Surgery and operating rooms- the journey continues

By Muniini K. Mulera

East Africa

June 22, 2016

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In the blog on Caesarean Section in Buganda in 1879, we reproduce the report of a surgical delivery of a baby that was witnessed by Robert William Felkin, a medical student who was serving as King Mutesa's personal physician. The advances in human surgery that have taken place over the intervening 130 years represent the proverbial giant step for mankind. Early and accurate diagnosis, infection prevention and treatment, and safe and adequate anaesthesia have had an enormous impact on healthy survival of the patients. Other advances that have positively changed the outcomes include evidence-based fluid management, blood product transfusion, parenteral nutrition, artificial respiration, effective resuscitation, improved surgical techniques, advanced imaging modalities (ultrasound, CT and MRI scans, nuclear scans, PET scans and many offshoots of these), laboratory tests and so on. Dr. Felkin, who died in 1926, would be speechless to witness today's robots performing surgery. While he would marvel at the real time images of internal organs that surgical teams watch on screens as they direct tiny knives inserted through tubes (scopes), his hosts in the operating rooms would refer to that technology as an old story. Imagine his reaction to the sight of surgeons performing microsurgery on an unborn baby inside the mother's womb! The advances in the last 40 years alone are simply mind boggling even for doctors who have been witness to the evolution of life inside the operating rooms. There was a time when Uganda, for example, was on the cutting edge of medicine and surgery. Whereas Ugandan physicians and surgeons continue to offer excellent treatment and care for their patients, they are handicapped by suboptimal resources such as well equipped and well staffed operating rooms. However, progress has been made in some areas, and not just the big city hospitals. In rural places such as Ruhiira Millennium Village in Isingiro, Nkore, there are  functioning operating rooms in Health Centre IV units.  A functional operating room in every health centre IV and hospital is not an option. It is an affordable necessity.

Operating Room, Ruhiira Millennium Village, Isingiro, Nkore, Uganda

They may not do complex or advanced surgery, but the doctors and nurses at Ruhiira have the capacity to save your life and mine should we need their help during a visit to that rural area. They have changed the lives of the community.. Clearly the facilities at Ruhiira meet the bare minimum recommendations. Opportunities for improvement exist in order to provide safer surgery, especially for mothers who need caesarean delivery. A fully equipped operating room, such as the one in the image below, costs less than a couple of Mercedes Benz sedans that are favoured by Africa's rulers. A change of priorities by governments would equip each District Hospital and Health Centre IV with at least 2 of these Operating Rooms (Theatres). The anaesthetist's team, the surgical obstetric team and the neonatal (baby) team have state of the art equipment to which they apply current knowledge and skills to ensure the best outcomes for the mothers and their babies. It is a question of priorities, of course. A rethink of many of Africa's inflated national parliaments and other patronage appointments would free money to pay the doctors, nurses and technologists to take good care of patients in these centres. Funny thing is that a population given such resources would become less difficult to govern. They might even keep reelecting their rulers until nature ends the latter's tenure. We have come a long way since 1879, but there are communities in East Africa whose pregnant mothers are not as lucky as the 20 year old woman whose Caesarian delivery Dr. Robert William Felkin witnessed in that distant past. It does not cost much to change that.