Fred Elective11

KING CAESOR UNIVERSITY
COLLEGE OF HEALTH AND LIFE SCIENCES.

SCHOOL OF MEDICINE
ELECTIVE REPORT SUBMITTED IN PARTIAL FULFILLMENST OF THE

REQUIREMENT FOR THE AWARD OF A BACHELORS DEGREE OF MEDICINE
AND BACHELORS OF SURGERY.
MULAGO NATIONAL REFFERAL HOSIPITAL
P.O.BOX 7051, KAMPALA (U)
DEPARTMENT OF SURGERY
ACCIDENT & EMMERGENCY UNIT
THE CLINICAL HEAD, SURGICAL SERVICES MNRH: DR KAMIGAMBA GIDEON
SIGN & STAMP………………………………………………………..
NAME: IYAMULEMYE FRED (MBChB 1V)

REGISTRATION NUMBER: 2018AP/MBChB/1110
Contact: +256775004317, +256702989427
EMAIL; iyamulemyefred5@gmail.com
SUPERVISOR: Dr JACKIE MABWEIJANO (CONSULTANT SURGEON)
SIGNATURE:……...............................
04th/ 04/ 2022– 29th/ 04/ 2022 (3 weeks)

TABLE OF CONTENTS
DECLARATION ..................................................................................................................... iii
APPROVAL ............................................................................................................................ iv
ACKNOWLADGEMENT ......................................................................................................... v
DEDICATION .......................................................................................................................... vi
INTRODUCTION / ELECTIVE PROGRAM .......................................................................... 5
MULAGO NATIONAL REFERRAL HOSPITAL PROFILE ................................................ 6
VISION ...................................................................................................................................... 7
MISSION ................................................................................................................................... 7
GOAL AND CORE VALUES ................................................................................................. 7
DEPARTMENTS………………………………………………………….. …………………9
MY ELECTIVE OBJECTIVES .............................................................................................. 10
ACTIVITIES PERFOMED/PARTICIPATED IN .................................................................. 10
PROCEDURES PERFOMED ................................................................................................ 11
SURGICAL PROCEDURES…………………..…………… ………………………………11
LESSONS LEARNT ............................................................................................................... 12
LIMITATIONS………………………………………………………………………………13
RECOMMENDATION………………………………..…………………………………….13
CONCLUSION…………………………………………..…………………………………..14
ANNEX ……………………………………………………………………….......…………15
Medical Electives 4th April, to 29th April, 2022 At Mulago National Referral Hospital By IYAMULEMYE FRED
MBChB 1V, King Ceasor University
Page 2
DECLARATION.
I IYAMULEMYE FRED hereby declare that the entire content of this report is an original
product of my activities and hard work compiled during the time of my attachment to Mulago
National Referral Hospital, department of SURGERY for my electives program.
All information is based upon my activities, experiences, findings, expectations and views.
Signature………………………. Date ……………………….
Page 3
APPROVAL
This elective report has been written under our supervision and I therefore authorize its
submission to KING CEASOR UNIVERSITY research department.
Signature………………………. Date…………………
Prof. Ndungutse David
Head of research department, KCU
Page 4
ACKNOWLEDGEMENT.
I thank God for enabling me to successfully complete my elective period in perfect health.
My sincere appreciations go to the King Ceasor university; college of health sciences for
enabling me to have the elective program. Specifically, I would like to appreciate the
department of surgery, Mulago national referral hospital for accepting me to train in the
accident and emergency (causuality) department, especially the heads of department Dr
Gideon Kamigamba and Dr Jackie Mabweijano.
I do appreciate the tireless efforts made by Dr. Aujo J. Caroline ,the chairperson students
rotation committee and the entire students’ coordination office and the office of the Deputy
executive director who made sure that we get officially introduced to the office of the
clinical head surgical services ,MNRH ,which later guided us to benefit during this elective
period by showing us ways to expand our individual knowledge of common surgical cases
on A & E ( causality).
Special thanks also go to the team of senior house officers (SHOS) who were there for us
especially Dr. Kyanda Philip, Dr Bakulumpangi Deo, Dr Atusinguza Nelson, Dr. Nyeko
Andrew, Dr Zepher Turyabirira, among others who always had ward teachings for us. The
interns in particular Dr. Ocaya, Dr. Lillian during our elective period were also very helpful
to us, in that they taught us how to do many procedures, and the spirit of teamwork in the
ward, among others.
Not forgetting the nurses who oriented us on the ward and were very educative and co-
operative and helpful in case we needed anything except a few who could ask us to buy and
carry our own gloves yet we needed to help the patients.
Lastly, a bit of gratitude to my fellow students i did my electives with on the same ward.
They exhibited a high level of teamwork, hard work, and dedication. With them, i am proud
to assert that we did a pretty good job at the department. These included Tumusiime Eric,
Hagumimana Robert plus the rest of the students who were doing the junior surgery
rotation both from makerere and king Ceasor University.
The electives period was by far one of the most instrumental times in my time at medical
school, in that it molded me and gave me a clear insight of what to expect just after medical
school.
The University administration for providing the technical guidance and officially introducing
me to the Elective site.
Page 5
DEDICATION
I dedicate this report to the patients at causuality, medical personnel and students at Mulago
national referral Hospital; Accident and emergency unit, surgery department, my entire
family and friends for the enormous support you rendered to me during my time at the
Hospital.
May God bless you abundantly.
Page 6
INTRODUCTION:
A medical elective is an ingenious component of the medical curriculum which allows
students to gain clinical skills and boost their confidence. The placement is undertaken as part
of medical degree in which the content and setting of the placement are largely decided by
the student undertaking it, with some students choosing to spend it in a different country or
region from where they study from.
It provides a vast experience especially pertaining the medical conditions encountered and the
social background upon which they present in the area of choice. In addition, students are
also enlightened to identify and appreciate some of the factors affecting the health service
delivery in the developing countries and particularly in the areas they will, in future, serve as
Doctors.
Electives represents a unique opportunity to experience health care systems in a setting which
is unfamiliar to that in which they are accustomed to studying or in a place or field of specific
interest. This is of benefit because it helps students to acquire new skills, work alongside
medical professionals, and standout from crowd, personal development and experience of a
new culture.
Through guidance I chose MULAGO NATIONAL REFERRAL HOSPITAL as the site
and surgery as the department of interest; because this is the specialty of my interest. I chose
Accident and Emergency unit specifically because I wanted to have more experience in
giving care to causuality patients especially victims of Road transport accidents (RTA)
including resuscitation, surgical toileting and suturing, wound dressing and triaging.
My electives rotations, however, were not limited to the Department of surgery since being at
causuality allowed to see a variety of patients both surgical and non-surgical (medical)
patients.
My expectations for this elective program were to improve on clerkship, emergency triaging
of patients, assessments and physical examination skills, witnessing and assisting in surgical
procedures where necessary, perform some under supervision, and lastly participate in other
ward activities.
This program was initially scheduled to run from 28th /03/2022 to 22nd /04/2022 but
because of unavoidable delays by the student’s coordination office MNRH and the student’s
rotation committee, the program began 4th /04/ 2022 up to 29th /04 /2022 ( 3 weeks).
Page 7
MULAGO NATIONAL REFFERAL HOSIPITAL PROFILE.
Mulago National Referral Hospital, commonly known as Mulago Hospital, is a hospital in
Uganda’s Capital, Kampala. The hospital is on Mulago Hill in the northern part of the city of
Kampala, immediately west of the Makerere University College of Health Sciences. It is
approximately 5 kilometers (3.1 miles), by road, north-east of Kampala's central business
district. It is the largest public hospital in the country, with Official bed capacity 1790
although it often houses over 3,000 patients. Old Mulago was founded in 1913 by Albert
Ruskin Cook. The New Mulago facility was completed in 1962.
The hospital is the teaching hospital of the Makerere & King Ceasor University Colleges of
Health Sciences. It is also one of the two national referral hospitals in the country, the other
one being Butabika National Referral Hospital. It has several departments including
department of surgery, obstetrics and gynecology, internal medicine, pediatrics and child
health, ophthalmology, Ear Nose and Throat (ENT), mental health among others .
The hospital offers services in most medical and surgical sub-specialties, in addition to
dentistry, emergency medicine, pediatrics, and intensive care.
It serves as a National Referral for the entire country and a general hospital as well as Health
Center IV, III for the Kampala metropolitan.
LOCATION OF MNRH
Page 8
A&E (Causality), MULAGO HOSIPITAL ENTRANCE.
Mulago National Referral Hospital (MNRH).
Mandate: To provide super-specialized healthcare, training and conduct research in line with
the requirements of the ministry of health.
Vision: To be the leading Centre of healthcare delivery in Africa
Mission: To offer state-of-the –art healthcare services
Credo: We are better together
Core values:
 Our priority is the patients’ health and safety
 We observe the highest professional standards maintain ethical code of conduct
 Responsive to persons with special needs
 All medical and non-medical staff serve with excellence, innovation and creativity.
 Committed to continuous staff development
 Safe environment; preserve and protect the environment.
DEPARTMENTS:
The Hospital has different departments which include;
 Obstetrics/Gynecology,
 Internal Medicine,
 Pediatrics and Surgery Departments.
Other services provided by the Hospital include:
 Diagnostic Laboratory,
 Diagnostic Dental services,
 Emergency medicine,
 Orthopedics, ENT, Ophthalmology/ Eye clinic, Family planning as well as Outpatient
Department.
Page 9
MY ELECTIVE OBJECTIVES:
1) To improve on my clinical clerkship skills in surgery.
2) To improve on my skills on both general and systemic examinations of patients
especially causality.
3) To make diagnosis of common diseases conditions and participate actively in their
management.
4) To assist in procedures and do as many times as possible especially STS, I & D,
fracture splinting and immobilization.
5) To learn and improve on my ability to perform ward procedures, learn and improve
on my ability to interpret investigations i.e. x ray ,CBC
6) To find out some of the factors that hinder quality service delivery in the hospital at a
national level.
ACTIVITIES PERFORMED:
During my stay at the hospital I managed to perform the following activities, some of which
were under supervision and others without supervision.
CLINICAL CLERKSHIP:
For the entire program the most performed activities were AMPLE history taking and
physical examination and assessment. I managed to triage patients and they were attended to
as urgent as possible depending on the severity of their conditions on arrival especially RTA
victims. These histories enabled us to carry out physical examination that included both
general and systemic examinations and ordering for necessary investigations including Blood
workups, E-FAST, X-ray and CT-Scans.
WARD ROUNDS: During ward rounds that are conducted twice a day by a team doctors
including specialists, SHOS from different surgery units and intern Doctors plus medical
students. .I was able to participate in review of patients, discussing their conditions with
doctors and my fellow students, taking and recording the patients vitals which included blood
pressure, fasting and random blood sugar levels, temperature, pulse rate, respiratory rate,
SPO2 and then discuss management plan with doctors and my fellow students.
Page 10
Other activities I performed included: assisting and carrying out ward procedures like
surgical toileting and suturing, wound dressing, resuscitating accident victims, patient
Cannulation, catheterization and assisting in the insertion of an underwater seal chest tube in
a patient with haemothorax following assault by thugs and assisting in theater in different
procedures like exploratory laparotomy (EX- LAP) among others.
SURGICAL PROCEDURES OBSERVED AND ASSISTED.

Appendicectomy
This is the surgical removal of the vermiform appendix due to such conditions as Acute
Appendicitis or ruptured appendix.
Sequestrectomy
This is a surgical procedure involving the removal of a sequestrum: a fragment of dead bone
or other tissues that has separated from healthy tissue as a result of injuries or disease. Such
fragments often end up in a wound or abscess. I was able to assist and appreciate.
Page 11
Exploratory Laparotomy
This is a general surgical operation where the abdomen is opened and the abdominal organs
are examined for injury or disease. One of them there was presence of intestinal obstruction; I
was able to appreciate 2 of these procedures.
In addition, I have learnt basics of Anesthesiology and emergency resuscitation of a patient

on operating table as applied in the Operating Theatre, including such maneuvers as Jaw
thrust, Chin lift and Cardiopulmonary resuscitation in cases of Difficulty in breathing
following increased airway mucus excretion.
SELF -DIRECTED LEARNING

In my free period after hospital work I would read about the conditions I had found on ward
which included Traumatic brain injury(TBI), skull and bone Fractures following RTA,
Gangrenes, Tetanus in open dirty bone fractures ,Heamothorax , intestinal obstruction,
intestinal perforation, acute appendicitis among others.
Page 12
LIMITATIONS
1) The elective program was too abrupt with ineffective communication that we were
unable to plan and budget in advance for facilitation of the program.
2) More so, the university did not orient us on what we were expected to do during
electives and really it was very challenging.
3) There has been a delay from reporting to the electives sites because the student’s
coordination office Mulago National referral hospital and student’s rotation
committee took so long to give us introductory letters to the respective departments
like surgery among others, this shortened the period of the electives as per the
schedule forcing us to extend our period at the elective site to complete the required
time.
4) Limited resources in the hospital especially MRI scan, drugs, beds, we had to
improvise so many times and most times we would treat patients empirically and this
was hindering service delivery to patients.
5) Lack of Internet provision to supplement on reading efforts.
RECOMMENDATIONS
1) There is need for better coordination between the University and the different elective
sites; this can help make the students better prepared for the Elective program.
2) There is need for the University/ College to facilitate students’ welfare such as
Accommodation and meals at the Elective sites.
3) Longer duration should be created for the elective period as it prepares and helps a
student gain confidence in patient care.
4) Electives should always be scheduled for classes that have finished at least all 4 major
rotations of junior clerkship as this gives them a wider basis of learning many
different cases in line with what they studied and this a bigger role in enabling to
make rightful choices for their specialization.
5) I recommend that the university should issue the introductory letters early enough so
that students use the elective period effectively according to the university academic
program without losing time waiting for introductory letters.
Page 13
6) The A&E unit should be expanded, there’s is a problem of limited space, beds and
limited protective gears like gloves, face masks not forgetting basic medications like
pain medications essential for proper service delivery to the patients.
7) Health Education of patients in clinics and wards about the cause, prevention of
common surgical & medical illnesses.
CONCLUSION.
My elective period at Mulago National Referral Hospital has been so wonderful, because of
the vast experience of knowledge and skills I have acquired especially at A&E unit.
In the period of 3 weeks, I was able to learn, perform procedures, among the many, I was able
to perfectively insert intravenous lines in patient resuscitation, catheterization in preoperative
care as well as drawing blood samples for blood grouping and x-match of patients due for
surgery, on ward procedures like wound dressing, surgical toileting and suturing (STS),
Fracture immobilization and application of Plaster of pulse (POP).
I was also able to associate and interact with different cadres at the hospital that helped me
learn work ethics and how to handle patients professionally by observing their privacy and
confidentiality when providing health care at all levels.
However the 3 week period of electives was not enough to perfect skills, I therefore hope to
perfect my skills and increase on my knowledge in the remaining time in the medical school.
Besides all the limitations and challenges through this period am privileged for having chosen
MNRH; (A&E) unit (CAUSALITY) for my electives, because of the unbelievable experience
I have acquired in the shortest period of time. I will forever make use of this experience I
gained from Mulago Hospital to help others and save lives.
I appreciate King Ceasor University administration that gave me this privilege to go and
search for knowledge from the place of my interest, I will live to remember the good
hospitality of the Mulago National Referral Hospital (Teaching hospital) and the generosity
of the doctors for pouring out their knowledge and skills to me and the impact they have
made in my medical career.
Page 14
Introductory letters
5/3/2022
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KING CAESOR UNIVERSITY

COLLEGE OF HEALTH AND LIFE SCIENCES.

ELECTIVE REPORT SUBMITTED IN PARTIAL FULFILLMENST OF THE

NAME: IYAMULEMYE FRED (MBChB 1V)

04th/ 04/ 2022– 29th/ 04/ 2022 (3 weeks)

Signature………………………. Date ……………………….

SURGICAL PROCEDURES OBSERVED AND ASSISTED.

In addition, I have learnt basics of Anesthesiology and emergency resuscitation of a patient

SELF -DIRECTED LEARNING

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