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Kisiizi (Uganda)

Aim

The primary aim of the Urolink workshops at Kisiizi Hospital is to train local urologists to perform TURP and to improve patient care.

BACKGROUND: Uganda is a presidential republic in East-Central Africa with an area of around 241,000 square kilometres. It is classified as a low-middle-income country (LMIC) and has a population of 43 million. Uganda is said to contain one of the physically fittest populations in the world, with only 5.5% of people being physically inactive on a daily basis! Average life expectancy is 60 for men and 65 for women. 47% of the population are under 14 years of age; infant mortality is 40 per 1,000 live births. ** (see below for UK comparison)

Church of Uganda Kisiizi Hospital is situated in Rukinguri District south-west Uganda, between Kabale and Rukungiri. approximately 42 kilometres (26 miles) south of Rukungiri, where the district headquarters are located. The bed capacity is 250 plus 10 cots/incubators in the Special Care Baby Unit.

Uganda's healthcare system works on a referral basis. Level I care is provided by voulnteers, level II by nurses and level III by clinical officers. Level IV care is provided by a constituency's "mini" hospital, with more specialist care being provided in a district hospital. There is a national referral hospital at Mulago in the capital, Kampala. Services in public facilities are supposed to be free, but in many cases healthcare is provided dependent upon ex-gratia payments to individuals in the system. There were 0.2 doctors per 1,000 people (2017). ** (see below for UK comparison)

Kisiizi is a fee-paying hospital, although no-one is turned away because of their inability to pay. The fees collected from the patients cover only about 40% of the total hospital expenses. To supplement that income, the hospital operates several other businesses and receives charitable contributions from supporters in Uganda and overseas. The hospital's other businesses include a primary school, a school of nursing, a health insurance scheme and the local power station.
** UK population: 67 million (2019) - UK area: 242,500 sq Km - Life expectancy: M80 / F84 years (2020) - Age demographic: 18% < 14 years (2019) - Infant mortality: 4 per 1,000 (2018) - Doctors per 1,000 population: 2.8 (2018) - https://data.worldbank.org
UROLOGY DEPT: There are two qualified general surgeons (with the urology lead being Dr Robert Mugarura), one obstetric and gynaecology surgeon, two physicians and several medical officers. Dr Ian Spillman, a retired UK paediatrician, is the Medical Director and has introduced governance systems, uptake of WHO checklists and projects on surgical safety. 
HISTORY: Kisiizi is a community hospital, founded by Dr John Sharp, a missionary doctor in 1958, and later taken over by the North Kigezi Diocese of the Church of Uganda. It is one of the 55 non-government hospitals in Uganda and has operated continuously from the day it was founded in 1958. TURP camps are organised by Adam Jones, and this maintains strong links with the Royal Berkshire Hospital, together with The Countess of Chester Hospital. In practice, an involved UK urologist visits Kisiizi approximately every six months. 
OBJECTIVES: The workshops are designed to be predominantly TURP camps and, while they are taking place, all other elective surgery is put on hold. Ultimately, the aim is to train local surgeons to undertake TURP independently.
NEEDS:
  • To expand the range of urological conditions supported other than TURP. As an initial step the first hypospadias camp was held in 2020
  • To continue to support the unit so that it can provide a casemix that makes it an attractive place for junior doctors in training and senior doctors, thereby enhancing recruitment and retention to this rural hospital

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