Report Bwindi by Andrew Kizito, young medical doctor, march 2024

    An annually organized camp at Bwindi community hospital by AFRICOMED to benefit residents in the surrounding community who live with urogenital diseases through consultations, advanced diagnostic investigations (imaging, laboratory and histology), medical prescriptions and surgeries (minimal access and open surgeries) by a comprehensive team of medical workers; nurses, doctors, surgeons, radiologists, laboratory technicians, histopathologists, surgeons, anesthesiologists and urologists both local and international. This year it happened from 11th March to 21st March 2024 which I happened to be part.
    Bwindi Community Hospital is at a Village called Bwindi, in Kanungu District in South Western Uganda next to the Boarder with DR. CONGO. Approximately 530 KM from Kampala and 12 to 14 hours by bus. I left Luwero on 9th March afternoon to Kampala where I boarded a night bus to Bwindi. This was one of the longest journeys I have taken, being a night time, it was not that tiring as some parts of it I was asleep. It was nice driving through the mountain ranges.
    I reached Bwindi on 10TH March afternoon, and utilized the rest of the day to secure a place where I would spend the nights for the two weeks I will be at the camp. It was a small trading Centre amidst hills with a few restaurants, one or two motels one little supermarket, a nursing school and the community hospital being the biggest facility around. A calm environment with a cool weather and a beautiful sunset amazing to watch on the other of the hills with a small stream through the town
    It was very easy for me to settle in as the people were welcoming and I was quite familiar with the native language because it close to that used in Ishaka where I spent 4 years of the medical school.
    A very organized neat hospitals I have been to, not on a very big land space but with departments well situated serve, good sanitation around with a calm environment. Noted a lot of services offered there some of which are hard to expect in such a remote area thanks to AFRICOMED, had never been to such a private big hospital setting had a lot to add to my experience. A church-based health facility, they had a gathering every 8 am of the working days for a simple 15 minutes prayer and communications before work starts.
    Dr. Forat had earlier connected me to Mr. Barnabus the communications person who was guiding me through, as I was traveling and settling in who earlier told me of the meeting point on Monday.
    I happened to join the hospital staff members on the Monday morning at a prayer gathering they hold every morning of the working days. I noted all actively participate and after which they go to do their daily work. That morning we started with a debrief about how the camp will run and introduction from each member of the teams that will participate in the camp.
    The first day of the camp was spared for screening the patients, this was to diagnose the patients that needed different modules of management. An approximate of over 79 patients turned up for screening and some were managed with medications for their conditions did not need any surgeries and over 45 patients were scheduled for surgeries on different days of the camp. Priority was given
    to all men that were living with catheters for obviously they needed to benefit from this camp. Two children too benefited from the camp as they presented with urethral strictures from traumatic causes one of them was a 16 year old who was bound to a wheel chair after a fall from tree a few years ago and sustained a spine injury with hemiplegia and strictures to his urethra, despite the cost of these surgeries in Uganda and his parents poor economic status this kid benefited from the camp and at least got relief from his urinary symptoms. All these beneficiaries where from different remote areas of Kigezi region that could not easily access these services the nearest being in Mbarara City for an approximate of 600 to 900 USD that not all could afford.
    Tuesday day 2 of the camp was the first day for surgeries, a list of 39 patients was produced on Monday for operations. Operations included TURPs transurethral resection of the prostate for patients that had bladder outlet obstruction symptoms and histology sampling, DVIU direct vision internal urethrotomy for patients with urethral strictures, open prostatectomy for patients with grossly enlarged prostates and may not benefit from TURPs, BSO bilateral scrotal orchidectomy for patients whose histology confirmed prostate cancer and one fistulectomy for the patient who had a urethral cutaneous fistula.

This were the strangest operations to me, since it was my first time being exposed to minimal access surgery in my medical journey. I must admit it was a very great opportunity I had here that there were plenty of patients to get me enough exposure. Theatre nurses got to teach me how minimal access surgery technology works, the whole instruments setup, arrangement of equipment and the Urologist doctors taught us (me and DR. Izimba the hospital surgeon) the other technical bit of operating the machine. How ever much emphasis was more to the surgeon since he was to still do these operations even when the camp was done, but I still benefited a lot along side him. By the end of the camp we could TURPs with minimal supervision from the urologist him being the main surgeon and me the assistant. TURPs and DVIU surgeries to some extent raised my interest in urology seeing how easy life challenging symptoms can be resolved with minimal access.

Open surgeries :
This was another interesting bit, I had attended some open prostatectomy surgeries at Luwero General hospital where I currently volunteer, but this was another whole new experience. There were adequate facilities like diathermy, suction machines that made work a lot easier than it was in the public hospital. I also got a chance to learn and independently do BSOs from the camp and I would confidently do one now without any close supervision.

I enjoyed every bit of time in theatre learning, interacting with other theatre staff and the Swiss team Dr. Patrick, Dr. Thomas and Dr. Braun.

After the first Tuesday every morning we always did a ward round for 15 minutes to review patients that were operated before. In earlier training I had, post-operative patients always received prophylactic antibiotics for at least 3 days but all the patients that we operated only received pre-operative antibiotics, this sounded more practical because otherwise what would be the relevancy of aseptic techniques during surgery.

All patients operated at the camp received very close monitoring, quality nursing from the elephant team and nursing students on wards that no serious post-operative complications were registered. At
the time of discharge, you could tell how great their lives were changed, some went an extra mile of trying to thank everyone on the team in English even when they could not speak it perfectly.

Hand outs were printed both in the local language and English will clear illustrations and were pinned all over the walls of the ward to educate these men on the possible unpleasant outcomes of the operations like; bloody urine and dribbling among others and for how long to expect them.

I got a chance to participate in few other surgeries outside the camp. One of them was Open reduction and Internal Fixation of the humorous fractur with the hospital director Dr. Ashaf an orthopedic surgeon, and also got chance to observe a caesarean section done in another better way than we used to do them at Luwero General Hospital and obviously I picked a leaf that I took back home to my fellow pre interns there

    Towards the end of the camp, I was invited to attended the dinner with Dr. Forat, Dr. Patrick, Dr. Thomas, Dr. Ashaf, Dr. Braun, Dr. Izimba and Mr. Barnabus, such a great evening, one of my best in Bwindi for the two weeks. A Restaurant somewhere in the wood with sounds of chimps in the trees seated around a fire place sharing about us outside work and profession, “for the two weeks I didn’t know Dr. Forat cracks jokes too till that evening.” Days before Dr. Patrick and Dr. Thomas had told me about the swiss cheese that I had not tasted before and they were always curious about the facial expression that I will have that evening I will try it. It was actually better than I expected and I nearly finished a plateful. It was a great evening.
    The camp ended a day earlier than planned because Dr. Forat and team had to meet Dr. Asiimwe a urologist at Mulago National referral hospital to discuss about the possible partnership with the urology clinic at Bwindi Community hospital.
    It was ended with a debrief about what transpired in the two weeks’ time, more focus on the negative complements to better the next camps in the future, a few came up but generally it was such a successful camp. The hospital administration gifted all the visiting members with a T shirts and caps of the hospital with celebration of 20 years of Bwindi Community hospital.

I got a whole new different exposure of a medical setting outside what I knew or the previous four months after school, quite advanced and more organized
Made a lot of new friends both at the hospital and in the community, had an exposure of exotic medical practice from the Switzerland team.
Learnt plenty of new skills at hospital, that inspired me a lot to arrange for at least one month of internship at Bwindi Community hospital before my official internship in August
And look forward to attending the camp again in the futuress