Mulago, 34 hospitals to get machines to improve surgery safety

Up to 35 health facilities will benefit from the 54 patient safety monitors (capnographs) donated to Uganda by global health organisations, Smile Train and Lifebox.

“We are distributing these capnographs to 35 hospitals but we are doing this in a phased manner,” Dr Elizabeth Igaga, the director of safety and quality at Smile Train told Monitor after giving the machine to CoRSU Hospital in Entebbe on Thursday.

“Facilities receiving these devices have service providers who have already been trained on using them. The facilities that will get include Mulago, CoRSU, Mbale Hospitals and Makerere University Teaching Hospital among others,” she added.

Dr Juliana Nanimambi, an anesthesiologist at CoRSU Rehabilitation Hospital said the portable machine would ease their work and improve patient monitoring during surgery.

“We have been privileged to get a donation from Lifebox and Smile Train, they have donated the capnograph. It is a device that is used in measuring carbondioxide that the patient is breathing out during surgery. Once you know how much it is, when it is enough, it tells you that the patient’s heart is pumping well enough, meaning the patient is alive and all the body system is doing well," she said.

"This machine also tells you the oxygen level in the body and the heart rate, and it can have a battery of about six hours and is not bulky when compared to the anesthesia monitor that we have,” she added.

According to a 2016 meta-analysis report by Soha Sobhy and colleagues of 44 studies (632, 556 pregnancies) in low- and middle-income countries which reported risks of death from anaesthesia in women who had an obstetric surgical procedure, researchers found that the numbers of deaths associated with anesthesia are high.

"Anaesthesia accounted for 2·8 percent of all maternal deaths, 3·5 percent of direct maternal deaths (that is to say, those that resulted from obstetric complications), and 13·8 percent of deaths after caesarean section," the report published in a scientific journal (The Lancet) reads. 

"The current international priority on strengthening health systems should address the risk factors such as general anaesthesia and rural setting for improving anaesthetic care in pregnant women," the researchers recommended. 

According to scientists, the most common causes of anaesthesia related deaths are circulatory failure due to hypovolaemia (decreased volume of circulating blood) in combination with overdosage of anaesthetic agents or regional anaesthesia. 

The other causes of the death can be decline in oxygen levels in the body and sub-optimal breathing after for instance undetected intubation to the throat (pathway to the stomach), difficult intubation, technical failure in the anaesthetic equipment, or aspiration of stomach content. 

Intubation is a process where a healthcare provider inserts a tube through a person's mouth or nose, then down into their trachea (airway/windpipe). The tube keeps the trachea open so that air can get through. The tube can connect to a machine that delivers air or oxygen to sustain breathing. 

According to a 2019 study report by Katherine Albutt and colleagues in Uganda, the annual volume of surgeries conducted is “36,670 cases or 144.5 operations per 100,000 people per year.”