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Mengo surgery deaths put US doctors in spotlight

Several people have died inexplicably after undergoing brain surgery at Mengo hospital performed by American doctors between October 23 and 29. Now, the Uganda Medical and Dental Practitioners Council and the ministry of Health want to know what went wrong.

Dr Rose Mutumba, the medical director at Mengo hospital, promised to issue a statement, scheduled a press conference and then kept on postponing it. As relatives demand for answers, Mutumba repeatedly said she was busy in meetings and could not comment.

One of the organisers of the medical camp, Dr Joel Kiryabwire, has said he will not comment since the media has already exaggerated the issue, without knowing whether the patients had a high risk of dying or surviving.  

The visiting American doctors getting themselves ready at Mengo hospital on October 22. Photo: @alamb

Their combined silence leaves the death of 63-year-old Hajji Mustafah Kisayire unexplained. The former resident of Lukuli Nanganda in Makindye division died on November 29. He had been diagnosed with a brain tumor. His family had hoped that the medical camp run by neurosurgeons from America would help him. According to Hajji Muhamood Katongole, his brother’s problems started in July with a painful eye infection.

Doctors at ASG Eye hospital in Kampala found that his optical nerves were affected and recommended a CT scan. A scan performed at Nsambya hospital revealed Kisayire’s brain tumor.

ASG Eye hospital then advised that the tumor first be removed before any work on his eyes could be considered. Several doctors in Mulago national referral hospital also made the same observation.

Kisayire later consulted Dr Hussein Senyonjo, a neurosurgeon at Platinum Medical Centre, Buganda road, Kampala. Dr Senyonjo said he would operate for Shs 18 million. It took a month to raise the money but when the family went to confirm a date, Dr Senyonjo “told us he wasn’t available for a month since he was travelling to America.”

“He advised us to wait for him after his trip, or go for surgery in this camp. Kisayire refused to wait for a month because of too much pain and requested Senyonjo to recommend him to the camp. Senyonjo connected us to Dr Joel Kiryabwire, a neurosurgeon at Mulago, who was among the organisers of this camp,” Katongole said.

They first deposited Shs 4 million for the operation, an amount which went up to Shs 9.5 million after medication and admission costs were included at Mengo hospital.

“The American doctors came with their equipment which they used in the operation and [set up] three theatres at Albert Cook [ward], where they operated on about 20 people in five days.

“Apart from the pain in the head Kisayire was feeling, the other parts of his body were okay. He came driving himself, understanding properly and was operated on October 25,” Katongole said.

After eight hours in theatre, he was transferred to intensive care for three days and later to the hospital ward for a week. He showed signs of recovering although his memory was weak.

“He was discharged and they told us, he will recover slowly. In that process Issa Kikungwe also came and told us he was going for the same operation for the second time although the first one was done abroad,” Katongole says.

Kikungwe, the former MP for Kyadondo South, died in the Intensive Care Unit. At home, Kisayire relapsed and lost his memory. The family took him back to Mengo hospital where he died.

“I am accusing the American doctors for leaving immediately after the operation without monitoring the patients’ progress as they recover. They would have stayed for two weeks and exchanged ideas with Ugandan doctors and nurses who were monitoring patients. Why were they rushing to go?” Katongole asked.  

Hajji Mustafah Kisayire (R) at Mengo hospital. Photo:@alamb

Katongole says the family is preparing a formal petition to the Uganda Medical and Dental Practitioners Council (UMDPC).  Dr Gubala Katumba Ssentongo, registrar at UMDPC, told The Observer that the Americans’ trip was made with the knowledge of ministry of health.

But this information will be little comfort to Amina Marsal, wife to Hajji Abud Marsal of Entebbe. Marshal says her husband is in critical condition after being operated on in Mengo hospital by the same doctors.

“After the operation on October 23, he spent three weeks in a coma in the Intensive Care Unit at Mengo hospital. We paid Shs 47 million for the operation and medication yet earlier they told us it was free operation in the camp,” she said.

Amina told The Observer that Abud is now paralysed, has lost his memory, can’t eat, move or drink and his head has started swelling. On December 9, state minister for health Sarah Achieng Opendi promised an inquiry.

Opendi said the ministry will establish if the doctors entered the country legally. If they entered illegally, she said, they will be held liable.

“We are going to start investigations after people raising complaints to Uganda Medical and Dental Practitioners Council,” she told The Observer.

Dr Katumba Sentongo said he is waiting for a report from the camp organisers, detailing how many people were operated on, those who died and what went wrong.

“Since we approved them to assist Ugandans, the ministry of Health gave each of them a waiver to allow them work. Other doctors who come here to do business, they pay a fee of $400 (Shs 1.2m) to allow them to work,” Katumba said.

Katumba said UMDPC conducted an independent search and verified their qualifications.

“We also got recommendations from their referees and tracked their background online to confirm their licenses. But what we need to know is what went wrong in this operation. If there is a failure somewhere, the person will be responsible,” he said.

He said they were invited officially by neurosurgeons at Mulago but they worked at Mengo hospital to train doctors in brain surgery and reduce backlog of brain tumor patients. They were 10 doctors and nurses headed by Dr Gerald Arthur Grant and Dr Allen Lin Ho, both registered by the Medical Board of California.

Others were Dr Kimberly Bojanowski Hoang and Dr Michael Martin Haglund, registered in North Carolina as neurological surgeons. Katumba, however, observed that there are always high chances of death with brain surgery. Survival chances are only 15 per cent, he said.

“We haven’t yet started investigations since we haven’t got complainants. In our procedure, we start investigations after a complainant or ministry of health writing to us. The complainants should be responsible for the case,” he said.

Katumba said Uganda has only six practicing neurosurgeons and five cardio-thorax surgeons, all at Mulago. This reality sees experts inviting foreign doctors to come and assist.

“The experts from abroad also come with modern used equipment which they use in these camps and also train our doctors on how to use them. They donate this equipment to us since they are expensive,” he said.

The public relations officer, Mulago, Enock Kusasira, said on Friday that whenever they conduct camps, ministry of health is informed for approval purposes.

In October, UMDPC issued guidelines for all medical surgical camps conducted here, requiring approvals by National Drug Authority, among others. Were those guidelines followed in the case of the dead and dying from Mengo’s brain surgery camp?

zurah@observer.ug

Comments

0 #1 miki 2017-12-15 02:50
Looks more like the post-surgical care was not adequate for these patients.

Post-surgical care is as important as the surgery itself. It is planned and mapped out well before the surgery happens.

A plan of care is developed and is followed right from the time gets the surgery. The first phase of post-surgery care starts with the recovery from the induced sleep in this case. monitoring for response to the surgery. monitoring for adverse effects if any.

Patients are also monitored for post op infections and more. it appears like the visiting doctors were responsible for the surgeries and the Ugandan counterparts were left to handle the post op care.

And things seem to have gone wrong with the post op care.
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+1 #2 miki 2017-12-15 03:04
In many cases issues leading to death or morbidity in surgical patients happen post-surgery due to inadequate care planning in the first place.

From the reporting of this story, it appears that there was little, if any, post surgical care planning.

This seems to be the most likely reason - especially considering the fact that over 90%of the patients made it through the surgery, made it through the recovery room, back to the wards.

These were successful surgeries with poor post-surgical care.
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