Plastic Surgery – Plastic Surgery – Uganda?Uganda?

Dr. Kevin BushDr. Kevin Bush

UBCUBC

UBC Division of Plastic Surgery UBC Division of Plastic Surgery participationparticipation

12 active division members12 active division members 5 of 12 members doing overseas work5 of 12 members doing overseas work 8 residents set to go8 residents set to go 6 of 8 residents completed missions6 of 8 residents completed missions 2 did not complete missions because of 2 did not complete missions because of

political issues i.e. 9/11political issues i.e. 9/11

BC participationBC participation

2 plastic surgeons from Campbell river doing 2 plastic surgeons from Campbell river doing work in Guatemalawork in Guatemala

1 plastic surgeon in Kelowna1 plastic surgeon in Kelowna Dr.Rai running operation rainbow out RCHDr.Rai running operation rainbow out RCH 1 surgeon from Victoria1 surgeon from Victoria

Why Uganda?Why Uganda?

Other groups goingOther groups going Loose agreement with UBCLoose agreement with UBC Possible new residency programPossible new residency program Chance to build capacityChance to build capacity Chance for full division participationChance for full division participation Regular resident participationRegular resident participation

Uganda-Political issuesUganda-Political issues

Limited resourcesLimited resources ““Stable government”Stable government” 32 year war32 year war Public/private medical systemPublic/private medical system

500 dollars a month500 dollars a month

Mulago HospitalMulago Hospital

Group roundsGroup rounds Weekly opd clinicWeekly opd clinic Weekly roundsWeekly rounds 2 plastic OR days a week2 plastic OR days a week 3 Burn days a week3 Burn days a week

My WeekMy Week Monday - 8:00am Weekly Meeting at Dept. of Monday - 8:00am Weekly Meeting at Dept. of

Surgery followed by patient roundsSurgery followed by patient rounds Tuesday - 9:00 am Plastic OR day at Mulago Tuesday - 9:00 am Plastic OR day at Mulago

HospitalHospital Wednesday - In-patient rounds (9:00am start)Wednesday - In-patient rounds (9:00am start)                                     - meeting with Ministry of Health- meeting with Ministry of Health                                     -meeting with Dept. of Dentistry-meeting with Dept. of Dentistry Thursday - 7:00 am - Private Clinic day with Dr. Thursday - 7:00 am - Private Clinic day with Dr.

KhingiKhingi Friday - available in case Wednesday meetings have Friday - available in case Wednesday meetings have

to be rescheduledto be rescheduled

Medical ResourcesMedical Resources

Mulago hospital Mulago hospital – – 32 million referral hospital. Four surgeons – 32 million referral hospital. Four surgeons –

none plastic surgery certified.none plastic surgery certified. Approximately 1000 burn admissions a yearApproximately 1000 burn admissions a year

CBM – mission hospital doing more elective CBM – mission hospital doing more elective surgery. One British trained plastic surgery. surgery. One British trained plastic surgery. One local trained plastic surgeon.One local trained plastic surgeon.

Plastic surgery equipment resources Plastic surgery equipment resources at Mulagoat Mulago

Microscope – uncertain ability to focusMicroscope – uncertain ability to focus C-arm – not workingC-arm – not working

Donated c-arm waiting at CambieDonated c-arm waiting at Cambie Dingman – occasionallyDingman – occasionally Plates and screws – not availablePlates and screws – not available Sutures limitedSutures limited

AnaesthesiaAnaesthesia

ProblematicProblematic

NursingNursing

PresentPresent Visiting nurse in past was a poor experience Visiting nurse in past was a poor experience

making nursing assistance EXTREMELY making nursing assistance EXTREMELY difficultdifficult

Dedicated burn unitDedicated burn unit Plastic floorPlastic floor

Current Medical relationshipsCurrent Medical relationships

Netherlands burn connectionNetherlands burn connection Smile trainSmile train Summerland from UKSummerland from UK Occasional visiting surgeonsOccasional visiting surgeons

CBM?CBM?

Who does what?Who does what?

Hand surgery – nobody and everybodyHand surgery – nobody and everybody Soft tissue coverage – plastics occasionally but Soft tissue coverage – plastics occasionally but

relationships with orthopedics and other relationships with orthopedics and other specialties limitedspecialties limited

Clefts – CBM plastic surgeonsClefts – CBM plastic surgeons Mulago plastic surgeonsMulago plastic surgeons Lips and palates onlyLips and palates only

Burns – Mulago plastic surgeonsBurns – Mulago plastic surgeons Elective plastics?Elective plastics?

Residency ProgramResidency Program

ApprovedApproved Not yet in placeNot yet in place Residents unfundedResidents unfunded Curriculum unclear and minimally developedCurriculum unclear and minimally developed Certification - COSECACertification - COSECA

What they wantWhat they want

Collaborative relationshipCollaborative relationship Possible rotations in VancouverPossible rotations in Vancouver

Curriculum development for COSECA Curriculum development for COSECA certificationcertification

Development of current skill setDevelopment of current skill set

ProblemsProblems

Equipment issuesEquipment issues Anaesthesia issuesAnaesthesia issues Nursing issuesNursing issues Work ethicWork ethic

What could we set up?What could we set up?

Collaboration with other groups from UBC Collaboration with other groups from UBC during their visitsduring their visits

Program developmentProgram development Curriculum development and particularly Curriculum development and particularly

filling in areas of expertise not largely filling in areas of expertise not largely available thereavailable there

Resident /staff educationResident /staff education

Model weekModel week

Arrive weekendArrive weekend Monday clinicMonday clinic Plastics main OR toes and FridayPlastics main OR toes and Friday Burns OR Weds, Thurs, FridayBurns OR Weds, Thurs, Friday CBM OR dayCBM OR day TeachingTeaching

CostsCosts

1000 dollars per trip for accommodation, 1000 dollars per trip for accommodation, licensing etclicensing etc

Airfare 2300 dollarsAirfare 2300 dollars Miscellaneous equipment costsMiscellaneous equipment costs

Roughly 4000 dollars per person per tripRoughly 4000 dollars per person per trip