Office of Pediatric Surgical Evaluation and Innovation

Uganda Hearing Health Care Program |

The Uganda Hearing Health Care Program began when Dr. Irwin Stewart first visited Uganda in 2000. He recruited otolaryngologist Dr. Brian Westerberg from BC Children’s Hospital and St. Paul’s Hospital to the first team trip to Uganda in 2001 to determine the prevalence and causes of hearing loss. Subsequent trips by Dr. Westerberg to Uganda primarily involved treatment of those patients who were deaf or hard of hearing by both medical and surgical means. The project has always included more than just ear surgery, including for instance water and sanitation projects in Arua under the guidance of Mr. Michael Crean.

The goal has always been to train the trainers through education of local Otolaryngology-Head and Neck Surgeons (Ear, Nose and Throat Surgeons) and supplying them with donated equipment needed for ear surgery, thus allowing ultimately for independent practice in Uganda. The program strives to create a sustainable benefit for the people of Uganda. The project has expanded considerably to include a broader range of health and educational services with the addition of experienced personnel in Nursing, Biomedical Engineering and Anesthesiology.

In 2009, OPSEI executive director Damian Duffy joined the group for their October trip. The group saw 92 patients in 10 clinic days in four centers. Of those patients, surgery was performed on 9 men, 3 women, 3 boys and 4 girls. The average age of the patients was 29. The surgeries were done on 10 days in four different centers, always in conjunction with local Otolaryngologists being instructed/assisted in provision of care for otolaryngologic disorders.

The main health concerns which were addressed were chronic ear infections complicated by perforated ear drums and ear drainage issues. For the pediatric patients this was particularly problematic as it negatively impacted school learning activities and social development with other children. The team witnessed occasions in which children no longer attended school as they were either sent home by the, or they chose not to go rather than face the teasing experienced teachers because of ear discharge.

Additionally, there were a number of ENT surgical conditions seen and treated including masses of the neck, nose and sinus. Procedures which were undertaken were done in concert with the local Ugandan surgical team.

Uganda Sustainable Trauma Orthopaedic Program|

The burden of injury is a public health issue felt across all geographic and socioeconomic boundaries. Injury related deaths in sub-Saharan Africa outnumber all deaths from HIV, TB, and malaria combined. The numbers are particularly troubling in Uganda, currently ranked second worldwide in the rate of fatalities per vehicle behind Ethiopia.

The Uganda Sustainable Trauma Orthopaedic Program was established in 2008, as a collaboration between the University of British Columbia and Makerere University in Kampala, Uganda to reduce the burden of neglected orthopaedic trauma in the country. The program in coordinated by OPSEI administrator, Nathan O’Hara.

During the most recent trip in October 2009, a medical team consisting of two orthopaedic surgeons, one anesthesiologist, two orthopaedic surgical residents, one anesthesia resident, three nurses and a sterilization technician worked with local staff of Mulago Hospital to analyze and strengthen the current system for managing traumatic injuries. Policies were changed to ensure injured patients receive direct admission to the surgical wards, decreasing average wait time previously at 30 days to 2 days for isolated femoral head fractures.

With over half of the Ugandan population under the age of 15, many of patients admitted during the program require pediatric care. UBC residents familiar with the modern techniques play an important role in training their peers during these visits. The group is currently planning their next visit for November 2010.

Pulse Oximeter for Low Resource Regions

Pulse oximetry has been a standard a care in the developed world for nearly two decades. Recent standards published by the World Health Organization, list the pulse oximeter as an essential device for patient safety in the operating room. The reality is that many surgeries are performed in operating rooms in many parts of the world without this devise.

Dr. Mark Ansermino from the Department of Pediatric Anesthesia is currently working to develop a low cost pulse oximeter, which easily connects to mobile phones and displays relevant information for use in low resource areas of the world. This breakthrough technology is to be piloted in Uganda in 2010.

Resident training – Uganda

The University of British Columbia's Division of Otolaryngology and the Department of Anesthesia, Therapeutics and Pharmacology supported two outstanding residents from Makerere University in Uganda for three month training electives.

Dr. Emily Kakande

Dr. Kakande is in her final year of residency training in Uganda, specializing in Otolaryngology. During her time at UBC, Emily has had the opportunity to train at BC Children's Hospital, St. Paul's Hospital and Vancouver General Hospital under some of the leading experts in the field. Dr. Kakande has also undertook research on the link between autism and hearing loss.

Global Health	Uganda Sustainable Trauma Orthopaedic Program	Pulse Oximeter for Low Resource Regions	Resident training – Uganda