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UCSF Surgical Outreach to Kapchorwa, Uganda By Alexander Ayzengart On February 18, a group of surgeons from UCSF, including Dr. Doruk Ozgediz (Asst. Adjunct Professor of Surgery), Dr. Alexander Ayzengart (PGY4 in general surgery), and Paul Shen (MS IV), embarked on a surgical outreach visit to rural Uganda organized by the African Medical and Research Foundation (AMREF). The initial invitation came courtesy of Dr. Jane Fualal, a general surgeon with interest in endocrine surgery, who is a staff registrar at the Mulago Hospital in Kampala, Uganda. We were to accompany Dr. Fualal to the district hospital of Kapchorwa, located in a small village in the valley of Mount Elgon on the eastern border of Uganda. At the time of this invitation, our group was actively involved in teaching, patient care and collaborative research projects with the Department of Surgery at the Mulago Hospital. Due to the gradually strengthening bond between the faculty and residents from our two departments, the degree of our team’s involvement went far beyond mere surgical volunteerism and, over time, has developed into a productive collaboration. Needless to say, we were happy to contribute to this growing relationship in yet another way, by bringing surgical services to the place rarely accessible by modern medicine. On the day of our departure to Kapchorwa, and not knowing what to expect on site, we collected a few boxes of medical and surgical supplies, piled everything into a large mini-van, and headed out to meet Dr. Fualal at the district hospital. After six hours of bouncing around on the rural roads of Uganda (imagine potholes sprouting bigger potholes!), we were being greeted by dozens of patients, curious on-lookers, and members of the operating theater staff. However, our meet-and-greet was short-lived, as we were scrubbing on our first case within an hour of arrival. Dr. Fualal, who arrived in Kapchorwa by plane a few hours ahead of us, has been busy evaluating and triaging many patients lining the halls of the hospital, in order to create a manageable operating plan. Within the span of 2.5 days, we performed close to 25 operations – all under the conditions rivaling the most hardened of any surgical field hospital, where the lack of running water, working surgical lights, and functioning instruments created an additional element of difficulty. Most of the procedures consisted of subtotal and partial thyroidectomies, aimed at providing relief to the patients with gigantic goiters that developed due to widespread iodine deficiency. However, since surgical care has always been hard to come by in many district hospitals of Uganda, and Kapchorwa was no exception to this rule, our operative log covered a multitude of problems that required surgical intervention (anything from large salivary gland tumors to chronic appendicitis). True to the surgical etiquette practiced worldwide, we made it a point to see all of our patients after each operative day. Despite all of the challenges mentioned above, most operations went as smoothly as expected, with all patients doing well on their first postoperative day. Just imagine stepping into a large room full of people that are gingerly nursing their neck dressings and actively sharing their experiences and worries with any neighbor willing to listen! This was one of the many cultural differences that stirred and shocked our senses on the daily basis while in Uganda. So, was it all work and no fun, all the time? Of course not! At the end of our stay in Kapchorwa, we found a little free time to visit the valley of Mount Elgon and to track on foot to the top of Sipi falls. It is difficult to do justice to the beauty of Uganda’s countryside in simple words, instead, I would rather extend my invitation to join our Global health surgical collaboration on the next visit to Uganda and witness everything for yourself. For more information, and for an extensive photo collection from our trip, please visit www.globalpas.org.
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