pediatric surgery at mbarara regional referral hospital (mrrh)/ mbarara university of science and...
DESCRIPTION
Activities Clinical services (to patients), both Outpatient and inpatient Teaching (students, residents) Research 1/19/20163TRANSCRIPT
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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