D. F. Grabski1, N. Kakembo2, M. Cheung3, I. Okello2, A. Shikanda5, M. Langer7, M. Nabukenya4, M. Ajiko8, G. Villalona6, T. Fitzgerald9, G. Kateregga10, J. Tumukunde4, A. Muzira2, P. Kisa2, M. Situma5, J. Sekabira2, D. Ozgediz3 1University of Virginia School of Medicine,Department Of Surgery,CHARLOTTESVILLE, VIRGINIA, USA 2Makerere University, Mulago Hospital,Department Of Surgery,Kampala, KAMPALA, Uganda 3Yale University School of Medicine,Department Of Surgery,New Haven, CT, USA 4Makerere University, Mulago Hospital,Department Of Anesthesia,Kampala, KAMPALA, Uganda 5Mbarara University of Science and Technology, Mbarara Hospital,Department Of Surgery,Mbarara, MBARARA, Uganda 6Saint Louis University School of Medicine,Department Of Surgery,Saint Louis, MO, USA 7Northwestern University School of Medicine,Department Of Surgery,Chicago, IL, USA 8Soroti Regional Referral Hospital,Department Of Surgery,Soroti, SOROTI, Uganda 9Duke University School of Medicine,Department Of Surgery,Durham, NC, USA 10Mbarara University of Science and Technology,Department Of Anesthesia,Mbarara, MBARARA, Uganda
Introduction:
Pediatric surgical resources are significantly limited in Uganda, especially in rural areas. The result is a back-log of elective cases and emergency procedures performed by general surgeons or medical officers in rural hospitals. Surgical camps run by local and international partners have historically assisted with rural service delivery. We describe the effectiveness of locally led rural pediatric surgical outreach on service delivery and training.
Methods:
We performed a retrospective review of data from rural outreach camps completed by the pediatric surgery and anesthesia teams at Mulago Hospital in collaboration with international partners from 2012-2017. Primary outcomes included surgical volume and immediate surgical outcomes. Secondary outcomes included the share of elective cases and the trainee involvement in the camps. The 2017 joint “Guidelines for Short Term Missions” (STMs) from the American Pediatric Surgery Association (APSA) were used to assess possible areas of quality improvement.
Results:
From 2012-2017, 7 surgical outreach camps ranging from 3-5 days occurred in Soroti (5/2012, 1/2013), Masaka (8/2013, 02/2015) and Mbarara (01/2016, 11/2016, 04/2017) (Table 1). 394 cases were completed, with 383 (97.2%) elective procedures. There were 4 re-operations and 2 post-operative deaths. 48 Trainees (6 from USA) in general surgery and anesthesia were involved in the camps. 6 general surgeons and 11 anesthesia officers were additionally involved in pediatric surgical and anesthesia skill transfer. Reduction of elective case backlog and clinical skill transfer in pediatric surgery and anesthesia were successes highlighted by the local team. Perceived challenges included a lack of reliable intensive care, radiology and pathology. Qualitative review by the pediatric surgery and anesthesia teams of the Day-of Surgery Checklist from published guidelines revealed several areas of potential improvement including: allergy history (specifically where language barriers exist), evaluation for clinical changes after screening, pre-operative image review, and more formal intra-operative debriefing. Participants also emphasized possible burden on local hospitals.
Conclusion:
Pediatric surgical outreach camps led by local pediatric surgeons in Uganda are safe and help to address the back-log of elective cases. Outreach camps can be closely linked with surgical training and skill transfer. Challenges vary by site and camps can stress the local system and must be well-coordinated with local teams. Lastly, the 2017 joint guidelines for STMs, adapted to the local context, may be a helpful tool for quality improvement and prospective evaluation is warranted.
