Outcome of major trauma at Mulago Hospital in Uganda. Assessment using the TRISS methodology

A prospective study of 150 patients presenting with major trauma (ISS >15) at  Mulago Hospital, Kampala over a period of 11 months starting from 1"' February 1998 was undertaken with the main objective of determining the trauma outcome using the TRISS methodology. Injury severity scores (ISS), Revised Trauma scores (RTS), age, sex, cause of trauma, investigations performed and treatment given were recorded. Using the TRISS methodology, and basing on the major trauma outcome study (MTOS) norms of North America, PRE-charts were construited to determine the outcome. Patients' follow up was Limited to two weeks. Autopsies were done for patients who died during the study period. The study population included 132 males and 18 females. Seventy-four percent of the patients were aged less than 40 years. The majority (86.7%) of the cases sustained blunt injuries.  Road traffic injuries accounted for 75% of the cases and these were followed by assaults in 21% of the cases. The mean ISS for the survivors was 20 and 29 for  non-survivors. There were 39 deaths (26% mortality rate), 25 (64.1%) of which were unexpected using the TRISS methodology. Of these 24 were deemed  preventable by peer review The following statistics were obtained: 2=6.838, W=14 and M=0.719, indicating that the performance of Mulago Hospital in trauma care  was worse than expected basing'our assessment on the North American standards. The leading causes of death were intracranial haematoma (46%) and haemorrhagic  shock (41%). Twenty-three (59%) of the death occurred on the frrst day of injury. Missed injuries contributed 13 (54%) of the preventable deaths. In conclusion, major trauma outcome in Mulago Hospital is far below expectations using the MTOS trauma outcome norms. Most preventable deaths were due to missed injuries.Key words: Trauma, outcome TRISS methodology

Improving Recruitment of surgical trainees and Training of Surgeons in Uganda

Background: The surgical work output in Uganda is qualitatively and quantitatively inadequate. The number of surgeons is estimated at 100 for a population of over 26 million Ugandans. Thispaper reports on how to improve recruitment of surgical trainees and training of surgeons in Uganda, focusing on perceptions of potential trainees, trainers, and medical administrators.Methods: This was cross sectional, descriptive study sampled at least 50% of each of the relevant category of interviewees. Self-administered questionnaire and focus group discussions were used tocollect data, which was analyzed manually using a master sheet. It was approved by the Ethics and Research Committee.Results: Paediatrics and Public Health were rated as the disciplines of choice for postgraduate training in Uganda. The reasons why potential trainees would shy away from specialized surgical training were excessive workload, risk of catching HIV/AIDS, low financial returns and a poorlearning environment. The major bottlenecks in surgical training, which were cited, included inadequate number of scholarships, inadequate supervision by trainers, inadequate facilities and poor work conditions for trainers.Conclusion: The remedies to this complex problem revolve round providing more resources, (human, materials, money), improving supervision by the trainers, advocacy for an evidence basedcurriculum content and availing more funding into the Medical Education sector to improve Human Resource for Health development

Is a PhD a necessary requirement for lecturers in a`Medical School? Report of a survey

Background: Makerere University introduced a new policy1 on the minimum qualification for appointment to a lecturer teaching position and eligibility for subsequent promotions. The highlight of the policy is a requirement for a PhD or equivalent as the minimum qualification necessary for appointment to a lecturer position and above.As a result of this policy fewer and fewer members have shown interest or indeed joined the Faculty of Medicine teaching staff roll.Objectives: This study set out to investigate the perception of the faculty and the impact of the policy on staffing.Methods: Literature review, oral and a questionnaire interviews were used to gather data. Participants included current members of teaching staff (of biomedical sciences and clinical disciplines) postgraduate students and visiting overseas academic staff and adjunct staff employed by the Ministry of Health at teaching hospitals.Data collected was analyzed and summarized in tabular form.Results: A PhD or equivalent is required as a minimum qualification to join academic positions at lecturer level and above at Faculty of Medicine and subsequent promotion to higher positions. There was a significant lag in promotions and recruitment in the Faculty of Medicine compared to counterparts employed by the Uganda Ministry of Health at the teaching hospitals. Participants expressed strong views that a PhD or equivalent should not be a minimum requirement nor should it be a prerequisite for promotions though it should be encouraged. Policy documents from other universities did not require a PhD or equivalent qualifications as a minimum requirement for appointment to the academic ranks of those institutions.Conclusion: Whereas it is desirable for the academic staff to acquire a PhD, it should not be a mandatory requirement. The policy was not in the best interest of the Faculty of Medicine and may not be for other medical schools to impose that requirement for appointment or promotion.University policy makers should consider schools of medicine as an exception to the policy requiring a PhD or equivalent as minimum requirement for teaching at a Medical School

The Burden of Hand Injuries at a Tertiary Hospital in Sub-Saharan Africa

Background. Hand injuries are common worldwide and lead to heavy financial losses in terms of treatment, job loss, and time off duty. There is paucity of data on hand injuries in sub-Saharan Africa. The aim of this study was to determine the burden and early outcomes of hand injuries at a tertiary hospital. Method. A descriptive prospective study. Eligible patients were recruited over 5 months and followed up for four weeks. Pain, nerve function, and gross functions of the hand were assessed. Results. In total 138 patients were enrolled out of 2940 trauma patients. Of these, 122 patients returned for follow-up. The majority of the patients were males (83%). Mean age was 26.7 years (SD 12.8). The commonest places of injury occurrence were the workplace (36%), home (28%), and on the road (traffic crushes) (23%). Machines (21.3%) were the commonest agent of injuries; others were knives (10%) and broken glass (10%). Sixty-three (51%) patients still had pain at one month. Conclusions. Hand injuries accounted for 4.7% of all trauma patients. Road traffic crushes and machines were the commonest causes of hand injuries. Men in their 20s were mostly involved. Sensitization for prevention strategies at the workplace may be helpful

Improving recruitment of surgical trainees and training of surgeons in Uganda

Background: The surgical work output in Uganda is qualitatively and quantitatively inadequate. The number of surgeons is estimated at 100 for a population of over 26 million Ugandans. This paper reports on how to improve recruitment of surgical trainees and training of surgeons in Uganda, focusing on perceptions of potential trainees, trainers, and medical administrators. Methods: This was cross sectional, descriptive study sampled at least 50% of each of the relevant category of interviewees. Self-administered questionnaire and focus group discussions were used to collect data, which was analyzed manually using a master sheet. It was approved by the Ethics and Research Committee. Results: Paediatrics and Public Health were rated as the disciplines of choice for postgraduate training in Uganda. The reasons why potential trainees would shy away from specialized surgical training were excessive workload, risk of catching HIV/AIDS, low financial returns and a poor learning environment. The major bottlenecks in surgical training, which were cited, included inadequate number of scholarships, inadequate supervision by trainers, inadequate facilities and poor work conditions for trainers. Conclusion: The remedies to this complex problem revolve round providing more resources, (human, materials, money), improving supervision by the trainers, advocacy for an evidence based curriculum content and availing more funding into the Medical Education sector to improve Human Resource for Health development

Outcome of major trauma at Mulago Hospital in Uganda. Assessment using the TRISS methodology.

A prospective study of 150 patients presenting with major trauma (ISS >15) at Mulago Hospital, Kampala over a period of 11 months starting from 1st February 1998 was undertaken with the main objective of determining the trauma outcome using the TRISS methodology. Injury severity scores (ISS), Revised Trauma scores (RTS), age, sex, cause of trauma, investigations performed and treatment given were recorded. Using the TRISS methodology, and basing on the major trauma outcome study (MTOS) norms of North America, PRE-charts were constructed to determine the outcome. Patients' follow up was limited to two weeks. Autopsies were done for patients who died during the study period. The study population included 132 males and 18 females. Seventy-four percent of the patients were aged less than 40 years. The majority (86.7%) of the cases sustained blunt injuries. Road traffic injuries accounted for 75% of the cases and these were followed by assaults in 21% of the cases. The mean ISS for the survivors was 20 and 29 for non-survivors. There were 39 deaths (26% mortality rate), 25 (64.1%) of which were unexpected using the TRISS methodology. Of these 24 were deemed preventable by peer review. The following statistics were obtained: Z=6.838, W=14 and M=0.719, indicating that the performance of Mulago Hospital in trauma care was worse than expected basing our assessment on the North American standards. The leading causes of death were intracranial haematoma (46%) and haemorrhagic shock (41%). Twenty-three (59%) of the death occurred on the first day of injury. Missed injuries contributed 13 (54%) of the preventable deaths. In conclusion, major trauma outcome in Mulago Hospital is far below expectations using the MTOS trauma outcome norms. Most preventable deaths were due to missed injuries

The Burden of Hand Injuries at a Tertiary Hospital in Sub-Saharan Africa

Background. Hand injuries are common worldwide and lead to heavy financial losses in terms of treatment, job loss, and time off duty. There is paucity of data on hand injuries in sub-Saharan Africa. The aim of this study was to determine the burden and early outcomes of hand injuries at a tertiary hospital. Method. A descriptive prospective study. Eligible patients were recruited over 5 months and followed up for four weeks. Pain, nerve function, and gross functions of the hand were assessed. Results. In total 138 patients were enrolled out of 2940 trauma patients. Of these, 122 patients returned for follow-up. The majority of the patients were males (83%). Mean age was 26.7 years (SD 12.8). The commonest places of injury occurrence were the workplace (36%), home (28%), and on the road (traffic crushes) (23%). Machines (21.3%) were the commonest agent of injuries; others were knives (10%) and broken glass (10%). Sixty-three (51%) patients still had pain at one month. Conclusions. Hand injuries accounted for 4.7% of all trauma patients. Road traffic crushes and machines were the commonest causes of hand injuries. Men in their 20s were mostly involved. Sensitization for prevention strategies at the workplace may be helpful

Student and Tutor Perception of a New Problem Based Learning Curriculum at Faculty of Medicine, Makerere University

Background: The Makerere University Faculty of Medicine started the implementation of the Problem Based Learning/Community Based Education and Service curriculum for incoming students in the academic year 2003/2004. It undertook an intense preparatory period of 2 years before implementation, which included sensitizing, and training tutors to take their new role. Objectives: To evaluate student and tutor perception of the New PBL Curriculum at the Faculty of Medicine and to evaluate tutors perception of how well the students were doing. Methods: The study was at the end of the first semester, after seventeen weeks of the new curricula implementation. A 19-item questionnaire was self-administered by the students. An open discussion led by one of the investigators followed that questionnaire filling session. A 5-point likert scale was used to rate the different aspects. A different questionnaire was administered to the 35 academic staff that had tutored the twenty tutorial groups of eight to ten students each. The data collected from the two questionnaires was analyzed using SSPS software. The Faculty Research Committee approved the study. Results: Out of 180 students, 135 students filled in the questionnaire. In addition 25 tutors out of 35 filled in their questionnaire. The tutors’ facilitation of the tutorials was rated highly by the students. Students’ rated their (students’) participation in the tutorial process as excellent. The students rated access to learning resources as inadequate and they were anxious as to whether they were learning enough. On the other hand the tutors were satisfied with the depth and scope of the discussions by the students. The majority of the tutors thought it was the right move to introduce PBL. They were however concerned about sustainability of the novel educational reform (PBL). Conclusion: The students perceived the new method as acceptable. They expressed anxiety and uncertainly as to whether they were learning enough. And whereas the students were not sure they were learning enough, the tutors were satisfied with the depth of knowledge exhibited by the students. To sustain the reform tutors’ concerns and fears ought to be addressed