Stichting Interplast Holland
Dr Titus Opegu
I am among the 8 Plastic Surgeons in Uganda, a country in East Africa with a population of 45 million. I started my studies in the 1980s, but these were interrupted by insurgency in the Teso region. The people in the Teso region were forced into camps by the government and many lives were lost during this time. I was lucky to have a brother working as a policeman with two small rooms as his accommodation in Naguru, Kampala. I and my siblings plus their families sought refuge here. We were 26 people crowded in his house. It's here that studying became the only hope. Despite these hardships, one of the primary teachers from Teso reminded me frequently of my responsibility, to one day return home to help. (R.I.P Mr Ojangole). And so I excelled in both the Arts and the science subjects. I wanted to be a Forest Ranger like my father. My elder siblings had other ideas! My career path was debated in a family meeting. In the divide, one group wanted me to be an Accountant (easy to earn lots of money) and the other wanted me to be a doctor. The year was 1995. The winners used the emotions of the insurgency, arguing that doctors easily get employment in any city, and or any country.
My undergraduate medical career was influenced by the Cuban doctors who were hired to start and teach at Mbarara University of Science and Technology. They were so creative doctors in a resource-limited setting and I learnt not only how to practice medicine but to take advantage of the side effects of medicines and to use tubes for different purposes to achieve desired treatment outcomes.
Missionaries from the UK and Germany taught us to empathise, to be passionate, and the principles of medicine.
I qualified in 2003, and returned to my place of birth, Ngora Fred Carr Hospital to work.
I noticed that most of the morbidity and mortality in the paediatric and maternity wards was attributed to delayed presentation.
I naively decided to educate the community on this challenge. This bore medical radio talk shows that I do up to date in Kumi. I learnt that the real problem was not only ignorance on the value of early presentation but also poverty. Through the medical radio talk shows patients began seeking for my help in my two incomplete rented rooms. They came with various medical conditions; but the following conditions stood out; incomplete abortions, babies convulsing, obstructed labour, severe malaria, and acute abdomens. Was forced to start a small medical centre that I supported with my monthly salary. USAIDS (Strides project) came to the rescue and built a labour suite and an Outpatient department.
Eight years into this, a new challenge of motorcycle accidents arose. This new mode of transport on poor roads caused many injuries. I had many failed tendon repairs, large wounds with exposed bones and I needed to acquire new skills to be of help. Masters in general surgery was the answer. I joined this study program in 2013. I struggled due to a lack of financial support (no salary and no sponsorship) yet in a week there was hardly time to rest or study. In Europe at least the students can take a loan and take on extra employment to earn. In Uganda and most African countries; it's impossible. I had to pay my own tuition and take care of my young family, then, 3 children and 3 adopted children. My mother was also becoming weak (R.I.P). I performed poorly. Little was known about plastic surgery by the trainers. It was perceived as an easy speciality of doing earlobe keloid excisions and skin grafting. So I decided to pursue this discipline. I got a Smile Train sponsorship.
I was very happy and informed my friends of the new discipline I was joining proudly, with little knowledge that the speciality was the widest in Surgery. I was in shock to learn that it was from hair to toe. Having informed colleagues with the excitement of the sponsorship, there was no turning back. I studied and slept in the wards like a patient, 5 days a week.
Most challenging, was that we had only two teachers. Our two teachers had to train the undergraduate, postgraduate and fellows as well. They also had to do administrative work and above all attend to the overwhelming numbers of patients. I had an opportunity to learn from Dr Zeeman who started the burns and reconstructive unit and the discipline in Uganda. He was dedicated and loving. He passed on at the beginning of the COVID-19 pandemic. It was dark in the department and there was uncertainty.
Prof Corstiaan Breugem who Dr Zeeman had earlier appointed as his successor and the chairman of Stichting Interplast Holland took on his role. There were expectations for him to deliver on. Prof Corstiaan cleverly eased into his roles. First, he introduced digital Zoom meetings that were educative and allowed us to know each other. Yes, he was inevitably compared with Dr Zeeman but he dealt with this admirably, with his own leadership skill set. Dr Kalanzi Edris the head of the department supported the Zoom meetings and ensured presentations were done. Zoom meetings supplemented our learning. My evaluation of patients improved with the zooms. After a few months, Prof Corstiaan and Dr Jenda Hope came to Uganda for the first time following the Covid 19 pandemic. Our first theatre day saw most of the team working with Dr Jenda. The team knew her; she had come before as a Resident. So one theatre room was left empty and I had no option but to operate with Prof Corstiaan. It was my first time to assist a professor. Trapped and terrified to the bone! I guess Prof Corstiaan saw this! He asked if I was conversant with cleft surgery. The answer was no, but I informed him of my experience in assisting and working on clefts with my teacher Dr Alenyo Rose. Prof Corstiaan was knowledgeable (wisdom is the word) and skilled; but also had a pleasant way of teaching. It seems to be a culture for the Dutch people. We reconstructed 6 cleft patients and I learned. He explained every step and asked few questions. I didn't want him to leave my country after this experience.
I wanted to be his friend but I was only a Resident and in Uganda these relationships do not always flourish as the supervisors are almost always "Unapproachable Boss". Our relationship was different and he nevertheless was taking the initiative as I was careful to take my luck.
Then, in the last year of my residency, he pulled off three memorable surprises. First, he brought me a Humby knife, one of my treasured useful gifts. He asked me about my plans during this moment of excitement and I bloated out with joy that I wanted to return to Kumi (my home in Eastern Uganda) to practice Plastic Surgery. His answer was an instantaneous no. He recommended I stay in Kiruddu Hospital.
The second surprise came the same day; he invited me to the Netherlands!
The third was his flight to my graduation ceremony where I had no one to share my joy with physically; No words to explain these great moments of my life.
Dr Titus Opegu. You can support this through Stichting Interplast Holland or through Prof Corstiaan Breugem Amsterdam Medical Centre (AMC).
