Uganda

  • UMN with Ugandans
  • Operating in Uganda
  • Uganda connections

Jeffrey Chipman, MD and Gregory Beilman, MD - general surgeons and critical care surgeons - began working in Uganda in 2009. Much of the work that the University of Minnesota has been a part of in Uganda focuses on research related to HIV and other infectious diseases, as well as assessing the burden of unmet surgical need nationwide. In more recent years, the University of Minnesota has partnered with the Ruth Gaylord Hospital Maganjo (RGHM) and Makarare University’s Department of Surgery and Mulago Hospital on research initiatives, clinical care, and educational exchanges.

Clinical Care

RGHM was founded in 2013 and is operated by Hope Medical Clinics Uganda, an NGO based in Minnesota. The hospital sits just outside of Kampala, the country’s capital city. Today, RGHM is home to a medical and professional staff of 43 people and provides services year-round - including OBGYN, general surgery, emergency, dentistry, optometry, labs, immunizations, imaging, and pharmacy. In addition, RGHM operates a mobile health clinic that brings education and medical check-ups to patients in the surrounding community for whom the costs of travel are prohibitive.

Capacity-Building

In 2014, a team of researchers - including UMN faculty - adapted the Surgeons OverSeas Assessment of Surgical Need survey and conducted a nationwide, cross-sectional survey of Uganda to quantify the burden of surgically treatable conditions. In 2017, they published their findings: unmet surgical need is prevalent across the country.

Through its connection to the Friends of East Africa Foundation - an NGO based in Minnesota - the University of Minnesota is currently working with RGHM and Makarere University’s Department of Surgery to expand surgical capacity in Uganda. Current collaborative efforts focus on education, training, and ongoing postoperative care for surgical patients.

Education

Since 2017, UMN medical residents have participated in 4 surgical camps. During these weeklong trips, UMN teams provide free operations to RGHM patients, working alongside RGHM surgeons and medical residents. Our physicians and residents learn to adapt procedures in a limited-resource setting while achieving the same outcomes. At the same time, teams offer specialized education and training to Ugandan medical professionals and trainees.

In addition to surgical camps, educational efforts in Uganda also include student and resident rotations at Mulago Hospital, as well as resident exchanges between surgical trainees at the University of Minnesota and Makarere University.

Research

Based on work conducted in Uganda, researchers from the University of Minnesota have published studies on HIV, yellow fever, unmet surgical need, and the safety of performing invasive research in resource-limited settings. The majority of this research has happened in partnership with the Joint Clinical Research Center (JCRC), and collaborations continue today.

UMN has a long-running series of USAID and NIH-funded grants evaluating the lymphatic system in the clearance of viral and other infections. Surgeons and infectious disease experts from UMN have worked with the NIH to evaluate lymph node trafficking in East African subjects.

In more recent years, UMN has begun to work alongside Makarere University’s Department of Surgery to expand research efforts and deepen that partnership.

Get Involved

The University of Minnesota’s work in Uganda offers opportunities to engage in ongoing research projects and provide clinical care. UMN partners with Hope Medical Clinics Uganda - an NGO based in Minnesota - to coordinate week-long surgical camps. These visits typically happen annually and are open to physicians and medical residents. Groups are housed at RGHM’s on-site guest rooms and provide free surgical procedures. Procedures during camps typically include hernias, lumps, and bumps - though surgical care is provided based on current patient need.

Publications

Rothenberger, M., Nganou-Makamdop, K., Kityo, C., Ssali, F., Chipman, J. G., Beilman, G. J., Hoskuldsson, T., Anderson, J., Jasurda, J., Schmidt, T. E., Calisto, S. P., Pearson, H., Reimann, T., David, C., Perkey, K., Southern, P., Wietgrefe, S., Helgeson, E., Reilly, C., Haase, A. T., Douek, D. C., Fletcher, C. V., & Schacker, T. W. (2019). Impact of Integrase Inhibition compared to non-nucleoside inhibition on HIV reservoirs in Lymphoid Tissues. Journal of Acquired Immune Deficiency Syndromes, 81(3), 355-360. PMID: 31192893 doi: 10.1097/QAI.0000000000002026

Butler, E. K., Tran, T. M., Fuller, A. T., Muhumuza, C., Williams, S., Vissoci JRN, Luboga, S., Haglund, M. M., Makumbi, F., Galukande, M., & Chipman, J. G. (2019). Optimizing Care for Ugandans with Untreated Abdominal Surgical Conditions. Annals of global health, 85(1), 50. PMID: 30951271 doi: 10.5334/aogh.2427

Fuller, A. T., Corley, J., Tran, T. M., Butler, E. K., Vissoci, J. R., Andrade, L., Makumbi, F., Luboga, S., Muhumuza, C., Ssennono, V. F., Chipman, J. G., & Galukand, M. (2018). Prevalence of Surgically Untreated Face, Head, and Neck Conditions in Uganda. World Neurosurgery. PMID: 29180091 doi: 10.1016/j.wneu.2017.11.099

Smith, E. R., Vissoci JRN, Rocha TAH, Tran, T. M., Fuller, A. T., Butler, E. K., de Andrade, L., Makumbi, F., Luboga, S., Muhumuza, C., Namanya, D. B., Chipman, J. G., Galukande, M., & Haglund, M. M. (2017). Geospatial analysis of unmet pediatric surgical need in Uganda. Journal of pediatric surgery, 52(10), 1691-1698. PMID: 28427854 doi: 10.1016/j.jpedsurg.2017.03.045

Tran, T. M., Fuller, A. T., Butler, E. K., Makumbi, F., Luboga, S., Muhumuza, C., Ssennono, V. F., Chipman, J. G., Galukande, M., & Haglund, M. M. (2017). Burden of Surgical Conditions in Uganda: A Cross-sectional Nationwide Household Survey. Annals of surgery, 266(2), 389-399. PMID: 27611619 doi: 10.1097/SLA.0000000000001970 

Farber, S. H., Vissoci, J. R., Tran, T. M., Fuller, A. T., Butler, E. K., Andrade, L., Staton, C., Makumbi, F., Luboga, S., Muhumuza, C., Namanya, D. B., Chipman, J. G., Galukande, M., & Haglund, M. M. (2017). Geospatial Analysis of Unmet Surgical Need in Uganda: An Analysis of SOSAS Survey Data. World journal of surgery, 41(2), 353-363. PMID: 27539489 doi: 10.1007/s00268-016-3689-5 

Butler, E. K., Tran, T. M., Fuller, A. T., Brammell, A., Vissoci, J. R., de Andrade, L., Makumbi, F., Luboga, S., Muhumuza, C., Ssennono, V. F., Chipman, J. G., Galukande, M., Haglund, M. M., & Smith, E. R. (2016). Quantifying the pediatric surgical need in Uganda: results of a nationwide cross-sectional, household survey. Pediatric surgery international, 32(11), 1075-1085. PMID: 27614904 doi: 10.1007/s00383-016-3957-3

Lorenzo-Redondo, R., Fryer, H. R., Bedford, T., Kim, E. Y., Archer, J., Kosakovsky Pond, S. L., Chung, Y. S., Penugonda, S., Chipman, J. G., Fletcher, C. V., Schacker, T. W., Malim, M. H., Rambaut, A., Haase, A. T., McLean, A. R., & Wolinsky, S. M. (2016). Persistent HIV-1 replication maintains the tissue reservoir during therapy. Nature, 530(7588), 51-56.  doi: 10.1038/nature16933 

Butler, E. K., Tran, T. M., Fuller, A. T., Makumbi, F., Luboga, S., Kisakye, S., Haglund, M. M., Chipman, J. G., & Galukande, M. (2015). Pilot study of a population-based survey to assess the prevalence of surgical conditions in Uganda. Surgery, 158(3), 764-72. PMID: 26088920 doi: 10.1016/j.surg.2015.05.011

Rothenberger, M. K., Keele, B. F., Wietgrefe, S. W., Fletcher, C. V., Beilman, G. J., Chipman, J. G., Khoruts, A., Estes, J. D., Anderson, J., Callisto, S. P., Schmidt, T. E., Thorkelson, A., Reilly, C., Perkey, K., Reimann, T. G., Utay, N. S., Nganou Makamdop, K., Stevenson, M., Douek, D. C., Haase, A. T., & Schacker, T. W. (2015). Large number of rebounding/founder HIV variants emerge from multifocal infection in lymphatic tissues after treatment interruption. Proceedings of the National Academy of Sciences of the United States of America, 112(10), E1126-34. PMID: 25713386 doi: 10.1073/pnas.1414926112

Rothenberger, M. K., Mutuluuza, C. K., Ssali, F., Jasurda, J., Schmidt, T., Schacker, T. W., Beilman, G. J., & Chipman, J. G. (2015). Inguinal lymph node and anorectal mucosal biopsies for human immunodeficiency virus research protocols in an emerging nation: patient outcomes and lessons learned. Surgical infections, 16(1), 68-71. PMID: 25650809 doi: 10.1089/sur.2013.179

Fletcher, C. V., Staskus, K., Wietgrefe, S. W., Rothenberger, M., Reilly, C., Chipman, J. G., Beilman, G. J., Khoruts, A., Thorkelson, A., Schmidt, T. E., Anderson, J., Perkey, K., Stevenson, M., Perelson, A. S., Douek, D. C., Haase, A. T., & Schacker, T. W. (2014). Persistent HIV-1 replication is associated with lower antiretroviral drug concentrations in lymphatic tissues. Proceedings of the National Academy of Sciences of the United States of America, 111(6), 2307-12. PMID: 24469825 doi: 10.1073/pnas.1318249111

Zeng, M., Paiardini, M., Engram, J. C., Beilman, G. J., Chipman, J. G., Schacker, T. W., Silvestri, G., & Haase, A. T. (2012). Critical role of CD4 T cells in maintaining lymphoid tissue structure for immune cell homeostasis and reconstitution. Blood, 120(9), 1856-67. PMID: 22613799 doi: 10.1182/blood-2012-03-418624

Zeng, M., Southern, P. J., Reilly, C. S., Beilman, G. J., Chipman, J. G., Schacker, T. W., & Haase, A. T. (2012). Lymphoid tissue damage in HIV-1 infection depletes naïve T cells and limits T cell reconstitution after antiretroviral therapy. PLoS pathogens, 8(1), e1002437. PMID: 22241988 doi: 10.1371/journal.ppat.1002437