Pediatric Surgery at Mbarara Regional Referral Hospital (MRRH)/ Mbarara University of Science and Technology (MUST) Martin Situma. Pediatric Surgeon MUST/MRRH/Bethanykids.

Pediatric Surgery at Mbarara Regional Referral Hospital (MRRH)/ Mbarara University of Science and

Technology (MUST)Martin Situma.

Pediatric Surgeon MUST/MRRH/Bethanykids

Background

• Started in Feb 2014

• Tripartite arrangement between MUST, MRRH and Bethanykids through Memorandum of understanding.

• 1 full time surgeon

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Activities

• Clinical services (to patients), both Outpatient and inpatient

• Teaching (students, residents)

• Research

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Outcome• Gastroschisis 16/17 100% mortality

• Omphalocele 1/5 20% mortality

• EA 2/3 66% (1 died at home)

• DA ¼ 20%

• JA 3/7 43%

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Numbers likely to grow

• MRRH serves as main referral hospital for 10 districts in southwestern Uganda.

• MRRH alone has up to 1000 deliveries in a month

• New PNFP children’s hospital (Holy Innocents children's Hospital) located about 5 minutes from MRRH.

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Tumors

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Factors affecting outcome• Chemotherapy available for most of these

• Young and vibrant oncology service, but no pediatric oncologist yet. Very good collaboration with the pediatric surgical service

• No radiotherapy.

• Protocols not necessarily suitable for our setting

• Lot of patient support systems needed to enable them complete treatment

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Other conditions

• 34 ARM

• 20 nephroblastomas

• 7 pullthroughs for hirschsprung’s disease

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Research

• Residents rotating on the unit and as masters thesis.

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Opportunities• Goodwill from both the hospital and university. Good inter

departmental cooperation

• Teaching hospital provides a source of potential fellows in pediatric surgery and nurses for training

• Variety of clinical conditions

• Several potential areas of research and collaborations

• Theatre structures are available although no staffing levels to be able to utilize them and no equipment yet.

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Challenges• No central place for pediatric surgery. Adults mixed with pediatric and

medical conditions with surgical.

• Inadequate personnel. 1 full time surgeon, few nurses, few anethesiologists.

• Lack of pediatric ICU facilities

• Poor record keeping.

• Inadequate theatre space and insufficient neonatal & pediatric instruments.

• Inadequate supplies.

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Possible solutions• Establishing partnerships with other institutions or centers and individual

surgeons to improve the surgical care of children.

• Have fellows train or at least rotate at the unit.

• Source funds to equip and operationalize a pediatric surgery theatre.

• Train more pediatric surgeons.

• Funding for record clerks, more nurses.

• Develop an ICU and high dependency area on ward for the more sick babies.

• Possible research collaboration with other centers.

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• Thank you!

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