Saturday, April 28, 2012


Dr. Mohan Keshavamurthy
MS (General Surgery), M Ch (Urology), FRCS(C), FASTS Consultant Urologist and Transplant Surgeon Dr. Mohan Keshavamurthy is an eminent urologist and transplant surgeon with over 16 years of extensive surgical experience. He is a pioneer in laser Urology as well as an expert in complex reconstruction of the urinary tract and major uro-oncological procedures in both adult and paediatric age groups. He has performed over 250 Laser enabled Transurethral prostate Vaporization procedures (LASER TURP), 1500 laser fragmentation of kidney(RIRS) and ureteric stones(URS), 1600 kidney transplants, and 75 pancreas transplant. He is an acknowledged expert in implantation of flexible and inflatable penile prosthesis & penile lengthening procedures. Professional qualification A meritorious and award-winning student, Dr. Mohan, after completing his MS in general surgery finished his M Ch urology from the prestigious KEM Hospital, Mumbai. He then completed his fellowship in urogynaec-oncology from Tata Memorial Hospital, Mumbai. Besides these, he has done advanced training leading to a Fellowship in solid organ transplantation from QE II HSC, Halifax, Canada and Fellowship of American Society of Transplantation thereafter. Dr. Mohan has contributed more than 100 articles in various peer reviewed journals like Transplantation Proceedings, The Canadian Journal of Urology, British Journal of Urology International to name a few. Apart from being the Chief Investigator-Middle East for Neoral MOST study, he contributed significantly to the medical fraternity by presenting on various topics at different international conferences like Congress of the International Pediatric Transplant Association, American Transplant Congress, Transplant Odyssey, etc. Tags: Dr Mohna Keshavmurthy, laser TURP, nephrology, prostate enlargment, Urologist HEALTHCARE A MAJOR CHALLENGE FOR UGANDA Uganda has one of the worst healthcare records in the world, but the development of local facilities and training of volunteers will bring life-saving services to thousands of people in Katine Annie Kelly, Wednesday 1 April 2009 00.01 BST Article history Elias Oluja, lab technician from Tiriri health centre tests patients for HIV during his weekly visit to the lab at the Ojom health centre, Katine Elias Oluja, lab technician from Tiriri health centre during his weekly visit to Ojom lab in Katine. Photograph: Dan Chung Talk to locals in Katine, north-east Uganda, about what worries them most in life and the answer will probably be their health and the health of their family. Look at the statistics and it's easy to see why. Despite record investment over the past five years, Uganda's healthcare performance is still ranked as one of the worst in the world by the World Health Organisation. The country is ranked 186th out of 191 nations. A Ugandan's health and life expectancy is among the lowest across the globe. In Uganda, one in every 200 births ends the mother's life, around 1 million people are living with HIV and although malaria accounts for 14% of all deaths, less than 10% of children under five are sleeping under insecticide-treated nets. The African Medical and Research Foundation (Amref), which with Farm-Africa is working to improve lives of Katine villagers, funded by donations from Guardian readers and Barclays, says health has proved one of the most complex and challenging components of its work in the sub-county so far. During the 18 months since the Katine Community Partnership Project began, serious external challenges have emerged with increasingly poor and erratic drug distribution, lack of trained medical staff and equipment and the looming threat of a global recession disrupting progress. Now, at the halfway point of our three-year project, it is clear that hitting the ambitious health targets set in 2007 will not be easy. However, there have been some notable achievements. The new laboratory at the Ojom health centre was joyfully welcomed by the local community and now means that more than 15,000 people can easily access simple but potentially life-saving diagnostic tests for HIV, malaria and tuberculosis. In a country where 51% of people don't have any contact with public healthcare facilities, nursing staff at Ojom report that the lab has also increased the number of people accessing healthcare services at the clinic. "They come for a blood test and then they come and see us, whereas before they wouldn't have made the trip," says Richard Okello, a nurse working at Ojom. According to Amref, one of the biggest discoveries of the project so far is that helping to build functioning community structures can lead to a tangible improvement in healthcare and access to health services at a local level. So far more than 300 local people have been trained as volunteer community healthcare workers since the project began. There is now a network of village health teams (VHTs), traditional birth attendants (TBAs) and community vaccinators supporting healthcare programmes in Katine and acting as bridges between local communities and frontline health services. Across Katine, VHT members are going out to remote households and making referrals to public health facilities, and have distributed thousands of treated nets to mothers and children under five. TBAs trained by Amref to recognise danger signs in birth are now referring more mothers to clinics than ever before. Before the project began, overworked healthcare staff were unable to run outreach immunisation programmes. Now, thanks to the work of community vaccinators, 90% of children in Katine are immunised against killer diseases such as measles and polio. Local people are now starting to demand the right to decent health services. Negotiations over the building of a new clinic at Merok are underway with the district government after community leaders called for better access to healthcare services for thousands of people living in this remote part of the sub-county. At the same time the fragility and gaps in existing healthcare provision in the sub-county have been starkly exposed. One Amref staff member in Katine described trying to tackle poor healthcare services as "trying to put out a bushfire". As soon as you've put out one blaze, another one has started behind your back. A well-documented problem has been the chronic shortage of trained professional staff in Katine's healthcare facilities. This is a story played out across the country. Only 38% of healthcare posts are filled in Uganda. Those healthcare staff who are working, have little incentive to work in poor rural areas like Katine. Some 70% of Ugandan doctors and 40% of nurses and midwives are based in urban areas, serving only 12% of the Ugandan population. In Katine, the fact that there is still no doctor at Tiriri, the sub-country's largest healthcare facility, has been a serious blow to the central goal of improving healthcare services to those most in need. Amref says it has been lobbying the district government to get this post filled, but with no luck. The lack of drugs at Tiriri and Ojom is a glaring testament to the failure of the national drug distribution programme, something not factored in to health goals at the beginning of the project. Again, Amref says it is lobbying for this to be improved, but has no mandate to distribute drugs itself. One major concern is the effect this is having on the morale of the community healthcare workers so integral to Amref's health strategy for the project. Susan Wandera, Amref's deputy director in Uganda, says the lack of vaccines and empty drug stock rooms that greet locals who have been encouraged by VHTs to walk hours to a clinic, could haemorrhage support and undo many of the relationships nurtured throughout the first phase of the project. "External challenges, like lack of drugs and lack of healthcare staff, mean we are putting demands on our VHTs and community vaccinators, who are already doing a very difficult and demanding job on a voluntary basis," she says. "We cannot risk losing their support as they are absolutely essential to our work in Katine." Hovering above all this is the increasingly ferocious global financial meltdown, which could threaten to derail Uganda's national health budgets – half of which are now funded by the international community – and undermine all progress made in healthcare provision over the past decade. There is no doubt that the ripple effects of any cuts in development or aid budgets to Uganda's healthcare system will be felt in Katine. In the 18 months left to run on the Katine project, Amref says it is going to build on the work it has already started. Refresher training courses will be provided to VHT members, community vaccinators and TBAs, as well as professional healthcare staff. An additional 30,000 anti-malaria bed nets will be distributed across the sub-county. The next year and a half will also see an increased focus on family planning, with VHT members distributing contraceptive pills and running outreach education and awareness programmes around sexual health and family planning. On top of this the clinic at Tiriri will undergo renovations and be upgraded so operations will be able to be performed on-site, rather than patients being transferred to Soroti district hospital, if it can find the staff to carry them out. The immunisation programme will remain a particular focus for Amref as the project draws to a close. New refrigerators and chill-boxes are being supplied to Ojom clinic to help community immunisation workers extend their reach into some of Katine's most remote and vulnerable communities. It hopes to be able to transfer a fully functioning community immunisation framework over to the district government, and is aiming for 90% of children under five to be immunised against eight killer diseases by the time the project finishes its three-year cycle.

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