Stitching Hope: The Quest for Surgery for all in Uganda

By Kasagga Brian

In Uganda, as in many other developing countries, there is a considerable number of people grappling with surgical illnesses that require assessment or intervention by a surgeon. Unfortunately, a significant proportion of these individuals in need of surgical healthcare lack timely access to affordable and high-quality surgical services in Uganda. 

Over the years, international organizations have flown in teams of foreign doctors to chip away at this high burden of surgical disease through surgical camps. But as more Ugandan doctors have built the capacity in performing surgery, the camps are undertaken regularly in Uganda by Ugandan surgeons. Notably, recent surgical camps in September 2024 in the Ankole region and September 2023 in Lango, organized by the Association of Surgeons of Uganda, spanned over 35 health centers. Reports show that over 20,000 adults were screened for surgical conditions, 6,000 children received eye and ear screenings in Ankole, and 3,657 life-saving and disability-relieving surgeries were performed in both camps over the last two years.

I was privileged to be a part of both teams serving patients at both these camps. And the stories from the patients were quite harrowing.  At the Ankole surgical camp, a retired plumber walked in, his shoulders heavy with the weight of more than just the physical burden he carried. For over eight years, a massive groin swelling had dominated his life. He had spent 1.5 million Ugandan shillings—money he could barely afford—on herbal remedies, clinging to the hope that they would cure what he was told was a hernia. Yet, despite the sacrifices, the swelling grew larger, and his hope dimmed with each passing year. One grandmother we saw during the Lango surgical camp was distressed about her sixteen-year-old grandson having only one testicle. She had failed to find any help until she heard of an announcement over the radio that surgeons were coming to work on patients in Lango for free.

While she hoped we could address the missing testicle, we explained to her that, given his puberty status, it was advisable to remove it as it most likely no longer functional. Additionally, retaining it posed a potential risk of cancer later in life. And these are just two of hundreds of chilling stories of people with surgical illnesses.

But they are telling of the perils of not or underinvesting in surgical health systems. The inability to access surgical care whether due to ignorance, or unavailability of this care, or health facilities unable to provide it in a safe manner have not only cost implications as many patients showed, but frequently as well, a life of pain, disability, loss of productivity, and premature death. 

Yes, our country is grappling with other serious challenges such as malaria, HIV, Tuberculosis Ebola, and previously COVID-19 which occupy the focus of the government. But diseases of which surgical healthcare is crucial such as, road traffic crashes, cancer, birth defects, and obstetric and gynecologic conditions, to mention but a few are also on the rise. There is a lot of health education needed to ensure that surgical health professionals, and not quacks or traditional healers are the recourse for patients with surgical ailments.

As evidenced by Uganda’s historic first kidney transplant in December 2023, followed by four more successful transplants in late 2024, we are witnessing significant advancements in surgical healthcare. These improvements have profound cost-saving implications, as procedures previously done abroad can now be performed within the country. If the Government of Uganda, does not prioritize strengthening surgical systems, the consequences for both public health and the economy will be dire.

Thankfully, however, our Ministry of Health is actively engaging with partners to support infrastructure for surgical healthcare and improve surgical workforce capacity to provide both emergency and non-emergency surgical care. The ministry is aligning with global policy trends and has embarked on formulating and implementing surgical health policies. It has initiated a children’s surgery strategic plan and is in the early stages of drafting the National Surgical and Obstetrics Plan (NSOAP).

These policies will ensure that surgical health professionals such as surgeons, nurses, and anaesthetists are trained in sufficient numbers and that they are jobs with sufficient pay for them. They will also ensure that hospitals have the required and fully equipped operating theatres and post-surgery units required to ensure safe surgery. 

However, establishing robust surgical systems for all requires a unified call on our leaders to prioritize and invest financially in this highly technical, complex, and essential aspect of healthcare—an often overlooked facet in healthcare.

In tandem, community education and early screening programs are imperative to raise awareness about timely surgical care in Uganda, mitigating the issue of late surgical disease presentation. Collaboration with key stakeholders, including academic and professional institutions, the Ministry of Health, development partners, and international organizations, will provide the necessary resources and expertise to drive these initiatives. The implementation of these measures promises to lead Uganda toward equitable access to safe and affordable surgical care, averting unnecessary suffering and disability.

The author is a General Surgery Resident Mulago National Referral Hospital