Plastic surgeons: Dr. Marie-Christine Gailloud-Matthieu, Dr. Marina Barandun

Uganda is a landlocked country in east-central Africa. It is populated by dozens of ethnic groups, the predominant religion is Christianity. Almost 80 percent of the population is younger than 30 years old, close to 50% is below 18 years of age. Despite very fertile grounds, favorable climate, political stability and economic growth in recent years, Uganda remains among the 20 poorest countries in the world. On the surface, women seem to have equal rights and possibilities as men. Many projects concerning the empowerment of women can be found throughout the country. However, when taking a closer look, very traditional gender relations become obvious, in more rural areas women and children are often seen doing the hard farm work, stories of domestic violence circulate – sometimes kept under the surface, sometimes addressed openly. There are even “camps” for rehab for alcoholic and/or abusive men.

*Typical landscape in southwestern Uganda*

*Empowerment through work – “Ride 4 a woman” non-profit organization*

Reconstructing Women International was invited by Africomed to join them for a trip to Bwindi Community Hospital (BCH) in southwestern Uganda to evaluate the necessities and possibilities for a reconstructive surgery camp focusing on women and children in the future.

Africomed is a small non-profit organization based in Fribourg, Switzerland. It was founded in 2007 by Dr. Forat Sadry, a Swiss radiologist who ever since traveled to Uganda several times a year organizing humanitarian camps at Bwindi Community Hospital with orthopedic and visceral surgeons as well as gynecologists and urologists. Africomed has been involved into the development of the BCH for 17 years, not only by organizing humanitarian camps but also by establishing new services as the radiology department, introducing general anesthesia to the hospital, providing equipment as large as radiographs and lately contributing to independence of electric power by sponsoring a large solar plant.

*Bwindi Community Hospital – entrance hall*

The BCH itself was founded in 2003 in the village of Buhoma by Dr. Scott Kellermann, an American doctor specializing in general and tropical medicine. It all started with a small tent under a tree. The initial goal was to provide health care to the indigenous people of southwestern Uganda, the pygme, who had been relocated from the Bwindi Impenetrable Forest when this area had been declared as a national park and UNESCO world heritage site for preservation of the mountain gorillas. It is a non-profit private community hospital with a catchment area of about 120’000 people in remote southwestern Uganda at the entry gate to the Bwindi Impenetrable Forest national park. People here are among the poorest in the country, living in a striking contrast to the numerous luxury safari lodges housing tourists for the popular gorilla trekkings. Thanks to the persistence of people like Dr. Scott Kellermann, Dr. Forat Sadry but also many local staff members, BCH today is a regional multi-specialty health center with a capacity of 155 beds and offering additional health care services to the population through satellite clinics in the villages. It has an associated nursing school with 400 students annually, assuring well educated health care staff for the hospital over the years.

*Dr. Scott Kellermann (front right), Dr. Forat Sadry (front left) and the Africomed team (Samuel Grenier, Dr. Ines Raabe & Dr. Veronique Erard) discussing with Dr. Marie-Christine Gailloud-Matthieu*

Dr. Marie-Christine Gailloud-Matthieu and Dr. Marina Barandun, plastic surgeons based in Switzerland, arrived in Buhoma village on October 4, 2024 late at night after a strenuous but exciting 12-hour drive from Entebbe Airport. The following days were dedicated to get in touch with the responsible administrative and medical BCH staff, get to know the hospital’s infrastructure, organization and surroundings. We also were able to follow the Africomed team who was present for a 2-week orthopedic camp. Overall, we have been impressed with how well most services are organized, how well the staff is trained and how dedicated they are to provide professional health care services to the patients under the given circumstances. Dr. Daniel Izimba, general surgeon and Dr. Asaph Owamukamaeli, orthopedic surgeon both are employed by the hospital permanently, providing surgical services on a good level. However, complex cases including complex soft tissue reconstructions and complex burn injuries need to be referred to a health care center in Mbarara, which is a 4.5-hour car drive away. We had the chance to work with Dr. Izimba on two cases: scalding to the upper body in a two-year-old child and post-burn scar contracture of the elbow in a woman. It became evident that basic reconstructive surgery knowledge and skills are present but further training would be most welcome to ensure a high quality of patient care.

*Dr. Marie-Christine Gailloud-Matthieu at teaching*

Besides all the positive impressions we got, we realized that although surgical services are at a good level, anesthesia is highly problematic. Anesthesiologists are very rare in the entire country and therefore asking for high salaries that at this stage cannot be provided by the BCH. Anesthesia services are currently provided by insufficiently trained paramedics. During camps, a German anesthesiologist is flying in and volunteering, which is a great relief for the foreign surgeons. However, a local anesthesiologist who is permanently based at BCH is surely one of the most urgent positions to be filled.

*Dr. Marina Barandun and Dr. Marie-Christine Gailloud-Matthieu with OR staff at BCH*

To round up our visit, we had various meetings with hospital authorities, the surgeons, the head scrub nurse, the head ward nurse and the founder of BCH, Dr. Scott Kellermann. Everyone agreed that there is a high demand for reconstructive camps with a focus on the treatment of women and children in the area – not only for direct patient care but also for training of the local surgeons and staff.

We left Uganda full of impressions and will try to come back within one year for a RWI reconstructive surgery camp at the Bwindi Community Hospital.

Reconstructing Women International x Africomed