1. Musculoskeletal Trauma Services in Uganda
EK Naddumba,Mmed(MU),FCS(ECSA)
Senior Consultant Orthopaedic Surgeon,
Mulago National Referral Hospital
Kampala Uganda.
ABJS Carl Brighton Annual Workshop,Dec.11th-14th,2007,India.

2. PURPOSE
Highlight Challenges
Suggest solutions.

3. PROBLEM Population=28m Growth rate=3.5%/yr
National Budget allocation to Health=9%
Inadequate resources.

4. Orthopedics in Uganda 2007 23 Ortho surgeons Kampala 18 Mbarara 1
Masaka 1
Mbale 2
Kumi 1
Unreliable equipment
Unreliable supplies
Orthopedic Officers 200

5. Health Care Referral system
National referral
Regional referal=10
District Hosp=56
Sub district Hosp=250

6. Resource Distribution & Access to Services
Specialist Services,only available at Regional &National referral Hospitals
Lower health units offer PHC,Maternity,General surgical and medical services.

7. Pattern of Diseases Acute &neglected fractures, Infections,
Spinal injuries,
Clubfeet,
Polio contractures,
SCD Osteonecrosis,
Tumors.

8. Musculoskeletal injuries in Uganda
2000 lives/year are claimed through RTA
Kampala,RTA account for 35.1%of all injuries,
Males of 15 to 45yrs are the majority.

9. CAUSES Boda Boda Traffic mix Urbanization Motorization Poor roads
Poor drivers.

10. SERVICES AVAILABLE SIGN Nail Cast, Skeletal traction, ORIF,
External Fixators
TBS.

11. PREVENTIVE STRATEGIES
Specialist Training (MMED,FCS(COSECSA)
Train all levels of Health workers in their environment to ensure a sustainable supply of human resource(JP.Dormans)
Govt effort to improve the Infrastructure& Equipment supply.
Law enforcement on poor road users.
Orthopedic outreach program to enhance Access.
International Collaboration(HVO,UBC,JAPAN)

12. Orthopedics Mulago Hospital, Kampala
Makerere Medical School
Professor Ronald Huckstep 1962
Professor Ronald Belcher 1990
Round Table Polio Clinic
8 Surgeons
16 Residents (4yrs)
100 Medical Students py

13. SERVICES Elective Surgery 2 Theatre 3 days per week 400 cases per yr
Infections
1 Theatre
2 days per week
500 cases per yr
Emergencies
Shared Theatre
7 days per week
500 cases per yr

14. DISCUSSION
Access to quality specialists services is a global concern due to poor infrastructure,and inadequate resources.
Uganda is among the most affected
Solution to the problem is through human resource training, deployment, Infrastructure development&Equipment supply.

15. Discussion
By 2020(WHO)Trauma will be the leading cause of life lost by both developed &developing countries.
Low and middle income countries account for 85%of the deaths&90%of the annual DALYs lost because of RTA.

16. Conclusion
Musculoskeletal Trauma Services in Uganda are largely inadequate resulting in neglected Trauma
High population growth,urbanization,motorization &poverty are compounding factors.

17. Recommendations
Need for Government to plan for the growing population to access essential Musculoskeletal trauma services.
Ensure sustainable supply chain of consumables &Infrastructure development
Training of specialists in their own environment.
North to South collaboration in participatory development,

18. References
Ralph K Ghormly.Progress report of the joint committee on postgraduate training in orthopedic surgery.JBJS(Am.)1946:28;
John P Dormans,MD.Orthopedic surgery in the developing world.Can orthopedic resident help?JBJS{Am.)84; (2002)
Olajede Olaolu Ajaye &Clement Adebayo Adebamowo,Surgery in Nigeria.Arc.Surgery.Feb 1999;134:2:
CBD Lavy,N Mkandawire&WJ Harrison.Orthopedic training in developing countries.JBJS(Br.);87-B,issue 1/10-11,(2005)

19. References
5 .Peterson:Neglected femoral fractures.JBJS;25(4),page 871
6. Klenerman I Neglected trauma.March 1998,JBJS,255.

20. THANK YOU