Workforce Expansion

GPAS & AAGBI collaborative workforce expansion & retention project highlights (2007-2016):

  • 16 GPAS/AAGBI Scholars Sponsored (Surgery & Anaesthesia)
  • 20 GPAS Senior Scholar Positions Awarded (Biomed, Surgery, Anaesthesia, Ob/Gyn, Ortho)
  • Enrollment increased from 20 to 51 (surgery) and from 2 to 27 (Anesthesia)
  • All sponsored graduates practicing in the region
  • Creation of advanced subspecialty training pathways in anaesthesia and surgery

Background

Sub-Saharan Africa carries a disproportionate 25% of the world’s total disease burden yet only 2% of the global health care workforce. Similar disparities exist for the surgical disease burden. Sub-Saharan Africa has the highest concentration of surgical disease burden though the fewest surgery and anesthesia providers per capita.

In 2006, The World Health Report by WHO identified Uganda as one of 57 countries with a critical shortage of health workers and in March 2008, the First Global Forum on Human Resources for Health was held in Kampala, Uganda. As a result of this forum, the Kampala Declaration to strengthen the health workforce was issued and has helped guide many of our projects aimed at strengthening the health workforce in Uganda.

In partnership with the Association of Anesthetists of Great Britain and Ireland (AAGBI), Mulago Hospital Departments of Anesthesia and Surgery, the Ugandan Ministry of Health, and the support of many donors including the Mulago Foundation, GPAS/AAGBI are working to increase the number of anesthesiologists and surgeons in Uganda and to improve the quality of training as well as retention of trainees.

The scholarship program represents one mechanism through which GPAS and AAGBI hope to address this workforce shortage by providing financial support, mentoring, and research resources to physicians committed to training and practicing in low-income countries.

At the initiation of this project in 2007 there were 13 physician anesthesiologists and fewer than 100 surgeons in Uganda (population 30 million). At that time there were only two Ugandan trainees in surgery and one in anesthesia who enrolled for training that year.

Between 2007 and 2011 AAGBI/GPAS recruitment and scholarship programs at Mulago Hospital (Kampala, Uganda) helped increase the number of surgery and anesthesia trainees from 20 to 40 and from 2 to 19, respectively.

In 2011 GPAS began phasing out the scholarship program. With renewed and sustained interest in surgery and anesthesia among graduating medical students as well as increased funding opportunities for these prospective trainees from several other organizations (including the Ugandan Ministry of Health) GPAS is now exploring new projects to promote workforce expansion and retention, including initiatives to help improve and monitor the quality of training in Uganda.

One such project has been the creation of a “Senior Scholar” position – for recent MMed graduates in the departments of Surgery, Anesthesia, Orthopedics, and Obstetrics, each year, to function as a ‘chief resident’ and focus on education, mentorship, and research. Since inception of the Senior Scholars program, 20 senior scholars in surgery, anaesthesia, obstetrics and orthopaedics have been awarded.


MMed Enrollment at Mulago 2006-2013

Surgery

2006

2007

2008

2009

2010

2011

2012

2013
Total enrolled

20

20

21

32

35

 39

41

 50
First-year trainees

5

7

12

14

11

 14

14

 15
GPAS Scholars

0

0

3

1

1

 2

2

 0
Anesthesia
Total enrolled

2

2

9

11

17

 19

24

 27
First-year trainees

2

0

7

4

6

 11

10

 10
GPAS Scholars

0

0

3

3

3

 0*

0*

 0*

*In 2011, GPAS partnership with the Ugandan MOH provided tuition for anesthesia trainees. During this time AAGBI continues to provide stipend support for Anesthesia trainees at Mulago.


GPAS/AAGBI Scholars (2008-2012)

Dr. Henry Dabanja bio  (Surgery 2011)
Dr. Robert Masereka bio (Surgery 2011)
Dr. Naomi Kebba bio  (Surgery 2010)
Dr. Lameck Ssemogerere (Anesthesia 2010)
Dr. Peter Agaba (Anesthesia 2010)
Dr. Mary Theresa Nabukenya (Anesthesia 2010)
Dr. Ian Asiimwe (Surgery 2009)
Dr. Emmanuel Ayebale bio (Anesthesia 2009)
Dr. Sharon Priscilla Mpumwire (Anesthesia 2009)
Dr. Paul Namwanja (Anesthesia 2009)
Dr. Henry Luweesi bio (Surgery 2008)
Dr. Wilberforce Kabweru bio (Surgery 2008)
Dr. Alex Elobu bio  (Surgery 2008)
Dr. Andrew Kintu bio  (Anesthesia 2008)
Dr. Tonny Stone Luggya bio (Anesthesia 2008)
Dr. Speciosa “Specky” Mbula Kimenye (Anesthesia 2008)

GPAS Senior Scholars (2010-2016)

Dr. Naomi Kebba bio (Surgery/Trauma 2015)
Dr. Cathy Kilyewala bio (Surgery 2014-16)
Dr. Arlene Muzira bio (Surgery 2014-16)
Dr. Janat Tumukunde bio (Aneasthesia 2014 & 2016)
Cosmas Kambere (Biomedical Technician 2014 & 2015)
Patricia Nyakecho (Biomedical Technician 2014 & 2015)
Dr. Mary Theresa Nabukenya bio (Aneasthesia 2013)
Dr. Dina Amongin bio (Ob/Gyn 2013)
Dr. Kintu Luwaga bio (Surgery 2013)
Dr. Racheal Ayikoru bio (Surgery 2013)
Dr. Rodney Mugarura bio (Orthopedics 2012-13)
Dr. Phyllis Kisa bio (Surgery 2012)
Dr. Juliet Birungi bio (Obs/Gyn 2012)
Dr. Emmanuel Ayebale bio (Anesthesia 2012)
Dr. Alex Elobu bio (Surgery 2011)
Dr. Andrew Kintu bio (Anesthesia 2011)
Dr. Arthur Kwizera (Anesthesia 2010)

Biographies


Dr. Arlene Muzira

Arlene completed her undergraduate training at Makerere University in 2007, as well as an internship at Mulago Nation Referral and Teaching Hospital in 2008. Upon certification, she worked as a general doctor in private practice at SAS Clinics in 2009.
She is passionate about paediatric surgery and hopes to pursue academic career that incorporates teaching, training and mentoring young surgeons.
Arlene developed a keen interest in surgery and in 2010, when she moved to the Kabarole District, and worked at Holy-Family-Virika Mission Hospital, where her passion for surgery was natured. In 2011 she enrolled for post-graduate training in Masters of Medicine in General surgery, which she completed in July 2014.
She has since then embarked on pursuit of a fellowship in paediatric surgery, as well as acquiring proficiency in clinical research in this field.

In 2014 Arlene was selected as a GPAS Senior Scholar for the 2014-15 academic year at Mulago.


Dr. Cathy Kilyewala


Cathy is a surgeon working with Mulago National Referral Hospital – Kampala Uganda, in the department of surgery. Right from childhood, she desired a solid foundation in a challenging, respectable and fascinating career. This drove her to Mbarara University of science and Technology (MUST) in 2004 for a Bachelors Degree of Medicine and Surgery she was awarded in January 2010. In 2011 she went to Makerere University College of Health Sciences to pursue a Master’s Degree of Medicine in Surgery which she has now completed.
During her training she has acquired interpersonal, leadership and training skills natured not only from the respective universities but also collaborations linked with them, like the African and Canadian committee. She is a Bursary award winner of the Annual congress of the Association of Surgeons of Great Britain and Ireland, “Education and Innovation” 2014.

In 2014 Cathy was selected as a GPAS Senior Scholar for the 2014-15 academic year at Mulago.


Dr. Racheal Ayikoru


Racheal was born in Uganda and attained a bachelor of Medicine and Bachelor of Surgery in 2006 at Makerere University. She was subsequently employed as a medical officer in the department of surgery at Nsambya Hospital for 3 years. Racheal completed a Masters in surgery in August 2010 is currently interested in Paediatric surgery. Her research interests currently include how local foods(groundnut paste,millet/sorghum/soya) can be used to improve nutrition among patients with enterocutaneous fistulae.
In 2013 Racheal was selected as a GPAS Senior Scholar for the 2013-14 academic year at Mulago.


Dr. Dina Amongin


Dr. Dinah Amongin is both a Public Health Specialist and an Obstetrics and Gynaecology Specialist at Mulago Hospital. She obtained her MPH from University of Manchester in 2010 and recently completed the MMED programme at Makerere. Her research areas of interest include quality improvement of services for women’s’ health especially regarding reduction of maternal mortality during childbirth.
In 2013 Dina was selected as Senior Scholar in Obs/Gyn.


Dr. Kintu Luwaga


Dr. Kintu graduated from Makerere University Medical school and recently completed a Masters degree in general surgery at Mulago Hospital in the Class of 2012. He completed his internship at Mengo hospital and Hoima Regional Hospital. Luwaga has been involved in Pediatric Research and also worked as Medical Officer in Pediatric Surgical Ward at Mulago Hospital. In December 2011 he qualified as a member of the College of Surgeons of East Central and Southern African (COSECSA). Since completion of his Mmed Gen.Surgery in May 2012, he was deployed to the Breast and Endocrine Surgery Unit at Mulago.
His current areas of research interest include Endocrine Surgery, and he is an active member of the Uganda Breast Cancer Research Group. In 2013 Luwaga was selected as a GPAS Senior Scholar for the 2013-14 academic year at Mulago.


Dr. Henry Dabanja

Dr. Dabanja graduated from Mbarara University Medical school and is pursuing a Masters degreed in general surgery at Mulago Hospital. He was born in the upcountry district of Masindi, about 250km North of Kampala. First born in a family of six children, raised by a single mother, a peasant farmer. After studying primary and ordinary level in the rural district, then Advanced level in a modest city school,he went to Mbarara University,and graduated in 2008 MBchB. Dr. Dabanja worked in his home district hospital, where he describes “…the challenges met were enormous, many patients, few doctors to attend to them, especially when it came to surgical emergencies. It’s upon this background that I decided to pursue a carrier in surgery. I have been working in Mengo Hospital since gradating.” Uppon finnishing, trainning he hopes to serve this underprevilaged population and to study urology with passionate interest in renal transplant surgery.


Dr. Wilberforce Kabweru

Dr. Kabweru graduated from Makerere University Medical school and is pursuing a Masters degree in general surgery at Mulago Hospital.


Dr. Naomi Kebba

Dr. Kebba graduated from Makerere University Medical school and is pursuing a Masters degree in general surgery at Mulago Hospital.

Growing up I always said that I would become a doctor as part of the answer you give when asked what you wanted to become in future. I didn’t have any inkling of what it entails and what it takes for one to be called a doctor. On completing my earlier school training and joining medical school, the reality of it all hit me. The jitters on seeing the cadavers, the hard work, the emotional challenges, no holidays; and still I loved it all and was very happy doing my job.
I completed my training and finally became the doctor I always wanted to be. I was trusted with preserving and prolonging the lives of my fellow human beings at all costs; with the assurance that I and other colleagues in the medical field would work as a team to achieve this fundamental task. Out in the field, it’s a totally different picture. The co workers you expect to find are hardly there. One often finds that one is alone at the work station with over whelming patient numbers making it impossible to effectively carry out one’s duties.
This is especially true of rural health centres where most doctors do not want to go and staff turnover is high. In all the years I have been working as a medical officer, I have mainly worked in areas considered to be remote. At times we were so understaffed that when a colleague goes for leave, I am left as the only M.O in a 150bed capacity hospital with the help of clinical officers, nurses and nursing aides. This meant that all complicated cases that were brought to the hospital and any intervention that required surgical intervention were all sent to me; from performing caesarean sections to simple debridement, because the other staff didn’t have the training to do simple surgical procedures. I found myself working from Monday to Sunday as well as at odd hours of the night. This was very exhausting and compromised my health and work. I resolved to teaching the staff I worked with some basic surgical skills like simple suturing, wound debridement, proper wound dressing e.t.c. the greatly eased the work load and reduced time to receive treatment. I also realized it improved prognosis for some patients because for those who got injuries during the night, the wounds would be effectively managed by the night nurse or even the day nurse when I was busy; and when I got to review them eventually, I would be able to do definitive management on a clean wound or if it was done well, just have them continue with the management.
When I realized that imparting these skills to the lower cadres was not only beneficial to me but to the patients as well, I realized the best way to make this work was to go back to school for more training and be able to impart these skills and more to other staff. The training would also help me because I at times would be faced with surgical conditions I couldnot manage on my own – in a way I was part of the untrained work force.
I have worked in the rural areas of Uganda and Southern Sudan and the problem is always the same; shortage of skilled staff with patients who need the services not being able to get them. This to me was something that could be solved with the right strategy and collaboration. I wanted to be part of the solution because I had experienced firsthand what a challenge it is to lack adequate trained medical staff on ground, and I had also observed the helplessness of the patients when their conditions are not managed in time and they developed avoidable complications.
Now I am back to school and pursuing further training and will ensure I work hard, complete my studies and join the struggle to ensure equitable distribution of these services, just like all my predecessors out there.


Dr. Andrew Kintu

Dr. Kintu Andrew is a native of Uganda and was born in Jinja. He graduated from Makerere University Medical School in 2007 and always wanted to pursue a career in emergency medicine and anesthesia critical care. During his internship, Andrew worked in Surgery and Obstetrics at Jinja Regional Referral Hospital where he encountered first-hand the critical shortage of anesthesiologists in the region.

I saw how hard it was to get an anaesthetic technician to work on emergencies, so I felt the best I could do, would be to join the field. You never know I could help change the situation on ground.

In 2008 Andrew was selected as a GPAS Scholar and recently completed anesthesia training at Mulago in 2011. Also in 2011, Andrew was selected as a GPAS Senior Scholar for the 2011-12 academic year during which time he will teach and mentor anesthesia trainees at Mulago.


Dr. Henry Luweesi

Dr. Luweesi grew up in the Luwero district of central Uganda. He graduated from Mbarara University Medical School in 2004, and after finishing his internship in 2005 he performed medical outreach services in his home district of Luwero. While practicing during this time he noted many people dying of treatable surgical conditions simply because no surgical treatments were available in that area of Uganda. As a result of these recent experiences Dr. Luweesi chose to pursue a Masters in surgery and was selected as a GPAS scholar in 2008 to support his training.


Dr. Robert Masereka

Dr. Masereka Robert, a medical officer formerly working with Kilembe mines hospital(kasese,western uganda) since october,2008 shortly after my internship training. Iam a holder of bachelor of medicine and bachelor of surgery of Makerere university which I attained in 2007.

I have always been fascinated by surgery, for example when a patient comes to hospital with a cut wound bleeding profusely and the attendants are all scared by sight of blood among other things; within minutes I arrange for surgical toilet and suture (STS) and its done. The patient says thank you doctor and once again the attendants are all smiles. This is what i love doing but also because I love to help to save a life. This is one of the main reasons I went to work in rural Uganda after my internship training, and I have never regretted.

I did my Internship surgical rotation in Hoima regional referral hospital under supervision of Dr. Moro and Dr. Mbogo, both specialist general surgeons. This is when i appreciated and participated in the management of most of the commonest surgical emergencies including among others trauma from assault and road traffic accidents, Intestinal obstruction from whatever cause, acute appendicitis, peritonitis. I was able to perform successfully 4 hernia repairs, chest tube insertion in chest trauma (haemothorax, pneumothorax) ,excision of lipomas and granulomas, basic surgical skills such as STS. I also performed 70 caesarean sections successfully.

As medical officer in Kilembe mines hospital, I have perfomed 130 laparotomies especially for perforated terminal Ileum due to salmonellosis (enteric fever) complications-where resection and anastomosis of gut was done, ileostomy and Ileostomy closure for both end and loop ileostomies. Suffice to note is that enteric fever and its complications especially perforated terminal ileum has now become endemic in kasese and the neighbouring districts. I also repaired 5 gastric perforations, 65 hernia repairs, inserted 4 chest tubes, several STS.
In the discipline of obstetrics and gynaecology,I have performed 230 caesarean sections, laparotomies for ovarian cysts and ruptured ectopic pregnancy among others.

I have been a team leader during outreaches and support supervisory visits to the lower health centers.
I am also the chairperson of the education (continuing medical education) committee of kilembe mines hospital where i have participated in presentations among which pertains to surgery.

My career goals;
-to reduce the surgical work crisis especially upcountry where there Is limited access to specialist surgical care.
-to do clinical research and influence current surgical trends in the developing world.
-to inspire other young doctors to take up surgical careers through mentorship and career guidance.


Dr. Tonny Stone

Dr. Stone was born in Mbale, Uganda and is a graduate of Makerere University and Makerere Medical School. Pursuing a career in anesthesia has been a childhood dream for Tonny. He has spent time working up-country with limited resources and hopes to apply his skills in such settings after completing his training in anesthesia.


Dr. Rodney Mugarura


Dr. Rodney M. Mugarura was born on 20th March 1981 at Mulago hospital. He attended Mackinon Kindergaten, Kitante Primary school and St. Mary’s college Kisubi (SMACK) before joining Makerere university medical school in September 2000. He was awarded a Bachelors of Medicine and Surgery (MBchB) in October 2005.
In August 2008, he enrolled for a Masters of Medicine in Orthopaedic surgery at Makerere university; a course he successfully completed in May 2012. He worked as a medical officer in the ministry of health (Kabale Regional referral hospital) between 2005 and 2008. He is a Sportsman, writer and Rotarian.


Dr. Phyllis Kisa

Phyllis is a surgeon working in the paediatric surgical unit of Mulago hospital. She graduated with MMed Surgery of Makerere University in 2012, with a dissertation measuring extent of malnutrition of children on the pediatric surgical unit. She completed her fellowship exams for COSECSA General Surgery in 2012. Prior to her post-graduate training, she served as a medical officer at Lacor Hospital in Gulu, Northern Uganda. She recently worked with an Italian NGO-Surgery for Children offering paediatric surgical services in northern Uganda. She is also a facilitator of a Social Medicine course run at Lacor Hospital. She is currently a trainee of paediatric surgery at Mulago hospital.


Dr. Emmanuel Ayebale

Emmanuel is a former GPAS Scholar who completed his MMed training at Mulago Hospital in 2012. Emma went on to conduct research and clinical teaching at Mulago as a GPAS Senior Scholar in 2012-13 and is currently an attending anesthetist at Mulago hospital. Outside of the hospital he has a passion for racing and rugby.


Dr. Isabella Epiu

Isabella is completing her final year Master of Medicine in Anaesthesiology and Critical Care at Makerere University. Prior to anaesthesia specialist training (MMed) at Makerere University College of Heath Sciences in Kampala Uganda , she graduated from Medical School at Makerere University.

As an anaesthesiologist she is particularly enthusiastic about reduction in maternal and child mortality through safe anaesthesia and safe surgery. Her current studies have involved assessment of the capacity of the main referral hospitals across East Africa to provide safe anaesthesia for obstetrics patients. This work was supported by GPAS and the WFSA. She was recently awarded a Fogarty grant along side the University of California GloCal fellowship and as part of this work will be assessing capacity for obstetric anesthesia and provision of safe surgical care across Uganda at the regional and district hospital level.


Dr. Mary Theresa Nabukenya


Mary lives in Kampala, Uganda, where she is an anesthesiologist in the Department of Anesthesia at Makerere University College of Health Science – Mulago Hospital and a GPAS Senior Scholar. Prior to this she completed her specialist training, receiving MMed in Anaesthesia and Critical Care from Makerere University. Prior to that she completed medical school also at Makerere.

During her training, she was closely involved in training and teaching of undergraduate students, and many projects/programs around Uganda including training of anaesthesia providers and provision of anaesthesia.
Her current areas of interest are paediatric anaesthesia, regional anaesthesia and research. It is a dream of Dr. Nabukenya to see the specialty of anaesthesia grow in Uganda.