Scaling up head trauma and critical care capacity in a resource-poor setting: Mbarara Hospital, Uganda (1 of 4)

Saturday, November 5, 2011

My main goal for the 10 days I will spend in Uganda is to help scale up head trauma capacity at Mbarara Regional Referral Hospital in Western Uganda. I have brought along a cranial drill and plan on training the general surgeons and residents in its use. In addition, I plan to look at how the hospital is managing head trauma, and help set up baseline data collection so we can track outcomes and measure the effects of interventions. Finally, I want to contribute to scaling up ICU care, since it is so crucial to caring for head trauma patients, and help establish future collaborations.

Other than a brief visit to Cape Town 8 years ago, this is my first trip to Africa. My first impression is that Uganda is a very young country. During the 5-hour drive from Kampala to Mbarara, I see a lot of kids, teenagers, and young people. Almost no one appears to be over 50. Kampala appears to be a hotbed of economic activity, with a proliferation of every imaginable type of small shop:  mobile phone kiosks, hair salons, bars, convenience stores, produce and meat stands, and furniture sellers. There are goats, chickens, and cows everywhere, often grazing alongside the road. People are carrying enormous loads of wood, water, produce, clothing, and even gas cans on their heads or shoulders, or on the backs of bodabodas (motorcycles) and bicycles. Many of the women also have a small child or two slung over their lower back or stomach. A lot of people are cooking food outdoors on wood or gas stoves.

Before coming here, I already knew that head trauma was a huge issue for developing countries. Here, I get firsthand glimpses of the road safety problem. The road to Mbarara is now officially “paved,” but it often changes to dirt or mud when going through populated areas, with potholes capable of popping off tires on cars or swallowing bodabodas. It is also narrow with almost no shoulder. Nevertheless, it has to be shared by cars and trucks, bodabodas, cyclists, pedestrians, and animals.

Anna R. Terry, MD, MPH
PGY-5, MGH Department of Neurosurgery