Dr David Sharp recently spent time in Uganda, working in a remote hospital in the small village of Kagando - in the foothills of the Congo - to assist local women and children with vaginal reconstruction, burns and congenital deformities.
It was the first time a plastic surgeon had accompanied the international team from Medical Training in Africa, consisting of Professor Judith Goh AO, Dr Hannah Krause AO, Dr Alex Mowat, Dr Jackie Smalldridge, Mr Darren Diserens and Dr Geerte den Hollander.
The journey began with a flight to Entebbe, Uganda, with the team transporting their surgical equipment in their luggage - including a donated diathermy machine, dressings, sutures, anaesthetic medication and scrubs to wear in theatre.
From there, a small chartered plane took them from Entebbe, to a grassy landing strip near the isolated village of Kagando.
Their first clinic commenced within hours of arriving.
The two week clinic saw over 80 women receive life changing surgery. Surgery was mostly performed with patients awake during the operation, using spinal anaesthesia, due to a lack of anaesthetic resources in the isolated hospital.
Dr Sharp operated on patients suffering from complex obstetric fistula, where flaps or skin grafts were required to effectively repair vaginal wounds that could not otherwise be surgically closed.
Soon after arriving, nearby villagers who had heard of his arrival made their way to the hospital with children also suffering from a range of other issues, including burns, scars and facial deformities - which previously been untreatable in the region.
One six year old patient had sustained burns to the left side of his body, leaving him with severe scarring that was painful, and limited the movement of his neck - causing his head to be tethered to his shoulder.
Dr Sharp performed scar release surgery, which enabled the brave young man to move his head freely for the first time in two years.
He is pictured, left, receiving a bag of small gifts, during his final consultation with Dr Sharp.
Another child had sadly fallen into a fire during an epileptic seizure, leaving him with a burn that went untreated, fusing his hand to his forearm.
After his scar was released and skin grafts performed, the patient was able to hold his hand out and regain some function.
The courage and resilience of both children - through fear and pain - was incredibly humbling.
Ideally, both children would have gone on to have further surgery and intensive rehabilitation, including compression garments and therapy.
However at this stage, local villages do not have access to the resources required to provide this level of ongoing care.
There is still much work to be done in this area and it’s hoped that future fundraising and resourcing through generous donations (which you can learn more about here) can make it possible to provide the kind of optimal post operative care and rehabilitation all children deserve.
In the second week of his visit, two mothers arrived unexpectedly at the hospital with very young babies, to see if Dr Sharp could repair their children’s cleft lips.
Both children received cleft repairs and recovered well, leaving days later to return to their villages without the stigma attached to facial deformities.
The impact of the trip extended beyond time spent performing surgery; it was also about creating long term knowledge and skills locally – to help future generations of healthcare providers and patients.
Dr Sharp taught local doctors new surgical techniques, including a procedure where muscle flaps from women’s thighs were used to reconstruct their vaginas.
Operating conditions were challenging, with high temperatures and a lack of air conditioning or fresh air in theatres leading the surgeons to work up a sweat. At times, the theatres experienced electrical outages, with loss of lighting.
Throughout, the clinical teams of local doctors, nurses and healthcare workers were enthusiastic, diligent and professional. Fully conscious patients stoicly remained calm and still on the operating table, while surgeons performed (and taught through) lengthy operations.
At the end of their time at the hospital, patients and their families treated the Medical Training In Africa team to a moving farewell song and traditional dance.
For Dr Sharp, seeds for this particular trip were planted two years ago, when he spoke to Professor Goh at a Greenslopes Private Hospital event.
She asked him to explain how he would approach a complicated reconstructive challenge she often faced when operating on women in Uganda.
On the back of a napkin, he sketched out a diagram demonstrating how the thigh tissue can be used to effectively close up some of the large wounds that are left after a fistula repair.
After looking at his diagram on the napkin, Professor Goh asked if Dr Sharp would be interested in joining her to operate and teach in Africa.
Medical Training In Africa also donates surgical instruments, consumables and disposables to hospitals at the end of each visit.
About Medical Training In Africa
Medical Training in Africa was founded by urogynecologists Professor Hannah Krause and Dr Judith Goh to offer specialist urogynaecological surgery to women living in remote parts of Africa and Asia, particularly those living with fistulas. Fistula is a condition caused by prolonged and obstructed childbirth.
Obstructed labour occurs disproportionately in girls and teenagers giving birth in regional Uganda, often because the mother’s pelvis is too small. The protracted labour usually results in the baby’s death, and the prolonged pressure of the baby against mother’s the pelvis damages the soft tissues around her bladder, vagina and rectum, causing tissues to die and tears or holes (fistula) to develop.
If the fistula is between the mother’s vagina and bladder, she experiences urine leakage, and if it is between her vagina and rectum, she leaks faeces. Women with fistulas constantly suffer from infections and pain as well as the embarrassment of wet clothes and a strong odour. They are often shunned or abandoned by their partners and communities.
The operations performed by Medical Training in Africa are inexpensive, costing $215 to treat a prolapse and $324 to repair a fistula. But for a woman in rural Africa, the cost of surgery is usually out of reach. An estimated 2 million women and girls live with fistulas across Africa and Asia.
Obstetric care in Australia is so good, fistulas rarely occur. So these reconstructive procedures don’t often arise in Australia; plastic surgeons usually perform them for infrequent cases of invasive genital cancer.
But women in remote Uganda do not have access to optimal preventative healthcare yet, and that’s also what we hope to change.
Since 1995, Professor Goh and Dr Krause have spent time every year training doctors in Asia and Africa on how to treat fistulas. In 2018, Prof Goh was named the AMA’s Woman in Medicine.
The medical team pay their own costs for the trip, and the charity uses donated funds to pay the hospital for the patient’s surgery, accommodation and post operative care.
Retired gynaecologist Dr Barbara Hall and her husband, retired GP Dr John Taylor, have also been an integral part of the Medical Training In Africa team’s visits to Uganda since 2013. The duo treated women suffering from prolapse and fistula in another hospital, in Kasese, eight hours from Uganda’s capital.
The need for better surgical facilities and maternal and paediatric care is great in Uganda, and small contributions can make a great difference to healthcare in developing countries.