Surgical Care Delivery at University Teaching Hospital of Kigali: A Patient Satisfaction Survey

Background: Patient satisfaction is an important quality assurance measure in the delivery of health care. Objectives: The objectives were to assess current patient's degree of satisfaction; to document the main reasons for non-satisfaction and identify potential areas for improvement in surgical care delivered at CHUK. Methods: We conducted a prospective cross sectional survey on patients attending a tertiary surgical unit in Rwanda. For 6 weeks; 10 to 20 patients were randomly included in the study after an informed consent. A pre-established questionnaire was filled and descriptive statistics used to analyze the data using SPSS 16.02 and Excel computer programs. Results: 80 patients have been recruited and accepted to be part of the study. The overall satisfaction was 94. 93.8 have been well oriented.78.8 well received. 90 judged the consultation time enough. 96.87 reported having been respected during consultation. 84.37 of those who underwent surgery reported having received a postoperative fitness check appointment. Asked to mark their surgeon after consultation or on discharge; the patients gave an average note of 9.5 over 10. However 52.5 waited for more than 3hours before seeing a doctor in OPD clinic. For those who underwent surgery; only 58.53 were told indications for surgery; and no patient (0) was told eventual complications. 41.46 were not given appointment for elective surgery; 62.5 patients were not satisfied by information received on their disease and its management. 96.87 patients were not included in the treatment plan decision making. Conclusion: The overall patients 'satisfaction attending CHUK surgical facilities was 94. Clinical and nonclinical factors including waiting time; patient-care provider interactions; patient-centered care concept; and management of Rendez-vous have been identified as areas to be improved

Patterns of Injury at Two University Teaching Hospitals in Rwanda: Baseline Injury Epidemiology Using the Rwanda Injury Registry

Introduction: Globally; more worldwide deaths in 2010 could be attributed to injuries than the total number of deaths from infection with AIDS; tuberculosis; and malaria combined; with a disproportionate number of these deaths occurring in low- and middle-income countries. Yet; worldwide research and plans for prevention of injuries are far below other world health problems; especially in developing countries. Methods: A 31-item; 2-page registry form was adapted from regional trauma registries for use in Rwanda to collect data at the two main university referral hospitals in Kigali and Butare. Beginning in 2011; registrars recorded demographics; pre-hospital care; initial physiology; early interventions; and disposition of injured patients who met our selection criteria. Inpatient 30-day discharge status; mortality; and complications were abstracted from patient charts; ward reports and operating room logs. Descriptive analysis was used to evaluate patterns of injury and basic injury epidemiology at the two study hospitals from August 1; 2011-January 31; 2013. Results: A total of 3599 patients were registered from August 1; 2011 to January 31; 2013. Patients were predominantly male; and road traffic crashes were the leading cause of injury overall; contributing to a greater proportion of injuries in the more urban capital than the smaller city of Butare. The majority of patients were admitted to the hospital. All variables evaluated except for the percentage of injuries acquired via a penetrating mechanism showed statistically signifiant differences at an alpha signifiance level of 0.05; illustrating that the trauma population presenting at the two hospitals may be quite different. Conclusion: The Rwanda Injury Registry indicates a high burden of road traffic injuries in a predominantly working age male population over an eighteen-month period. This information can be useful in expanding injury surveillance programs and hopefully implementing population-based prevention programs

Successful Separation of Conjoined Pygopagus Twins in African Environment with Limited Resources

Conjoined twins are identical or monozygotic twins whose bodies are joined in utero. Pygopagus or Iliopagus twins are a type of conjoined twins in which two bodies joined back to back at the buttocks. Surgical separation of conjoined twins is extremely risk of death and life threatening. We report on cases of female pygopagus twins of three months operated and separated at Kigali University Teaching Hospital. For both babies a posterior sagittal anorectoplasty was successfully performed with derivated ileostomy. Despite limited resources to carry out such operation in our settings; no complications occurred during the operation and oral feeding was done at third postoperative day. Ileostomy closure was performed three weeks after and babies were discharged from neonatology unit at 35th postoperative day. In conclusion; adequate preoperative investigation with a well organized and trained team contribute a lot to the success of such conjoined twins separation

Gastric Cancers at Kibogora Hospital

Background: Epigastric pain is very common in our patients of both sexes and upper GI endoscopy is offered in very few hospitals. Antacids are routinely prescribed countrywide. Helicobacter pylori is very common in our region. Not only most clinicians lack the means to diagnose this infection; but they also cannot confirm its eradication. Many of our patients present with advanced gastric cancer with no prospective for cure. The aim of this study was to determine the frequency; the clinical presentations; the anatomical and pathological aspects and the management of gastric cancers at Kibogora hospital. Methods: This was a retrospective descriptive study of gastric cancer patients seen over a 1 year period from July 2006 to June 2007 at Kibogora hospital. Data was collected from records of patients with diagnoses of gastric cancers. Results: Thirty five subjects were diagnosed with gastric cancer during the study period. Their age ranged from 30 to 80 years with a mean of 55.8 years. There were more females 20 (57.1) than males 15(42.9) (F: M ratio = 1: 0.7). The commonest presenting complaints were epigastric pain (100); vomiting (94.3) and marked wasting (82.9). The physical findings included features of gastric outflow obstruction (60); epigastric tenderness (82.9) and epigastric mass (37.1). Diagnosis of advanced gastric cancer was made at endoscopy in 29(82.9). Palliative surgery was done for 34 (97.1) patients. Twenty seven (77.1) patients markedly improved their quality of life and were discharged home. Only one patient died in hospital. The hospital stay ranged between 7 and 32 days with a mean of 14 days. All the specimens sent for pathology were reported as gastric adenocarcinoma of the intestinal type. Conclusion and recommendations: Gastric cancer is an important public health problem in our region. Clinicians need to adequately diagnose and eradicate H. pylori infection if the incidence of gastric cancer is to be reduced in this region. Surgery can only offer emporary palliation for advanced gastric cancer. There is a need for palliative care in this country