Mulago Hospital has only four neurosurgeons

Doctors Michael Muhumuza, Joel Kiryabwire, Husein Senyonjo and John Baptist Mukasa are the only doctors in the national referral hospital who are trained to operate on brain problems yet the hospital has more than 50 patients at a time in need of their services.

It is not easy to get hold of Dr Michael Muhumuza on any given day much less on a week day. If he is not performing an operation, he is checking his patients in ward 3A of Mulago Hospital or consulting patients whereas his mobile phone is always ringing with callers, usually patients asking about one thing or another.

“It’s not easy, it’s tough,” he says when he finally sits down to have an interview with me.

The consulting neurosurgeon and also Acting Head of the Neurosurgical unit at Mulago Hospital is one of the only six government neurosurgeons in the country, four of them based at Mulago. This means that this team is always up and working, considering the number of patients who flock the unit on a daily basis.

Their backlog is even worsened by the fact that regional referral hospitals have no capacity to diagnose or operate brain ailments, thus, patients from all over the country go to Mulago hospital to see a specialised brain doctor.

Cases treated
“Many of our cases are emergencies. By the time a person comes from the countryside, it is always too late,” says Dr Muhumuza. “The mothers and their babies in wards, for example, spend a lot of time here waiting for an operation which, is not good yet some of these cases could be handled in the regional referral hospitals before it is too late if we had specialists there.”

Statistics from the hospital show that there are 50-60 in- patients at the neurosurgical unit at any given time. This is despite the fact that the unit was designed for only 25 beds.

The biggest number of patients at the unit are those with head injuries, he says, usually as a result of accidents` and iron bar victims. The other rampant brain ailments received at the unit are; congenital anomalies- babies born with swellings on their bodies like on the head, brain tumours , spinal cord conditions- including tumours and discs and intracranial infections or brain infections.

Although some of the brain conditions have known causes, doctors say that causes of most tumours are unknown.

Dr Muhumuza says majority of patients at Mulago Hospital are in need of surgery. Before a neurosurgical theatre was opened up at the hospital early this month, operations were only done twice a week, meaning that patients had to wait for weeks and months before they could be worked on for free.

Also, the unit relied on a neurosurgical camp which operated patients twice a year. The camp sponsored by Dr Michael Hugland from Duke University in the United States operated on at least 30 patients on each visit.

With a specialised neurosurgical unit now, fully equipped with previously lacking equipment like drills and microscope, patients can now be operated on, on a daily basis but the underlying factor of few doctors and lack of essential items like a CT and MRI scan still weighs a heavy financial burden on patients who have to seek these services elsewhere. To use a CT scan costs about Shs120,000 while an MRI is about Shs750,000 in a private clinic.

A private brain operation costs between Shs54m to Shs81m ($20,000 to $30,000) abroad, money which an ordinary Uganda cannot afford and yet without these operations, many people’s lives are at risk on a daily basis.

Dr Muhumuza says this new theatre will only reduce on the number of patients on the waiting list for surgery, as operations will now be done on a daily basis but the hospital needs to acquire other essential equipment needed for an operation.

“With this new theatre few patients will be delayed and some crooks will not solicit for money from the patients but there are more things crucial to an operation like anaesthetics, some drugs, linen that need to be readily available,” said Dr Muhumuza.

For now , in partnership with the Duke University and Dr Hughland, Mulago’s neurosurgical section hopes to train 18 neurosurgeons by 2020. Already, three are in the US undergoing training, but, if essential and recurrent equipment cannot be readily available, Dr Muhumuza says there will not be much need to smile.