Wednesday, November 23, 2011

Otolaryngology in Mbarara, Uganda

Otolaryngology in Mbarara (1 of 3)

As travel goes, the trip to Mbarara, Uganda, had a bit of everything. There was delay in Kigali due to an airplane crash on the Entebbe runway, failure of my hotel shuttle to pick me up (with several taxi drivers unexpectedly unwilling to take me), and the theft of some of my medical equipment out of my checked luggage somewhere in-transit. But there was also the stunning 5-hour drive from Entebbe to Mbarara and conversations with the driver about traditional medicine in Uganda, the role of foreign mzungu doctors, and the Ugandan soccer team that barely lost a birth to the Africa Cup by 1 point to rival Kenya. The drive also gave me a chance to take in the warm, visibly tropical environment of southern Unganda as we crossed the equator and catch a glimpse of Zebras as we passed close to Lake Mburo National Park.

I've arrived in Mbarara as an otolaryngology resident given the opportunity to spend 2 weeks learning about ENT Surgery in Uganda and also with hopes of exploring possible future research and educational collaborations with Mbarara Univerisity of Sciences and Technology (MUST) and the affiliated Mbarara Regional Referral Hospital. Mbarara is home to approximately 150,000 residents with 500,000 people in the surrounding area. Mbarara Hospital serves as a major referral hospital for all of southern Uganda with an even larger catchment of unknown numbers that at times includes patients from northern Rwanda, Tanzania, and the Congo. As a hospital, it offers two operative theaters, two-four ICU beds, multiple over-crowded adult wards (by most accounts), and roughly 6000-7000 pediatric admissions to the pediatric ward each year. There are currently plans in place to build/open a new hospital that will reportedly offer 8 ORs and greatly improve the capacity to accommodate the large inpatient volume, expected to be completed next year.

By the numbers, otolaryngology in Mbarara is easily considered a needed specialty. Mbarara Hospital has 1 staff otolaryngologist, who has been a different cuban otolaryngologist every 2 years for some time now. This makes the ratio of ENT surgeons to population in Mbarara is very similar to that of the national average in Uganda of 0.06 ENT surgeons per 100,000 people (based on a 2009 study), which is remarkably lower than the 1:100,000 ration in the UK and the approximately 3:100,000 ration in the US.
Over the past several years, however, MUST has been trying to alter this deficit in ENT surgeons by starting a residency program with the goal of training and retaining otolaryngologists to serve southern Uganda. There is currently one resident in her post-graduate year three of four years with hope of bringing in a second resident soon.

Having arrived in Mbarara, with this background in mind, I am very excited about the days ahead.

Kyle Chambers, MD - PGY-2
Harvard Combined Program in Otolaryngology-Head & Neck Surgery

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