Plastic and reconstructive surgery in Uganda – 10 years experience

Abstract

We describe our experience of working in plastic and reconstructive surgery in Uganda over the last 10 years. There is a high burden of disease, a health system that is under resourced, and few qualified physicians to provide healthcare for a principally rural population. Training the physicians of the future is essential. Prevention and early wound management needs to be emphasized for traumatic injuries including burns. Subsidized up-country visits by trained specialists with the appropriate equipment are required to provide a service for the rural poor. There appears to be a high mortality rate in babies with unrepaired cleft palate, probably due to feeding difficulties in an environment where intercurrent illness is common. We now offer nutritional support with early combined cleft lip and palate repair in these babies, a practice that has a high success rate and may be suited to other specialist units in the developing world.

Incidence of Cleft Lip and Palate in Uganda

“…The ratio of isolated cleft lip to cleft lip and palate to isolated palate was 37:12:1 (Hodges et al, 2009). As known from other research (Gundlach and Maus, 2006), it is very unlikely that so few patients with cleft lip and palate and with isolated cleft palate are born in Uganda.…”

Paediatric surgery and anaesthesia in south-western Uganda: a cross-sectional survey

“…Higher surgical rates were found where visiting surgeons funded by external organisations, such as Smile Train or Interplast, performed specialist surgery. 25,26 These teams bring specialist skills to rural populations, and they are also able to purchase additional drugs, equipment and monitoring to defined standards so that complex procedures can be undertaken safely. 26 Task-shifting is often seen as a potential solution to the medical workforce crisis.…”

“…21,42,43 Local clinicians can benefit from the valuable training opportunity offered by partnering with visiting specialists. 21,25,44 Task shifting has been suggested as a solution to workforce shortages in some areas, but support and supervision are needed to maintain the standards of care. 27,28 Although many anaesthesia providers in our study expressed the wish to have modern anaesthesia machines, this may not be feasible at present due to infrastructural limitations (reliance on electricity, pressurised oxygen supply and sophisticated maintenance).…”

Plastic Surgery—Myths and Realities in Developing Countries: Experience from Eastern Nepal

“…There is need for realization of problem, setting up priorities to develop infrastructure, laying down protocol, and publicity to educate people [2, 9]. …”