Measuring Head Trauma Outcomes and Neurosurgical Capacity Building in Mbarara, Uganda

Patrick Codd, M.D.
Neurosurgery, MGH

Site: Mbarara University of Science and Technology, Mbarara, Uganda

As part of an ongoing effort to build a collaboration between the neurosurgery departments of MGH and MUST, I have been working with Dr. David Kitya to improve neurosurgical capabilities within this hospital.  Dr. Kitya was recently hired to assist with care of the extrodinary number of head trauma patients witnessed by the MUST hospital as the result of bodaboda (motorcycle) and car accidents, as well as care for the general neurosurgical needs of the community.  He has been exceptionally welcoming, and we have worked for the last week on several issues.

First, the neurosurgical drill (including cranial perforator and craniotome) generously donated by Stryker and deliered to MUST by several of my resident colleagues over prior visits, appears to have broken.  This has left Dr. Kitya using Gigli saws and Hudson brace perforators to perform craniotomies, with variable success.  I spent last week trouble shooting these devices, and we determined that several of the components may have been improperly cleaned resulting in electrical shorts and instrument failure.  We have devised a plan to 1.  return the broken components to the US for repairs prior to them being delivered back to MUST, and 2.  to create simplified and readily available instructions for proper cleaning and handling procedures to help prevent the issue in the future. 

Also, we have been working to fine tune the record keeping for head trauma patients presenting to the hospital in order to quantify not only patient outcomes, but to objectively track the benefit or lack therof in introducing the electrical surgical drill and other instrumentation into the the equipment list of this hospital.  Dr. Juliet, an extremely capable senior surgical resident at MUST has taken on the task to tracking these data and we will continue to support her work.

It is anticipated that this coming week will bring several operative cases that have been awaiting the completion of the new operating theaters.  Updates and pictures will be pending.

Measuring “illness” and treatment-seeking behavior in rural India: a qualitative study of malarial infection among marginalized populations, Gadchiroli, Maharashtra, India.

Radhika Sundararajan MD PhD
Harvard-Affiliated Emergency Medicine Residency
PGY-3

My data collection in Gadchiroli District has come to an end for this year, and am now heading back to Boston to start the data analysis phase. It was quite an experience living and working in rural India during the monsoon season, battling mosquitoes, avoiding poisonous snakes, learning to have patience for power cuts, slow (and often non-working internet), phone service outages and learning to tolerate the overall dampness of everything I owned. Besides the innumerable lessons that came with each day of qualitative research, rounding in the rural hospital, and shadowing the physicians in outpatient clinic, I even learned that mold can actually grow on the outside of a suitcase and that DEET does not appear to deter the robust mosquitoes in this area. I will miss the lush greenery of forests, and rice paddies dotted with bright sarees and livestock. I am, however, looking forward to sleeping in my warm, dry bed. 

Our qualitative study of malaria infection and treatment-seeking practices among rural tribal communities led us to speak with over 80 people in this area, learning more about how malaria is conceptualized, knowledge is created, and disease treated (or not treated), from perspective of patients, health providers, community health workers and district health officials. This is a rather large sample for a qualitative study! I was privileged to carry out this important work in collaboration with the spectacular NGO, SEARCH (http://www.searchgadchiroli.org/), through which a tribal hospital and rural health outpatient clinics have been established, as well as a mobile medical unit which visits remote villages on a weekly basis to provide medical care. I look forward to returning to Gadchiroli next year to carry out the next phase of our project, which will be developed based on the results from this year's data collection. I have been assured that the climate is much more dry outside of the monsoon!