Tagada, small incisions and new friends
Surgical training in the Mengo Clinic, Kampala/Uganda
The Mengo Hospital in the capital city of Kampala has a history of 120 years and is not only the oldest clinic in Uganda, but in all East Africa.
The clinic has been founded in 1897 by Sir Dr. Albert Ruskin Cook, a British physician and missionary. After a trip to Uganda he was fascinated by the country and its people and decided to dedicate his whole life to their medical education.
Together with his wife Katherine he also founded the first midwife training center in Uganda and in 1907 his nephew Ernest brought the first x-ray machine in East Africa to the Mengo Clinic – sensational in those days.
The tradition to aim for the most advanced medical equipment in Uganda, a country with a population of almost 40 million, is still alive today. The ophthalmic division has several specialized outpatient departments and orthoptist’s practice.
In addition, they have four experienced surgeons for cataract, eyelid and glaucoma surgery. Another surgeon was trained in retinal and vitreous body surgery by an international fellowship. The equipment available for retinal surgery includes only the most necessary items, but they have a good microscope and surgical instruments.
Surgical Training for Retinal problems
In recent years, instruments and operation techniques have been further developed, particularly in the field of retinal surgery. In October 2016 I had the opportunity to introduce these new technologies and my experience to the Mengo Hospital for a week on a voluntary basis.
One of my major concerns was to introduce Dr. Ljubo, the local specialist, to macular surgery and to support her in treating several particularly difficult retinal cases. I also succeeded to bring six “small incision packages” and several Instruments at no cost.
The preparations for my stay in Kampala were rather stressful. Particularly the obligatory vaccinations and the gathering of necessary documents and recommendation letters for obtaining the license to work as a surgeon in Uganda required a lot of time and patience. I believe the requirement of such a license is very reasonable – despite all the hassles involved – because it ensures proper treatment and care on a high level and prevents surgical tourism by unexperienced surgeons.
The journey went as planned and also the suitcase containing the surgical equipment passed customs without too much delay, thanks to the confirmation letter from the Mengo Clinic.
What I learned right upon arrival:
Sometimes you have to make a detour to arrive faster at your destination.
Traffic in Kampala is much worse than at home. Especially in the morning and afternoon traffic jams regularly cripple entire roads in this city of 1.3 million inhabitants. The roads are filled with mainly Japanese made cars and many motorbikes with two or even three persons riding on them, mostly without helmets.
The drive to the hotel was a rather bumpy one because the driver chose less busy side streets to avoid the traffic and we got a good shake. After the drive I felt as if I had done a few tagada rides in an amusement park.
Monday morning I was picked up by an employee of the clinic. My first day in Mango Clinic started with a tour of the ophthalmic department and the introduction of employees and colleagues. I was welcomed most cordially and with great expectations as “the doctor we have been waiting for”. But before I could meet these expectations with my expertise, my blond hair was the attraction of the day.
Dr. Ljubo, the retinal colleague with whom I performed examinations and eye surgery over the following days, is a cheerful and young-at-heart 50-year-old lady who supports her whole family. While she is working very hard, her family takes care of the household, so she can concentrate on her work.
Soon after the introduction Dr. Ljubo and I started examining patients with macular and retinal diseases and decided on necessary operations.
After that I visited the operating room and inspected the equipment. The microscope and surgical device were very familiar and met our standards. The patient table, however, resembled more a metal plank bed.
All procedures were performed under local anaesthesia, but the patients were extremely cooperative despite the less than comfortable bedding.
My operation chair was some kind of office chair with limited adjustability for height, but after a while I got used to it. I was very pleased that the hygienic procedures were on a high level. This is reflected by the low infection rate in that department. All members of the surgical staff were well trained.
I noticed the engagement and enthusiasm of the surgical nurses who welcomed the “small incision” instruments and other new items.
Over the following three days I performed a total of six retinal operations and vitrectomies (as in phakic or pseudo phakic patients with retinal detachment, vitreous hemorrhage or macular diseases). Dr. Ljubo assisted me with all patients. Furthermore, I assisted her with two patients with macular holes. For two patients, I performed a combined cataract and retinal operation. We worked with endolaser and silicone oil tamponade, did membrane peelings and performed mainly 23-gauge but also 20-gauge vitrectomies.
Two of our patients were so-called “one eyed patients” with severe retinal detachments in their good eye. They were urgently included to preserve their eyesight. These patients were already nearly blind and had to be escorted to the clinic. One patient came in a few days later for a follow-up examination and gratefully reported that he had come alone to the clinic without any help of an escort. These wonderful moments lend meaning to what I am doing and I am very grateful that I am allowed to help people to preserve their precious eyesight.
We managed to perform two to three retinal operations per day, encountering more or less severe difficulties, like old and frail equipment, missing of usually available items and other minor obstacles. The packages I had brought along functioned perfectly and we could work successfully with the seamless small incision systems (23-gauge instruments).
For lunch they always cooked, and we ate our meals sitting on the floor of a room next to the operating room. In the evening we were deservedly tired because the eye operations were strenuous and we did not take many breaks. On the third day, while sterilizing the instruments between two operations, we noticed a soft sound of snoring. A surgical assistant had dozed off in a corner of the room and was awakened only by our laughter.
I am optimistic that Dr. Ljubo will treat patients with macular diseases by herself. She is a very skilled surgeon which I realized during procedures in the anterior segment of the eye.
The post operative control examinations I did went as I had wished for. The patients had no discomfort, looked fine and were extremely grateful. I could also advise the patients on proper behavior and further therapies.
Communication was mostly unproblematic, because almost everyone speaks English, the second official language of Uganda besides Swahili.
I really enjoyed the very pleasant atmosphere in the ophthalmic department and felt cordially welcome from the first moment on and during my entire stay.
Friday afternoon, I finally said goodbye to the whole team and promised to come back with more equipment, if everything went according to plan.
While spending time and operating, I got several helpful ideas for improvements, which will benefit the ophthalmic department and its patients.
In summary, the week in Kampala was very strenuous and challenging, but it brought also many gratifying moments I would not want to miss. This stay has enriched me not only professionally but also personally. And it has brought new friends into my life.
