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Lahor Report 2012

Date April 2012

CAGS/CNIS REPORT 2012

 

I had gone to Lacor Uganda this time around armed with the information that the 2 other CAGS surgeons who had normally volunteered for Lacor had informed me that they would not want to go again. The reasons varied from a feeling that perhaps they have outlived their usefulness, to lack of internet access. I then had gone with the intention of assessing if this this the right time to discuss an exit strategy.

I was able to have a meeting with all the general surgeons and had a very useful and frank discussions. I conveyed our concerns with the usefulness further CAGS visiting surgeons. I welcomed their feedback. The unanimous response was that we continue with our association with Lacor. However they see our role now in a more of a teaching role than as a service role. They now have 3 general surgeons and is better able to cope with their workload. Mr Martin ,however is increasingly busy with his administrative duties so I see our service role continue. After our meeting I outlined our future roles and have received their received their response in the affirmative. I attach the letter of proposal at the end of the report.

The part about CAGS surgeons visiting outlying mission hospitals needs a little more work as the facilities might not be ready to receive CAGS surgeons.

As for a more structured itinerary for visiting CAGS surgeons, I felt it was important to have this worked out especially if visit time is short. They have not insisted on 6 weeks long visits and I think 4 weeks is reasonable since travel time already takes up the better part of a week. There is some dysfunctional dynamics between St Mary’s Lacor and Gulu University. St. Mary’s Hospital is neither a Government Hospital nor a University hospital. It is a privately funded hospital ( by the Corti-Teasdale Foundation) but is the only major clinical facility in Northern Uganda. I think for the University to function properly it needs its own University hospital….either build its own hospital or designate St Mary’s Lacor as it’s clinical facility. This of course needs political will . This is Africa !

To facilitate a more structured itinerary for our visiting CAGS surgeons I had a meeting with Professor Moro at Gulu University. Prof Moro (a general surgeon) is Head of Surgery and also Associate Dean for Education. We had a very rewarding discussion and it gave me some insight into the politics and also the direction the University is pursuing.

Firstly Prof Moro had no idea that the medical students were not maximizing the availability of CAGS surgeons. He has agreed to be the go-to person and if I let him know ahead of time of visiting CAGS surgeons time-table he would be able to arrange a teaching schedule for us, even week-end lecture for the entire class. He can also co-ordinate that ESS be held at the time when our CAGS surgeon is there.He says the ESS course is actually now written into their curriculum.

He is interested in the structured hernia repair course developed by CNIS. He says they are ready to apply to the faculty board for approval to pursue the SHR program.

Lastly Prof Moro says they had been applying for a postgraduate surgical training program(in general surgery)and likely will receive approval in the next year or so. He is looking towards CAGS for help in this area. This is something the International surgery committee can discuss. In the meantime I told him I would ask Brian Cameron to get in touch with him since Brian has experience running the Guyana program. If another university would like to take this on e.g. UBC that would be great.

Also on this visit to Lacor I took along a team of nurses to teach peri-operative nursing skills. We developed a curriculum and taught a set of skills e.g. scrubbing and role in the OR, check list, running the OR, PAR, how to run the CSD with disinfection  and quality control of their sterilization. This was a 5 day course and was very well received and they want it repeated with some of their senior nurses as instructors. We had upgraded their CSD last year and with infection control ,they have reduced their infection rate by almost 50% ! A very impressive achievement.

The ESS was run without a hitch this April 10-14th. This despite some serous hiccups pre-ESS. Fortunately Ron Lett was able to resolve this with lots of cajoling and veiled threats. As I have mentioned ESS is written into their curriculum and is here to stay.

In conclusion , I would recommend that CAGS continue with its involvement with Lacor and Gulu University.

 

 

Ghee Hwang FRCSC

Co-ordinator CAGS Lacor Uganda program