Uganda's Irish connection under the knife

A virtual School of Surgery set up in Ireland is becoming a key part of surgical training in nine countries, including Uganda, writes NIAMH GRIFFIN

The wide corridors of Mulago Hospital in Uganda’s capital are thronged with people, but, in one small room, surgical interns sit in peace, in front of screens displaying the Royal College of Surgeons Ireland logo.

This website, complete with case studies, online tutors and satellite dishes for some hospitals, arose from collaboration between RCSI and the College of Surgeons in Eastern, Central and Southern Africa. Funded by Irish Aid, it works like a virtual school and is becoming a key part of surgical training in nine countries.

Dr Jane Fualal bustles along the corridor, heading up to the darkened room next to the busy TB wards. She says improved training is making surgery more attractive to interns here in Kampala and elsewhere.

And with just 175 surgeons treating 33 million people around the country – Ireland has 495 – she says support is needed. But the first step was finding space in the building for computers.

“Our association is only 12 years old, so RCSI can advise on technical things. And without them we would not have the IT lab for training, or the website access,” she says.

Since 1996, she has watched interns leave surgery to work in better-funded areas such as malaria or HIV/Aids. She says the online School for Surgeons gives a clearer academic path to qualified status.

“We have 13 accredited hospitals to our association but only five of them are actively training. But our membership and fellowship programme are expanding now because we have more material for them,” she says.

Part of the €500,000 per year provided by Irish Aid for 2011 to 2013 is spent on gathering African case studies for the website. Trainees chat online with their peers and lecturers in other hospitals to assess their approach.

Senior surgeons also receive Train the Trainer courses, delivered by RCSI surgeons volunteering their time.

Registrar Dr Kintu Luwaga says he is on the endocrine ward. But his day is always busy, he says, as he also operates on road-crash victims.

“The website is useful in terms of reducing the time we spend looking for information, and the programme helps us access it. We need to constantly update ourselves and buying hard-copy books is very expensive,” he says.

A student could spend more than one million shillings – three times the average monthly salary in Uganda – on just four books, he says. In contrast, monthly wifi packages average 51,0000 shillings (€15).

Dr Asuman Luwago of the Ministry of Health says the department wants to use this programme as a model.

“We plan to evolve this work and support the surgeons with nurses, anesthetists and other complementary staff. We are hopeful of increasing the specialisms on offer here,” he says, speaking just after the health budget was decided for 2013.

However, even in the capital regular power cuts mean relying solely on the internet is not practical. And outside of Kampala, the surgical programme has hit a few snags.

Dr Martin Ogwang, head of surgery at St Mary’s Hospital near Gulu, says he almost had to join the IT staff when the system was first installed. “We have had some difficulties,” he says, bringing wry chuckles from colleagues in the department.

Surgeons in this walled-in compound in northern Uganda have a strong reputation. It was the only hospital to treat Ebola victims 12 years ago, when 13 staff died; it was the sole hospital open during decades of conflict with Josephs Kony’s army; and it acts as a shelter for thousands of children running from the Lords Resistance Army. Practical training is not hard to come by here.