1. Pediatric Surgery at Mbarara Regional Referral Hospital (MRRH)/ Mbarara University of Science and Technology (MUST) Martin Situma. Pediatric Surgeon MUST/MRRH/Bethanykids

2. Background Started in Feb 2014 Tripartite arrangement between MUST, MRRH and Bethanykids through Memorandum of understanding. 1 full time surgeon 1/19/20162

3. Activities Clinical services (to patients), both Outpatient and inpatient Teaching (students, residents) Research 1/19/20163

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5. Outcome Gastroschisis 16/17 100% mortality Omphalocele 1/5 20% mortality EA 2/3 66% (1 died at home) DA ¼ 20% JA 3/7 43% 1/19/20165

6. Numbers likely to grow MRRH serves as main referral hospital for 10 districts in southwestern Uganda. MRRH alone has up to 1000 deliveries in a month New PNFP children’s hospital (Holy Innocents children's Hospital) located about 5 minutes from MRRH. 1/19/20166

7. Tumors 1/19/20167

8. Factors affecting outcome Chemotherapy available for most of these Young and vibrant oncology service, but no pediatric oncologist yet. Very good collaboration with the pediatric surgical service No radiotherapy. Protocols not necessarily suitable for our setting Lot of patient support systems needed to enable them complete treatment 1/19/20168

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11. Other conditions 34 ARM 20 nephroblastomas 7 pullthroughs for hirschsprung’s disease 1/19/201611

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14. Research Residents rotating on the unit and as masters thesis. 1/19/201614

15. Opportunities Goodwill from both the hospital and university. Good inter departmental cooperation Teaching hospital provides a source of potential fellows in pediatric surgery and nurses for training Variety of clinical conditions Several potential areas of research and collaborations Theatre structures are available although no staffing levels to be able to utilize them and no equipment yet. 1/19/201615

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17. Challenges No central place for pediatric surgery. Adults mixed with pediatric and medical conditions with surgical. Inadequate personnel. 1 full time surgeon, few nurses, few anethesiologists. Lack of pediatric ICU facilities Poor record keeping. Inadequate theatre space and insufficient neonatal & pediatric instruments. Inadequate supplies. 1/19/201617

18. Possible solutions Establishing partnerships with other institutions or centers and individual surgeons to improve the surgical care of children. Have fellows train or at least rotate at the unit. Source funds to equip and operationalize a pediatric surgery theatre. Train more pediatric surgeons. Funding for record clerks, more nurses. Develop an ICU and high dependency area on ward for the more sick babies. Possible research collaboration with other centers. 1/19/201618

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20. Thank you! 1/19/201620