Wednesday, 27 February 2013

My first Excursion to Uganda, Sp. Mbale Hospital

My first thoughts!
I was fortunate enough to be picked up as one of the team member to visit Uganda representing Royal Surrey Hospital. It was indeed a moment of pride. A few meetings and emails and lot of jabs later we found ourselves in this lovely part of east Africa which is rather famous for its wild life safari. A very warm welcome awaited us on our arrival past midnight on Monday the 18th Feb. During the day, we paid our first visit to the Mulago teaching hospital in capital city of Kampala and met with the local ENT and anaesthetic teams and plans were made for rest of the week. There was also a scheduled visit to another remote hospital in Mbale about 250 kms away. The team was split and five of us were picked up for this challenge. 
Tuesday
Next day we found ourselves in the back of a private van and were blessed with a driver who was rather on the over cautious mode. Hence the journey took forever. Better late than never we told ourselves.
On arrival  we visited the hospital director, and were introduced to the ENT surgeon who helped us to find our hotel as well. Another warm welcome it felt like. We were made aware of the next 48 hrs of surgical activity planned. 
Wednesday 
Tympanoplasty under progress
Due to a very unfortunate domestic event, we couldn't meet the surgeon again for the next two days of our stay. Hence we visited the hospital on our own  Myself, Manohar (the ear surgeon), Carl  (sinus surgeon), Rupinder (scrub nurse) and Dagmar (audiologist) found our way to the ward and then operating rooms. We could identify two cases lined up for the day:
8 year old girl for drainage of Ethmoidal mucocele  and 65 year old woman for Tympanoplasty.
endoscopic procedure in paediatric patient
There was an anaesthetic officer present with whom I got myself oriented to the theatre and the anaesthetic equipment.  Once all the checks including availability of surgical instruments was carried out, we sent for the Tympanoplasty. The drugs available for me were Sodium Thiopentone for induction of anaesthesia, Suxamethonium for facilitating oro-tracheael intubation, Halothane for maintenance.  I went through with anaesthetist as to how to use Laryngeal mask and hypotensive anaesthesia for such cases. Then I lost him to emergency Caesarean section and hence had to do the endoscopic drainage of Ethmoidal cyst by myself. I was a bit nervous at the beginning having to use a very-very outdated anaesthetic machine and also using drugs which I had not touched for almost 15 years. It was fun. The day finished uneventfully and we retired to the hotel and treated ourselves to local food. 
EMO vaporiser being used for adminstering Ether for maintaining GA



Thursday
Arrived promptly to theatres after having identified the two patients planned for the day:
34 yrs old man for septoplasty who was also a member of staff and a 8 yr old boy for nasal endoscopy. Both were done avoiding endotracheal intubation. This was quite educational for the local anaesthetist. I also demonstrated the use of fibreoptic intubation kit which I had taken with me which I ultimately donated to the department. They seem to be much obliged with this gesture. This would hopefully help them in managing difficult airways in future. Then I had the opportunity to get involved with an emergency GA Caesarean section conducted by one of London deanery anaesthetic trainee called Jordie who is pursuing her out of programme experience in Uganda. This was quite an experience as I saw Ether being used via historic EMO vaporiser. Meeting her also enabled me to sort of pass the baton for continuing to reinforce the principles of induced hypotension and minimally invasive airway management with the anaesthetic staff.
All in all a very satisfying day at the office I'd say.
Then was the journey back to Kampala and this time we had exactly the other extreme kind of driver who was so good at ignoring the various potholes and speed breakers. Good workout for our backs but we reached our destination well within time. Phew! Reunited with the rest of the team.
I'd say it was rather short timeframe to make much sense of the place and make any robust plans to improve the services. 
But this changed my approach somewhat to how we complain about the lack of resources in NHS. You sometimes don't realise what you've been blessed with unless you see the other side of the globe. An eye opening experience for sure which has surely made me more content with what I have at the moment and also stimulated me enough to undertake such assignments in future and make a little difference in someone's life. A very small step taken.
Harsh Saxena

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