Chairman’s report Oct 2021
The most important message from this year oct 20 – oct 21 is that despite Covid, UCIF are continuing to support childbirth injury repair in Uganda. An amazing 234 operations were undertaken in this difficult year, with one of the UCIF international staff present at over half and an excellent job done overall by our Ugandan colleagues.
The other notable achievement for this year for Ishbel Campbell, I s the publication of her manual of nursing care for childbirth injury patients. Publication was shared with FIGO (Federation International of Gynaecology and obstetrics) and they have now distributed it to 66 different registered fistula surgeons in 44 different countries. It is currently being translated in Portuguese and French. During the course of this year, we have seen it used as an excellent teaching tool and been impressed at the fast learning of the nurses using it.
Activity:
Mubende and Hoima, November 2020
These 2 camps were run with some restrictions on numbers due to the lockdown. Nonetheless, Dr Alphons Matovu and Dr Ian Asiimwe managed to treat 30 women with fistula and x with other conditions. They noted that the number of fistulae seems to be on the rise again with poor access to help in childbirth during the strict period of lockdown.
Kitovu Jan 2021
Unfortunately none of the UCIF international surgeons, nor Dr Michael Breen were able to travel to Uganda in January 2021. Nonetheless, Dr Nabukalu and her team did manage to put on a camp with sponsorship from UCIF. Dr Ian Asiimwe attended, working alongside Dr Florence as per their summary below:
OBSTETRIC FISTULA NARRATIVE REPORT FOR THE 1ST CAMP OF 2021 FROM 3RD – 17TH JANUARY 2021 The first camp of 2021 took off immediately on the arrival of Dr Asiimwe Ivan (Fistula Surgeon from Hoima Hospital) who was joined by Sr Dr Nalubega Florence (Gynaecologist, Fistula Surgeon from Kitovu Hospital) and Dr Kayondo Moses (Fistula Surgeon from Mbarara Referral Hospital). Those three surgeons are among the surgeons trained by our senior consults at Kitovu Fistula Training Program. There were 5 trainees: Dr Kaijamurubi Gregory, Dr Kato K. Paul, Dr Musanje Mathius and two Nurses from Kitovu Hospital. The assessment of patients was done by the 3 surgeons and the trainees throughout the camp. This camp was mainly sponsored by Uganda Child Birth Injury Fund….We appreciate all our funders, they came at the right time as the prices of transport and feeding have been VERY HIGH due to Covid 19 Pandemic, restrictions.
Total number of women: operated 57.
Kamuli March 21
A very successful camp was held in March in Kamuli. Ishbel Campbell attended the camp on behalf of UCIF. Unfortunately due to travel restrictions caused by covid the rest of the team were unable to join the camp. Dr Ian Asiimwe our Ugandan colleague was lead surgeon for the camp and had 3
surgical trainees to assist him. Dr Fiston, Dr Margaret and Dr Bonnie the Kamuli medical superintendant. Over 40 women were operated on during camp. Uganda Village Project provided food and transport money for the patients. The nursing team was lead by the fistula nurses, Joan and Joanita who are currently in training to become fistula nurse trainers. Sister Rose, Rebecca and Justine completed the nursing team on the ward. It was a very successful camp, run very well by our Ugandan colleagues with an enjoyable evening of food and speeches to celebrate the success of the camp on the last night.
A follow up camp was planned for June, but this had to be cancelled at short notice as Uganda went into strict lockdown.
October Kamuli/Kagadi/Kyangwali
October saw a welcome return to fistula camps for Mhairi Collie and Ishbel Campbell. The team were joined by Isbeal Uttley, volunteer. Despite delays from visas and COVID paperwork for Mhairi and Isbeal, everyone came together in Kamuli. The camp was run by Dr Ian Asiimwe, who had brought 2 senior trainees - Dr Medeyi Vincent and Dr Tinka Anna. Dr Bonny Ssere and Dr Margaret from Kamuli were also in attendance. Nurses Ishbel Campbell, Joan Nabbgala and Juanita ran an excellent nurse training program for 4 local nurses (Cissy, Immaculate, Maureen and Rebecca) using the superb Nurse training manual written by Ishbel and recently published. Most nurses need training programs at 2-3 camps to achieve competence in fistula care.
It was a very busy camp with 46 patients having operations, of which 26 were fistula. At the end of the camp, 22 of these patients were dry. There were also 13 patients with faecal incontinence treated successfully with perineal reconstruction. There were 2 other notable patients - one lady who had had a colostomy for 17 years. She was unsure as to why she needed it then and was having a terrible time managing it, using rags only - no colostomy bags available. Her husband left her because of it, and she was unwelcome in society, being always dirty with a bad odour. She had a fairly major operation to reverse it, but recovered well and was then able to pass stool normallyfirst time for 17 years!
The second lady had a condition which caused her to have a blind vagina, incapable of sexual relations and unable to marry. she had a new vagina made from a part of her bowel by Dr Asiimwe and Dr Collie - another very big operation, but she recovered well. She will be closely followed up to see how successful this is longterm.
Kagadi
The Kagadi camp ran for the week beginning Sunday 17 October. This venue was chosen for camps as it is currently very difficult to find enough beds available for camps in the hospitals in Mubende and Hoima. A new theatre bed and trolley were required to be able to run the camp while allowing for emergency Caesarean sections etc to carry on as well. This equipment was sourced by dr asiimwe, funded by ucif, and will be used for many other camps in Kagadi.
There was an international team of surgeons including senior trainees from Congo, Somaliland, Kenya and Uganda. It was very inspiring to see all of these surgeons learning techniques in repairing patients - knowledge which they will take back to their home countries to treat patients there. The nurse training program progressed very well with 6 new trainee nurses and Ishbel very pleased
with their quick learning. Isbeal Uttley was invaluable in undertaking the patient transfers from theatre to ward and in helping in theatre.
In terms of cases, there were a huge number of patients treated for faecal incontinence (27), as well as 11 urinary incontinence, including 8 fistula, 3 prolapse cases and one more very young woman who had lost her reproductive organs and most of her vagina following a disastrous childbirth with a ruptured uterus, age only 16. She had a new vagina created from bowel - again a major operation, but one from which she recovered well. The camp went well with very full days to get all of the work done. There were a few extra prolapse cases which could not be accommodated; these ladies were planned for treatment in Mubende in the next few weeks. Challenges to working in Kagadi include insufficient theatre gowns, such that only the operating surgeon could wear a gown and no one for tear operations. Also, there were terrible scissors outside of the special vvf packs, incapable of cutting and no sheets or gowns for the patients, leaving them naked in theatre. We will endeavour to address these challenges and await quotes from Dr Matovu to see how we can assist with future camps.
Kyangwali
The smaller team of Dr Asiimwe, Dr Collie, Ishbel Campbell and Isbeal Uttley then moved on to Kyangwali UN refugee settlement for a final camp. 120 000 refugees are in the settlement, some of whom have been here since the 1970s. Most are from Congo, some from Rwanda and Sudan. Vehicles sponsored by USAID travel around the settlement’s terrible potholed clay roads and bring patients to a small hospital just outside the boundary for treatment as required. The hospital is so small that there is almost no room for the usual emergency and obstetric patients to recover, with beds jammed against one another in the ward. UCIF has donated a large semipermanent tent to be erected on hard standing outside of the ward and used as extra ward space, for camps as well as for general postoperative patients.
In the ward, 2 of the nurses who had undergone training at Kagadi showed excellent organisational skills as well as understanding of the niceties of nursing fistula patients. Teaching of 3 other nurses continued at Kyangwali. Ishbel felt that the standard of nursing care was very high.
Within theatre, 15 cases were done, including 2 fistula and 5 tears. The 3 medical officers who work at the hospital attended for general surgical training and to assist in the cases. There was one case of post operative bleeding who had to return to theatre, but was fine after that. There were no other issues.
2021 remainder
Two further camps are planned by Dr Matovu and Dr Asiimwe in the next 2 months.
There remain many women with life altering injures from childbirth requiring assistance in Uganda. Poor access to hospitals and healthcare during the lockdown has certainly exacerbated the problemour UVP colleagues looking for and looking after fistula patients in the rural areas confirmed that they have many more cases awaiting the next camp, and many of these are teenagers.
Summary
Despite Covid problems, a lot of work has been done this year, something to be proud of. The country has suffered significantly from Covid, and also from the poor access to hospital during lockdown. All reports suggest an increased incidence of childbirth injury.
The publication of Ishbel Campbell’s nursing manual has been a huge boon this year, and will continue to be vital in improving nursing care for fistula patients in Uganda and throughout Africa.
We are forging ahead with the nurse and surgeon training programs as part of our long term vision. We hope that 2022 will see more work done by Ugandan and international teams in concert, more training opportunities for young Uganda nurses and doctors and fewer covid related problems.
2022 plans
For 2022, we hope to run 2 camps in Kamuli, 2 in Kagadi, and 2 others venue to be decided between Mubende, Mbale and Fort Portal. We also expect to sponsor the January Kitovu camp. We are working with Dr Matovu and Dr Asiimwe on addressing the perennial problem of bringing trainees on to standard and then advanced level. There are still only a few people around with the necessary surgical skills as well as the drive to undertake this challenging work. We need to do all we can to support them educationally and financially so that this vital work can continue and that these patients, surely amongst the world’s most unfortunate and miserable, can be treated.
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