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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

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Martin Situma . Pediatric Surgeon MUST/MRRH/Bethanykids

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

  2. Background • Started in Feb 2014 • Tripartite arrangement between MUST, MRRH and Bethanykids through Memorandum of understanding. • 1 full time surgeon

  3. Activities • Clinical services (to patients), both Outpatient and inpatient • Teaching (students, residents) • Research

  4. 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%

  5. 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.

  6. Tumors

  7. 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

  8. Other conditions • 34 ARM • 20 nephroblastomas • 7 pullthroughs for hirschsprung’s disease

  9. Research • Residents rotating on the unit and as masters thesis.

  10. 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.

  11. 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.

  12. 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.

  13. Thank you!

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