US trains Mulago doctors in brain surgery

Aug 09, 2009

WHEN the sun comes up to announce summer in North Carolina US, it sends rays of hope as far as Mulago Hospital, Uganda. Patients, who for months, have been on the hospital’s waiting list for brain and spine surgeries begin to receive calls, telling the

By Lydia Namubiru

WHEN the sun comes up to announce summer in North Carolina US, it sends rays of hope as far as Mulago Hospital, Uganda. Patients, who for months, have been on the hospital’s waiting list for brain and spine surgeries begin to receive calls, telling them to come in for tests because “the American surgeons will be coming soon.”

For three years now, a team of 18-35 surgeons, nurses, anesthesiologists and other theatre staff from Duke University in the US, visit Uganda annually to do marathon surgeries. In one day, they do more surgeries than what Mulago neurosurgeons do in a week.

The visiting team also trains their hosts in some surgical procedures and technologies. When they come, they carry medical equipment and surgical sundries to donate to their hosts.

So far, equipment worth sh4b has been donated to the hospital This has helped increase the number of operations. Since the first batch of donated equipment, the number of brain and spine surgeries done in Mulago has reportedly gone up by 167%.

It all began in August 2006, when Pastor Jackson Senyonga of Kampala, visited a church in Durham, North Carolina. Members of the church prayed for him as he prepared to start a preaching mission.

After the prayer, he told one of the church elders that he would be going to Uganda. The doctor was a neurosurgeon called Micheal Haglund.

“My first answer was a no. I was already doing God’s work in Ecuador. We had a clinic down there that we had been running for 10 years,” Haglund recalls. Still, Senyonga had planted a thought in his head. When Haglund went back to Ecuador that year, it occured to him that the clinic there could actually run well without him. He decided to visit Uganda in January 2007 and Senyonga introduced him to Mulago Hospital management. What Haglund saw at the hospital stunned him.

“Here was a hospital with 1,500 beds and only one ventilator, a machine which helps unconscious patients breathe during surgery. Someone had to squeeze an oxygen bag for the entire duration of the operation to keep the patients breathing.

They were doing brain surgery using technology that was used at Duke University hospital in the 1930s,” Hagland recalls. He went back to Duke University where he teaches and told colleagues about Uganda and asked for volunteers. He got 18 and seven months later, he had also collected nine tonnes of medical equipment worth $1m to donate to Mulago.

That is how the annual Duke–Mulago surgical camps began. Prof. Haglund is set to establish a local neurosurgery training programme that will, for the first time, see neurosurgeons made in Uganda.

How brain surgery is performed


It is close to midday and Annet Ntege Jaaya is lying on the operating table. She has been prepped for surgery for an hour.

Getting started

Prof. Michael Huglund takes what looks like a big lab clamp and fixes screws into it before clamping either side of Jaaya’s head. This clamp is called the mayfair headrest. It keeps the head raised and firmly stationary during surgery.

The area of her head that is to be operated, is isolated by covering the rest of the head first with polythene sheets then absorbent surgical towels. A scar is evident on Jaaya’s head. She has had brain surgery before, but her tumour grew back. Huglund says the tumour grew on the inside of the membrane that covers the brain. After the last operation, microscopic cells of the tumour remained embedded on this membrane, causing it to grow back. In addition to removing the tumour, he is going to cut away the diseased membrane and “replace it with a new one.”

Exposing the skull

The doctor draws a semi-circular curve along which he will cut the skin with a sharp blade. Dr. Micheal Muhumuza, who is working with him, quickly follows the blade with a sharp pointed surgical tool. The sharp tool carries an electric current which closes any blood veins it comes into contact with, hence minimising bleeding.

The cut edges of the skin are clipped with what look like pieces of spiral binding. The surgeon then begins to peel skin off the skull by sliding his sharp blade as close to the bone as possible. One of the theatre assistants says one’s skull can be totally undressed and safely redressed by stitching the skin back. For about 20 minutes, the surgeons search the inside of the skin for any bleeding veins, touching them with the electric tool whenever they find one. Satisfied that the bleeding has been minimised, the peeling skinned is wrapped in gauze and folded back leaving that part of the skull totally exposed.

Exposing the brain

The two surgeons have to carefully look at the scan images showing the location of the tumour again. They need to determine the exact position of the tumour to be sure that the part of skull removed directly exposes the tumour area. For long, they consult with each other before eventually deciding where to remove the bone.

With an electric drill, Huglund cuts a circle into the skull. Small splinters of bone splash about. To give him a better view of the bloody skull, Muhumuza cleans his drilling path with a splash of saline water. A suction tube pointed into the operation area sucks this water away. It takes two drilling rounds for the exorcised part of the skull to fall in.

A thick membrane is exposed, which is cut away. The brain is now exposed. Grey and white with darker, almost black veins in some places, the brain is alive and pulsating as a breathing chest would. The doctors probe around for the tumour. According to the theatre assistant, it should be yellow and easy to spot.

Exorcising the tumor

As one would do with a thorn stuck in their foot, the surgeon gently digs around the tumour’s side, making sure not to cut any big of it.

As he digs, he gently pushes upwards on the tumour. This goes on for about 25 minutes as the tumour moves a little upwards with the gentle pushes. Finally it is out. The surgeon picks it up and holds it in his palm. The eight-month-old tumour is about as wide as a soda bottle top. This is what has been causing Jaaya’s seizure attacks.

For a while, the surgeon scraps around the hole to remove microscopic cells of the tumour that might have been left behind. When sastified, he cuts away the membrane that was directly over the tumour and disposes of it.

Covering the tracks

Thin layers that were got from underneath the patient’s skin are sewn where the diseased membrane was cut away. Then the cut-away skull piece is placed back and screwed to the rest of the skull with three micro-screws. The skin is sewn back and four hours later ,the operation is finally over.

(adsbygoogle = window.adsbygoogle || []).push({});