A growing number of Ugandan major health facilities, both public and private are coming on board to embrace the recently introduced, less invasive surgery technique which uses laser technology.
The demo laser surgery usage in Uganda which started at a slow pace in 2016 is now being embraced by several private facilities and government hospitals including Mulago National Referral Hospital, and the soon to be launched Mbuya Military Hospital.
Dr Michael Oling, a General and Laparoscopic surgeon at IHK, who pioneered the technology in Uganda, discusses in this interview, the use of laser surgeries and how they are changing the medical landscape in the country.
Q: Biolitec in Partnership with Health Care Uganda is providing demo laser surgeries – minimal access surgeries – to enhance patient experience, but most importantly to introduce new treatment options for different conditions across board. Take us through what this is all about.
Basically lasers are energy devices. They are used in different industries; they can be used for engraving metallic materials; but in particular I want to introduce you to medical lasers.
These are also in different categories; some are used for skin conditions but I want to talk about the ones for surgery which are called diode lasers, and they range from 10 watts to 200 watts.
If you are doing a basic procedure like a haemorrhoid surgery, the power is almost 15 watts, but if you are doing for instance a BPH which is a large prostate, you need power of up to 200 watts.
Laser technology is not new in the world but it is relatively new in Uganda. We started doing surgeries in 2016
Q: If this tech has been employed across the globe and we are simply embracing it recently, why is it so?
It is our slow progress toward technological advancement across the globe. Personally I was introduced to lasers in 2016. We were trained by Biolitec, a German based manufacturer of lasers. We were three; myself, another surgeon at IHK and one at Nakasero Hospital.
The first surgeries were done in 2016 and they were all successful, and from then we have tried to scale up the procedure, and to include our colleagues.
To do theses surgeries you have to be trained; it is nothing complicated but because it is a lot of energy you have to be trained to minimise the complications.
Laser surgeries are less invasive and heal much quicker
Q: Since this requires training, you as surgeons, are the numbers currently sufficient to cater for patients in terms of patient – surgeon ratio? Can you meet the demand if knowledge about this becomes apparent?
At the moment I would say no, because we are few, we could be less than 20 and this is in a span of 7 years from 2016.
So I am doing about 10 haemorrhoid surgeries a month, I stopped using other technics I am only using the laser. My colleagues are also having a similar kind of work rate. But we also know now that about a third of the population have haemorrhoids, which is about 6million adults.
So if you look at the numbers, we are basically overwhelmed and due to resources, we are largely concentrated in Kampala.
It is a blessing that Biolitec is in the country and trying to scale up the trainings and train more doctors so that we can make the procedures available in all parts of the country.
Q: Is there any effort by government to bring public health facilities on board so that there is an arrangement that can afford the average Ugandan this kind of service?
Initially in 2016, laser procedures were not so popular, so we started using them for treatment of varicose veins, haemorrhoids and fistula. But with time we started realising the benefits for lasers. We realised for instance that if someone had surgery for haemorrhoids and used the laser, they would be able to return to work the next day. The procedure itself would take about 20 minutes compared to one hour if you are using the open techniques. So we noted that the long term cost for laser was cheaper.
Government also has surgeons and they realised that this technology is good. As I speak today, I know that they performed percutaneous laser disk decompression, where by you use a laser to treat a disk that has slipped from the back.
These procedures were done at Mulago Yesterday. At the same time, I am aware that the UPDF hospital made arrangements to have lasers commissioned in the new hospital. So I know that government has embraced this technology.
Private hospitals on the other hand, if they want the can acquire the laser machine directly, and they would have to also keep buying fibres (the consumables used for the different surgeries).
But they could also hire the machine. Biolitec has made arrangements and the different companies that have Biolitec machines that they are able to hire out at a cost.
What is the current cost for one to be able to acquire these services?
This will depend on what kind of procedure you are doing, but in general terms the average price will range from USD 1000. That is the least you can get in the market; but also the prices will vary depending on the hospital.
The most expensive may not exceed $2500.
This is in Uganda. But I have performed these surgeries in Dubai, in India, Tunisia, and I can tell you that the price there is about double.
In Uganda today, for many a single trip to the hospital could make you poor. Is there any arrangement to help those who might grapple with the cost?
Uganda is becoming a health giant. You notice that insurance companies are also embracing technology. So we have insurance on board and they are actually covering for these surgeries. So I would encourage everybody out there to try and sign up with these insurance companies so that you don’t get into this kind of trap.
One of the cost factors is that the fibres used are one-time use, you use it and throw it away. If there was a way to reuse them, the prices would come down.
If things are tight financially, what are the other options if I can’t go for laser surgery?
For different conditions we have different treatment modalities. If we talk about a vein surgery for example, you would have to think about going for vein stripping or using glue, where you go into the vein with a catheter and glue every spot.
But like is said, this would be a heavy surgery, and your surgeon will probably not have a good experience. The more difficult the procedure is, the more likely that you will have adverse outcomes.
The truth is technology improves outcomes, so if you have good technology you need to use it.
Q: Could you take us through access to Biolitec and this laser technology; I am sure that there are people out there who are offering these services, how do they access this technology within the country.
Biolitec is actually around as we speak today, the manufacturer is in the country, but they also have offices near Brookside in Industrial area, just next to Bata.
Biolitec has also made its lasers available in various hospitals. I know Nakasero hospital has a laser, Ruby Surgery Centre, IHK and then there are other companies such as Angelo Foundation Medical Suppliers who hire out laser machines and fibres separately.
