An Emerging Relationship Between a US Surgical Team and a Ugandan Hospital; Avoiding the Cut and Run

Kristin Colling; Mariya Skube; Peter Kiggundu; Jeffrey Chipman; Greg Beilman

International surgical missions increase access to surgical care for patients in low- and middle-income countries; however long term outcomes have not been well studied. We previously demonstrated that lymph node and anorectal mucosal biopsies can be safely performed in a low-income country with limited resources. We report our experience and outcomes of more complex procedures.

Moderately complex operations can safely be performed in a low-income country, using US-based teams and local staff.

US-based surgical teams (surgeons and anesthetists) performed all procedures in collaboration with local staff (nurses, surgical technologists, and residents) at the Ruth Gaylord Medical Clinic (RGMC) in Kampala, Uganda. The missions occurred in February and October 2017. RGMC house physicians saw all patients in follow-up, at a minimum once 2 weeks post-op. The US team remained in close contact with RGMC staff for postop management.

80 patients were seen in a one day clinic in February, leading to 32 procedures on 28 patients on the following 4 days. In October we returned and screened 58 patients, leading to 30 procedures on 27 patients (Table 1). Seven patients initially presented in February and went on to have surgery in October. All procedures were performed without electrocautery. Most procedures were performed under local anesthesia with mild sedation. Two procedures were performed with spinal blocks and sedation: a thrombosed hemorrhoidectomy and a large, incarcerated inguinal hernia repair with bowel obstruction. All inguinal hernias were repaired with mesh, whereas all ventral hernias were repaired primarily. No surgical site infections occurred.  The only complication was a hematoma after excision of a 10cm lipoma. The case was notable for significant intraoperative bleeding, likely due to thrombocytopenia related to HIV treatment.  This was successfully drained with no further complications.

Using minimal resources, including no electrocautery and minimal anesthesia, 57 patients were successfully treated through our partnership with RGMC with a low complication rate. Short-term medical missions are often criticized for their “cut and run” character, with foreign teams performing cases, then leaving with no follow up. Planned return trips, which allowed scheduling of cases we could not cover the first trip, as well as close collaboration with local staff helps create a  relationship benefiting both parties and improving patient care. Future plans include increasing the frequency of missions, allowing for closer follow-up and the ability to perform more complicated cases.