Stories From the Field:

UGANDA

Global Health Endoscopy

Kathleen Corey, MD, MPH, Director of the MGH Fatty Liver Clinic, was granted a Center for Global Health Travel Award to work in Uganda. Dr. Corey spent two weeks lecturing and teaching endoscopy to students and faculty at Mbarara University of Science and Technology.

As I approached the outdoor area that serves as the waiting room for the outpatient clinic I noticed a crowd had formed.  It was my first day at the Mbarara University of Science and Technology (MUST) Medical Center and Dr. Samson Okello, a MUST faculty member, was giving me a tour of his institution where I would be performing and teaching upper gastrointestinal endoscopy for the next two weeks.  Our plan was to evaluate the equipment and facilities that MUST had for endoscopy together and set up a pIan to perform endoscopies starting on our second day. I began to get an idea of the enthusiasm about the availability of endoscopy at MUST as I noticed the flyers posted around the campus advertising “NEW: Endoscopy Service DAILY November 11-22, 2013”.  However, I did not fully appreciate the need for endoscopy until I approached the waiting room. As I arrived, eight waiting patients stood and approached me.  All had been calling or coming daily to ensure they would not miss their chance to have their various symptoms evaluated.  We explained to the disappointed crowd that we would be starting endoscopy the following day and they should arrive at 8am for their procedures.

The following morning we were again greeted by an anxious crowd and we rapidly began to understand their anxieties.  Our patients told us stories of dramatic, unexplained weight loss, months of suffering with intractable abdominal pain and surviving on liquids alone due to the inability to swallow solid foods. That first day we diagnosed three of those patients with esophageal cancer and were able to refer them on for surgery and chemotherapy.  We also were able to start medical treatment on two patients with newly diagnosed gastritis and ulcers.

During my time in Mbarara we performed 29 upper endoscopies. We diagnosed six cases of stomach cancer, five cases of esophageal cancer and eight cases of severe gastritis.  We were able to provide medications to many and refer others to the growing Cancer Center at MUST. Since I departed, Dr. Okello has held weekly endoscopy sessions and independently performed endoscopy on an additional 32 patients. Routinely accessible endoscopy has now become a reality at MUST.

During my time in Mbarara, I was also fortunate to interact with the Post-Graduates (physicians in training) of MUST. I conducted daily lectures on topics ranging from the diagnosis of viral hepatitis to the management of acute gastrointestinal bleeding. These incredibly bright and motivated students challenged me daily with insightful and thought provoking questions. I frequently ended our time together with the response “I have never thought of that question but I will look into tonight and we can discuss tomorrow.” I recently learned that the PGs took their annual in-service exams and scored highest in the gastrointestinal section.

Much remains to be done in developing endoscopy services at MUST. Currently, we are able to provide diagnostic endoscopy but not offer treatment options. Ailments such as gastrointestinal bleeding, which can easily be treated with thermal therapy or clip placement in many institutions, remain untreated.  Our patients with esophageal cancer and the inability to swallow cannot receive the life altering stents placed to allow them to eat comfortably again.  We have taken an important first step in increasing the services patients can receive at MUST and are excited to take the next steps forward.