The massive KLM plane got in the air majestically and landed in Amsterdam at 10.09 am. We were warmly welcomed by Annemarie, Professor Corstiaan Breugem, and Stephen; the leaders of Stichting Interplast Holland. It was raining and cold on our way to Gouda City, our new home. The temperature was 13 degrees Celsius compared to our coolest of 17 degrees Celsius in Uganda. The sunlight stayed on up to 9.30 pm rather than the 6 pm I am accustomed to. My evening activities were prolonged unknowingly.
On Sunday, Annemarie equipped us with sim cards, travel cards, and sports shoes in preparation for the two-week program. Gouda was toured in the company of Dr Jenda. The walk on the streets showcased buildings of the 18th century (in Uganda, these are our latest). The tarmac streets were clean, with their security manned by hidden police cameras. There were no local guards as it's in Uganda. Expensive branded cars were parked outside, and the houses are valued at one (1) million euros! and the ones in Amsterdam much more.
In the Netherlands, sports shoes help with running to keep time. Everything is on time; trams, trains, and metros. People know the time it takes them to walk, ride, or drive to the train station. Being our first time, it took us one minute to figure out the terminal and four minutes to get there, usually by running. Missing the planned train was common, and the wrong destinations were taken. Our credit cards ended up needing to top up daily to the irritation of Stephen.
Our first train experience was to Amsterdam Medical Centre (AMC), a shockingly large hospital. Maybe five times the size of Mulago, the biggest hospital in Uganda. It was clean with shopping malls and restaurants incorporated inside. The executive single spacious rooms (wards) had loads of new tech equipment, and the shelves were heavily laden with medicines and sundries. Medicine pumps were the norm for the administration of parenteral medicines. The nurses most of the time were making entries to computers. Restricted areas like theatre and administration needed a card to access. Every department had a coffee dispenser with different flavours for the employees. The changing room to theatre had excesses of theatre shoes, changing clothes, caps, and masks. These things are scarce in Uganda and the theatre in- charge apportions these to select staff. Students have to carry these daily from home, and because most of the theatre-changing clothes are worn out; most Surgeons also carry theirs. The theatre rooms were spacious. There were shelves of stitches on a wheel trolley that can only march what is in the store of a hospital in Uganda on a good day. There were four (4) vital sign monitors with large screens and two anesthesiologists assisted by two trainees. There were portable X-ray and C-arms in theatre. There was no paperwork, and documentation was computerized. The surgeons take a coffee break as the patient is anaesthetised.
In Uganda, most of the equipment is imported from China, is of poor quality, and is prone to malfunction. Most times, one anaesthetic officer (nurse trained to give basic anaesthesia) manages two theatre rooms by administering spinal anaesthesia in one room and on the other general anaesthesia The surgeon can't operate without taking keen interest in the patient's vitals and fluid administration, which are not pump controlled. With general anaesthesia, the surgeon has to be actively involved in the intubation process, and at times, the surgeon intubates. The surgeon has to be on standby as the patient wakes up from general anaesthesia. I have occasionally ungloved to stabilize the patient and then resumed the surgery.
As the operation started, five (5) instrument sets were used to raise a gastrocnemius flap and reconstruct a lower thigh defect.
In Uganda, the surgeon is fortunate to have one complete set with all instruments functional. The tubings that are reused in Uganda were discarded. All the hospitals I visited in the Netherlands had similar abundance in staffing, infrastructure, equipment, technology, medicines, and sundries.
Most of my return journeys to Gouda left me sad and embarrassed with the state of health care in my country. I thought of my inadequacies in knowledge and skills! I wondered how the visiting teams managed to work with our instruments, without coffee breaks, with broken toilets; and the poorly surfaced roads. It was confusing, to say the least. Why was I not forewarned of these differences? I guess my hosts knew no warning could protect me.
Erasmus Hospital in Rotterdam was even bigger. I enjoyed the microsurgery certificate course in the skills laboratory. The learning facilities in the lab were better than those I use in daily patient care in Uganda.
Maasstad Hospital, in my eyes, matched AMC in size and had a burns unit. The burns unit had about ten (10) ICU (Intensive Care Unit) beds and about ten (10) wards equipped almost like an ICU room. There were specially furnished rooms for children. All these rooms were mostly empty. They were ready to receive burn patients. The burns prevention programme must be working, I thought.
In contrast, the only burns unit in Uganda is always crowded, and medicines and sundries are in short supply. It has three (3) malfunctioning monitors that can only record the pulse rate and oxygen saturation. It has no ICU and most of the patients with more than 60% total burn surface area die. Most of the patients that would benefit from admission are managed as out-patients. The unit is understaffed, and this translates into high complication rates and longer hospital stay, and the cycle repeats. This experience left me thinking of how the burns prevention programme can be improved in Uganda. It also gave me more resolve to start a burns centre in Kumi.
My wife is passionate about mothers and newborns. Her parting words as I left for the airport were the mortality rate of mothers giving birth and the neonates. "There are 15 mothers dying daily during childbirth. And there are 190 neonates dying daily. Please bring something new in this field, as well!".
The postnatal wards in Maasstad Hospital had similar equipment ready to care for the mother and child. There were special rooms for twin mothers, triplet mothers, and quadruple mothers that had not been used for months but with equipment and staffing. Most of the ordinary postnatal rooms were also empty. I felt like copying and pasting these maternal facilities to Kumi for my wife.
Helma dropped her uniform off to an automated computerized machine for cleaning, as we exited Maasstad Hospital!.
If I were born in the Netherlands, I would probably be living in Leiden city. It was serene and quiet with interruptions of landing planes in clear view. Leiden Medical Centre was equally beautiful. For the first time, I wanted to stay in the Netherlands. Elles was kind, organised, and passionate about the equipment and sundries under her care. Professor Corstiaan had a cleft palate set prepared for me. I had been struggling to reconstruct cleft lips and palates without proper instruments. I was over the moon because this will go a long way in improving my surgical outcomes for this category of patients.
Having lunch with the widow of Dr. Zeeman inspired me. She was part of the people behind plastic surgery in Uganda. I couldn't control my emotions at her frail health and the memories we shared.
Having dinner with Lydia's family was emotional as it highlighted the plight of African surgeons. They are overwhelmed with the number of surgical cases. They deal with medical ethical dilemmas on a daily basis when it comes to deciding who gets an operation with the limited resources. My decision to operate on a patient is guided by the impact of my surgery, i.e., will the patient recover productivity long-term and the resources it takes to bring total cure or improved productivity. Lydia asked for a favour from me to put a syndromic child with tetralogy of fallot on priority list for surgery through my colleagues in Heart Institute. My answer is your wild guess. Lydia, a medical student from Erasmus Hospital, met me in Kumi Hospital during her elective placement. She donated medical items to the paediatric ward.
As I packed to return home, I secured my cleft set and the doppler donated by Dr. Jenda to our burns and plastic unit Kiruddu first. This doppler will be the only one for the burns and plastics unit.
I had memorable experiences doing DIEP flap with Dr. Jenda, bilateral cleft lip, double opposing Z - plasty for mucosal cleft palate with Prof. Corstiaan. For the first time, I witnessed ear reconstruction for microtia or anotia by Prof. Corstiaan. The residents from the Netherlands are blessed to learn from many superspecialized plastic surgeons, and I hope they realise this. In Africa, it's a challenge to get more than two plastic surgeons in one country.
Presentations of my experiences created interest among the residents and surgeons from the Netherlands. They were all eager to help. Thank you.
How is it possible to write of my Netherlands experience without sharing my fun time, especially the presents from Annemarie, multiple carefully chosen dinners with Annemarie, the neatly chosen house in Gouda, dinner in New York Hotel, the boat ride with Mattijis, time and coffees with Mattijis, pizza making escapade with profess The massive KLM plane got in the air majestically and landed in Amsterdam at 10.09 am. I was warmly welcomed by Annemarie, Professor Corstiaan Breugem, and Stephen; the leaders of Stitching Interplast Holland. It was raining and cold on our way to Gouda city, our new home. The temperature was 13 degrees Celsius compared to our coolest of 17 degrees Celsius in Uganda. The sunlight stayed on up to 9.30 pm rather than the 6 pm I am accustomed to. My evening activities were prolonged unknowingly.
On Sunday, Ann-Marie equipped us with sim cards, travel cards, and sports shoes in preparation for the two week program. Gouda was toured in the company of Dr. Jenda. The walk on the streets showcased buildings of the 18th century (in Uganda, these are our latest). The tarmac streets were clean, with their security manned by hidden police cameras. There were no local guards as it's in Uganda. Expensive branded cars were packed outside, and the houses are valued at one (1) million euros! and the ones in Amsterdam much more.
In the Netherlands, sports shoes help with running to keep time. Everything is on time; trams, trains, and metros. People know the time it takes them to walk, ride, or drive to the train station. Being our first time, it took us one minute to figure out the terminal and four minutes to get there, usually by running. Missing the planned train was common, and the wrong destinations were taken. Our credit cards ended up needing top up daily to the irritation of Stephen.
Our first train experience was to Amsterdam Medical Centre (AMC), a shockingly large hospital. Maybe five times the size of Mulago, the biggest hospital in Uganda. It was clean with shopping malls and restaurants incorporated inside. The executive single spacious rooms (wards) had loads of new tech equipment, and the shelves were heavily laden with medicines and sundries. Medicine pumps were the norm for the administration of parenteral medicines. The nurses most of the time were making entries to computers. Restricted areas like theatre and administration needed a card to access. Every department had a coffee dispenser with different flavours for the employees. The changing room to theatre had excesses of theatre shoes, changing clothes, caps, and masks. These things are scarse in Uganda and the theatre in- charge apportions these to select staff. Students have to carry these daily from home, and because most of the theatre changing clothes are worn out; most Surgeons also carry theirs. The theatre rooms were spacious. There were shelves of stitches on a wheel trolley that can only march what is in the store of a hospital in Uganda on a good day. There were four (4) vital sign monitors with large screens and two anesthesiologists assisted by two trainees. There were portable X-ray and C-arms in theatre. There was no paperwork, and documentation was computerized. The surgeons take a coffee break as the patient is anaesthetised.
In Uganda, most of the equipment is imported from China, is of poor quality, and is prone to malfunction. Most times, one anaesthetic officer (nurse trained to give basic anaesthesia) manages two theatre rooms by administering spinal anaesthesia in one room and on the other general anaesthesia The surgeon can't operate without taking keen interest in the patient's vitals and fluid administration, which are not pump controlled. With general anaesthesia, the surgeon has to be actively involved in the intubation process, and at times, the surgeon intubates. The surgeon has to be on standby as the patient wakes up from general anaesthesia. I have occasionally ungloved to stabilize the patient and then resumed the surgery.
As the operation started, five (5) instrument sets were used to raise a gastronemius flap and reconstruct a lower thigh defect.
In Uganda, the surgeon is fortunate to have one complete set with all instruments functional. The tubings that are reused in Uganda were discarded. All the hospitals I visited in the Netherlands had similar abundance in staffing, infrastructure, equipment, technology, medicines, and sundries.
Most of my return journeys to Gouda left me sad and embarrassed with the state of health care in my country. I thought of my inadequacies in knowledge and skills! I wondered how the visiting teams managed to work with our instruments, without coffee breaks, with broken toilets; and the poorly surfaced roads. It was confusing, to say the least. Why was I not forewarned of these differences? I guess my hosts knew no warning could protect me.
Erasmus Hospital in Rotterdam was even bigger. I enjoyed the microsurgery certificate course in the skills laboratory. The learning facilities in the lab were better than those I use in daily patient care in Uganda.
Maasstad Hospital, in my eyes, matched AMC in size and had a burns unit. The burns unit had about ten (10) ICU (Intensive Care Unit) beds and about ten (10) wards equipped almost like an ICU room. There were specially furnished rooms for children. All these rooms were mostly empty. They were ready to receive burn patients.The burns prevention programme must be working, I thought.
In contrast, the only burns unit in Uganda is always crowded, medicines and sundries in short supply. It has three (3) malfunctioning monitors that can only record the pulse rate and oxygen saturation. It has no ICU and most of the patients with more than 60% total burn surface area die. Most of the patients that would benefit from admission are managed as out-patients. The unit is understaffed, and this translates into high complications rates and longer hospital stay, and the cycle repeats. This experience left me thinking of how the burns prevention programme can be improved in Uganda. It also gave me more resolve to start a burns centre in Kumi.
My wife is passionate about mothers and new borns. Her parting words as I left for the airport were the mortality rate of mothers giving birth and the neonates. "There are 15 mothers dying daily during childbirth. And there are 190 neonates dying daily. Please bring something new in this field, as well!".
The postnatal wards in Maasstad Hospital had similar equipment ready to care for the mother and child. There were special rooms for twin mothers, triplet mothers, and quadruple mothers that had not been used for months but with equipment and staffing. Most of the ordinary postnatal rooms were also empty. I felt like copying and pasting these maternal facilities to Kumi for my wife.
Helma dropped her uniform to an automated computerized machine for cleaning, as we exited Maasstad hospital!.
If I were born in the Netherlands, I would probably be living in Leiden city. It was serene and quiet with interruptions of landing planes in clear view. Leiden Medical Centre was equally beautiful. For the first time, I wanted to stay in the Netherlands. Alice was kind, organised, and passionate about the equipment and sundries under her care. Professor Corstiaan had a cleft palate set prepared for me. I had been struggling to reconstruct cleft lips and palates without proper instruments. I was over the moon because this will go a long way in improving my surgical outcomes for this category of patients.
Having lunch with the widow of Dr. Zeeman inspired me. She was part of the people behind plastic surgery in Uganda. I couldn't control my emotions at her frail health and the memories we shared.
Having dinner with Lydia's family was emotional as it highlighted the plight of African surgeons. They are overwhelmed with the number of surgical cases. They deal with medical ethical dilemmas on a daily basis when it comes to deciding who gets an operation with the limited resources. My decision to operate on a patient is guided by the impact of my surgery, i.e., will the patient recover productivity long-term and the resources it takes to bring total cure or improved productivity. Lydia asked for a favour from me to put a syndromic child with tetralogy of fallot on priority list for surgery through my colleagues in Heart Institute. My answer is your wild guess. Lydia, a medical student from Erasmus Hospital, met me in Kumi Hospital during her elective placement. She donated medical items to the paediatric ward.
As I packed to return home, I secured my cleft set and the doppler donated by Dr. Jenda to our burns and plastic unit Kiruddu first. This doppler will be the only one for the burns and plastics unit.
I had memorable experiences doing DIEP flap with Dr. Jenda, bilateral cleft lip, double opposing Z - plasty for mucosal cleft palate with prof. Corstiaan. For the first time, I witnessed ear reconstruction for microtia or anotia by Prof. Corstiaan. The residents from the Netherlands are blessed to learn from many superspecialized plastic surgeons, and I hope they realise this. In Africa, it's a challenge to get more than two plastic surgeons in one country.
Presentations of my experiences created interest among the residents and surgeons from the Netherlands. They were all eager to help. Thank you.
How is it possible to write of my Netherlands experience without sharing my fun time, especially the presents from Annemarie, multiple carefully chosen dinners with Annemarie, the neatly chosen house in Gouda, dinner in New York Hotel, the boat ride with Mattijis, time and coffees with Mattijis, pisa making escapade with professor's family, dinner in the terrace (with Jenda, Shiosta, Stephen, Joel, and Mythe), beech moments with Dr. Caroline, boys' presents from Jasper Breugem, the gold present for my wife from Mythe, and the nightclub dance.
Lastly, it was great learning that the Netherlands and Uganda are two nations apart in terms of resources and development; as plans for hospitals are made, 300 year considerations need to made; it will take time and support from the more established nations like the Netherlands to achieve health care improvements in Uganda.
Special thanks to Stitching Interplast Holland and Professor Breugem Corstiaan for making this possible.
Dr. Titus Opeguor's family, dinner in the terrace (with Jenda, Shiosta, Stephen, Joel, and Myrthe), beach moments with Dr. Caroline, boys' presents from Jasper Breugem, the gold present for my wife from Mythe, and the nightclub dance.
Lastly, it was great learning that the Netherlands and Uganda are two nations apart in terms of resources and development; as plans for hospitals are made, 300 year considerations need to made; it will take time and support from the more established nations like the Netherlands to achieve health care improvements in Uganda.
Special thanks to Stichting Interplast Holland and Professor Breugem Corstiaan for making this possible.
Dr. Titus Opegu
