Updated by Faith Barbara Namagembe at 1208 EAT on Saturday 25th February 2023.
Mulago National Referral Hospital, Uganda’s largest hospital and home to Makerere University college of health sciences held a paediatric surgical camp recently in which 48 children with various conditions were operated on.
The hospital, from time to time, organises such camps to help clear a backlog of cases they have in their system. Robert Ssengooba caught up with Dr Phyllis Kisa, a paediatric surgeon and urologist at Mulago hospital who discussed the significance of holding such camps and the impact of operating room paediatric theatres since their installation in 2019.
Why is a surgical camp dedicated to hernias and stoma reversals?
We are always swamped with children born with life-threatening conditions; these will always take priority. After this cluster, there are those with cancer and they are considered next in urgency. Then when you come to the hernias or the so-called smaller things, they are not small in the grand scheme of things but in terms of all other cases, they rank lowest, they wait the longest.
The other thing is that children who go to school are among those who wait longer for surgeries. This is because many times when we call them for their appointments, often, they are at school and the parents don’t want to take them out hence they keep missing the opportunities. But we have these on-and-off types of surgical camps that target school-going children.
It is not always easy to organise these camps. It requires a lot of manpower and resources; bring more teams to help with the rigorous activities and because we are running longer hours, we provide transport allowance for some of our staff and lunch as well. We always target to do 15 to 20 cases a day.
What difference have the dedicated paediatric operating rooms made in terms of complex surgeries?
If I could give the example of conjoined twins, before the dedicated paediatric theatres, most of the time they were futile operations (where both children died). There was a case where my boss had to travel with a set of twins to Egypt for their separation.
We received another set of twins around 2013/14 that were joined in the back by the spinal cord, the distal part of their alimentary canal and the urinary system. The most we could do for them here with the resources and equipment we had is put for them stomas (where poop is diverted to come out through the belly wall). The children were later taken to John Hopkins for surgery.
Fast-forward to 2020, we get a new set of conjoined twins. KidsOR by then had installed the three paediatric rooms at Mulago hospital. We had machines that we could ventilate up to the littlest child – we could have a baby weigh half a kilogram and our equipment could put babies to sleep and wake up safely (administer anaesthesia safely): further, we were able to support the children’ breathing after surgery. These are some important logistics that go in when handling complex cases.
With the theatres, we were able to keep the babies in the ORs – we had the machines and skills to look after the babies. The operation went on for almost 24 hours. When you put a baby to sleep, and we do an operation that could go up to 24 hours it’s important not to try and wake the baby immediately because their body will not be able to handle it. We did not have the equipment to support this prior to the KidsOR theatre.
Without these theatres, I doubt we would have had a smooth and successful process. Before the ORs, we had to make hard decisions to carry out complex surgeries; it was always a case of – should we, should we not? Now we have the equipment, and expertise needed. What then would be our excuses for not handling complex cases. So, we get down and do the work.
There are a few things: one is that it keeps us on our toes because you need to be a step ahead of your students so that there is always something to teach them. The other fact is that once I transfer some operations to the trainee, then I must do the harder ones, this makes one aspire to be better and do more complex cases.
Additionally, having trainees means more workforce. When we operate, it’s a lot of teamwork, not just the surgeons. There are anaesthetists, nurses, and scrubbers among others. Trainees serve the purpose of a helper, even as you are teaching them, they help operations go smoothly because they assist during the procedure. Lastly and more importantly is that when they eventually graduate, they add to the workforce who are much needed and we will reach more children.
Anaesthesia providers are still a challenge but with the training efforts going on (at universities and practically in theatres), we are optimistic this will change.
We also have cultural practices and opinions which are hard to fight hence a big factor contributing to children’s being brought to hospital later than sooner. It’s really challenging to try fight the cultural mindset and their health-seeking behaviours (for this we need to get out of the hospital and do more advocacy).
Others are country-specific: We have shortages of provisions from time to time but at times we are lucky thorough our friends abroad or partnerships, we receive consumables (Facial protection, body wear, disinfection products-gloves, bandages among others) and we can do cases which are more complex than we expect to do. These are the collaborations we don’t close doors because they help us greatly in our work.