Uganda

A surgeon's struggle to serve patients at Uganda's Mulago Hospital - By Dr. William Manyilirah, Consultant Cardiothoracic Surgeon Uganda Heart Institute

A surgeons struggle to serve patients at Ugandas Mulago Hospital - By Dr. William Manyilirah,  Consultant Cardiothoracic Surgeon  Uganda Heart Institute

Dear colleagues. 

 I don't normally write on this WhatsApp group, but I've been forced to do so. This morning, 26th October, my team and I went to the Main Operating Theatre (OT) of Mulago Hospital Complex to operate on two thoracic cases. The first patient was supposed to be for thoracic duct ligation + wash out via right thoracotomy and the second case for a chest wall tumour excision and major chest wall reconstruction. 

 On arrival at the OT at about 08h30, we were told that there was no oxygen in the OT. We then decided to borrow oxygen (in cylinder) from 3CTS, our thoracic ward. Then suddenly came another reason to cancel the operations - there was no anaesthetist! Three reasons for lack of anaesthetist(s) were advanced:

 1) the senior anaesthetist on duty was "indisposed", but he promised to send an SHO. 

2) a few minutes later we were told that the SHOs supposed to "cover" for the senior were busy attending some research conference and thus could not work with us.

3) and that there were no other anaesthetists to work with us, as there were busy in other OTs! 

 

 These are my concerns and sentiments: 

 1) 3CTS is only able to work on Fridays because that's when we're able to use the better operating table and light brought into the country by our colleague from South Korea. We can't comfortably operate thoracic cases on Mondays because that's when the Korean colleague uses his table and lights! 

 2) It takes a lot of resources, both human and time to prepare a patient for surgery. It's disheartening when we casually cancel the case at the last minute. The cancellation wastes not only the patient's but the hospital resources. 

 3) I personally go to operate in the Mulago OT for three main reasons:

  1. to share my thoracic skills and knowledge with the surgery SHOs and other surgeons 
  2. to help operate needy Ugandans with more complex thoracic disease who would otherwise not afford the cost of the same surgery in private hospitals
  3. to prevent attrition of my hard earned thoracic skills and knowledge

 Other than the above reasons I have no obligation to work on the Mulago thoracic ward! 

 

 4) please note that the setup of the Mulago Main OT calls for a high degree of sacrifice by a right-thinking surgeon (or other staff) to perform surgeries there! The arrangement in that OT goes against most standard operating protocols and good common sense. I'm afraid sometimes I think it takes some degree of insanity to accept to perform specialised surgeries in that OT. Forgive my strong language. 

 5) on some days, if it is not lack of essential supplies, a surgeon has got to literally beg and cajole the anaesthetist or theatre staff to have a case operated on in that Mulago OT. Sometimes it appears as though the surgeon owns or has a special interest in the patient! 

 6) I have, on several occasions, observed that the staff (especially nurses and doctors) of Mulago Hospital quite often turn a blind eye to problems in their units, reportedly because reporting them would lead to admonition from the hospital administration and perhaps cause loss of employment. This is very disturbing and is a source of despondency among the staff - a recipe for poor service delivery. 

 

  My wishes and suggestions: 

 1) the administration of Mulago Hospital interests itself in the reasons for case cancellations and together we find solutions, if it hasn't already done it.

 2) all the stakeholders MUST show some courtesy in informing each other in advance in the event that there's going to be a case cancellation for genuine reasons. The members must be informed at least 24hrs prior to cancellation, not on the morning of surgery. 

 3) it is only civil - and in fact an obligation - that each one of us makes optimal use of the "little time" we have at our work stations to perform our core activities to the best of our abilities. At the same, let's boldly voice out our concerns about the poor working environment and not to, directly or indirectly, perpetuate it.

 4) that the administration of Mulago Hospital finds a way of encouraging the staff to come forth and discuss sensitive issues openly without fear of being unfairly reprimanded. 

 

William Manyilirah 

Consultant Cardiothoracic Surgeon 

Uganda Heart Institute.

 

Level 1 (XP: 0)
4 years ago
Eeehh what a sad story,
Mulago has been abandoned for a long time now and the government doesn’t care anymore main reason i think is because the government officials and other rich people can afford to take their children and family members out of the country for medication so they don’t know what happens at Mulango they don’t know how frustrating it is to have a patient at Mulango.
Mulago has been left for those that can’t afford to fly out of Uganda for medical attention those that can’t even afford to go to private hospitals in Uganda since they cost an arm and a leg.
The government doesn’t see a need to improve Mulango since non of their family members goes their for such complicated cases that require immediate attention.
It’s time for the people to voice up and campaign for their hospital to be the Mulango it used to be.
May God help our country!

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