, it was apparent that our workload was below that which we had requested. Accordingly, TD and MR personally funded the hospital 250 US $. This enabled the hospital to halve the cost to the patient and, unsurprisingly, within hours a decent workload arrived at the doors of the hospital.
Our work was appreciated very much by the theatre staff and the Nun administrators. Our team taught theatre technique and procedures to the local nurses and the technique of mesh hernia repair to the local junior surgeons (there were no resident qualified surgeons present).
Our UK trainees had a very productive time performing surgery and anaesthesia at a much greater frequency than they would at home; they were given increased responsibility and had one to one teaching from consultants.
The team is most grateful to the Rotary Clubs in the Reading area for providing funding of the camp. Apart from the cost of surgical and anaesthetic supplies the cost to each team member is approximately £1,000. This sum comprises the airfare (£600), entry visa to Uganda (100 US $), medical indemnity from UK (£50), medical registration in Uganda (400 US $), cost of antimalarials (£60), accommodation and food at the hospital (70 €) and accommodation/food in Kampala on arrival and departure (250 US $) and travel in the UK.
The morale of the team remained high and the fact that we have now made 5 trips to Uganda and 4 to India speaks for itself.
In January 2016 we are undertaking a camp in NE India and plan a further camp in the autumn of 2016.
No operating lights! See the use of lights from mobile phones!
No scalpel handle!
The Dining Area
Surgery and more surgery
Children with umbilical hernias