There will always be stress before a mission, regardless of the time taken in preparation. This time, it was particularly difficult to digest the problem of customs clearance!
Despite non-stop correspondence between the hospital and ourselves, we still had no Ugandan import documents two days prior to departure, a problem caused by the laxity of the Ugandan customs administration! …..I dropped a bomb when I told the hospital management that I was going to cancel the mission: to arrive at the hospital without the essential equipment that we were bringing would have been a waste of time! The mission was planned to last a week and, as there would not have been enough time to recover our equipment, it would have been impossible carry out the planned operations.
Our cases contained generators, monitors, urological surgery equipment, pieces to repair the fluoroscope and anaesthesia Equipment.
My bomb was effective – a staff member was swiftly sent to Kampala to put strong pressure on the customs clearance office and thus we avoided having our luggage go through the three scanners recently installed at the arrivals of the airport in Entebbe.
Dr. Gideon Kurigamba had been waiting impatiently for our visit; he had been looking forward to this mission for months. A mission including Dr. Farshid Fateri in 2013 had aroused his interest in urology, an interest which he had further developed during the second visit of Dr. Fateri in 2017. This time, our objective was to tackle a more difficult operation: the endoscopic resection of the prostate. This operation, done via the urethra, avoids an abdominal scar and allows the patient to resume activity after just a few days. In addition, it normally does not require a general anaesthetic.
The ability to offer this operation to physically active patients who are handicapped by the need to use a catheter to urinate, either frequently or permanently, is an asset for the hospital. Bwindi tries to attract better-off patients by offering speciality treatments which are at the moment only available in Kampala (10 hours drive away). The ability to provide “Speciality” surgery makes it possible to create additional income, to offset the lack of revenue from poor patients.
This too-short mission was quite stressful: to teach a young surgeon the techniques of endoscopic surgery cannot be done in a few days!
Thirty-seven patients, who had been preselected before our arrival, came for preoperative consultations. Twenty-seven patients underwent surgery including 11 endoscopic resections of the prostate, two endoscopic resections of a bladder tumour and 6 stenosis of the urethra.During our stay, a patient who had ruptured his urethra in a traffic accident, was advantaged by Dr Fateri’s presence. Some boys also benefited from his skills for the correction of hypospadias ( a birth defect in which the opening of the urethra is on the underside of the penis instead of at the tip) .
Dr. Fateri was assisted by Daphne Mermod, a scrub nurse making her first visit to the hospital. Her expertise was very much appreciated by the hospital staff. She also had to struggle to drive home the importance of the care and maintenance of the very fragile equipment we had brought with us.
Two anaesthetists made this journey with us, Dr. Ralph Le Dinh, a regular at our missions, and Dr. Corinne Grandjean. Corinne became fully integrated into the anaesthesia team to the extent that she was invited to dance during the last evening!
Finally, the radiology team, after so many years of effort, had the satisfaction of seeing that the premises are well maintained, the equipment is correctly stored and the developing machine is still working. Our self-educated technician, Moses, continues to take his role very seriously. He took advantage of the presence of Dominique Schmid and Philippe Besson to perfect his X-ray technique and learn new radiological positions. The doses were also readapted to the new equipment and Philippe recorded all the values in case of a new visit by the Atomic Energy Council (who had banned the use of the radiology machine at the beginning of the year, see mission March 2019).
The steriliser had been delivered a week before our arrival but it would not work: Philippe diagnosed a fault in the pump. After a few calls, he decided to order a replacement pump … under warranty.
But who will install it ??????? another challenge for the next mission. Meanwhile, it is ready for use with an external water supply, as this room has no running water!
We now have to organise a follow-up to this urological project so that our investment in time, energy and money is not lost.
Dominique Schmid, Dr. Farshid Fateri, Philippe Besson, Dr. Corinne Grandjean, Daphne Mermod.
Dr. Forat Sadry Dr. Ralph Dinh