Uganda is challenged with both a lack of perisurgical care providers and an undersupply of necessary modern equipment to provide safe anesthesia. While humanitarian efforts to provide equipment and short-term physician staffing are helpful, the issue of day-to-day access to high quality care remains a matter of life and death for Ugandans on a daily basis.
As a country, Uganda has one of the largest anesthesia provider deficits in the world with approximately 70% of job postings unfilled. In response, the Ugandan health system offers 3 levels of anesthesia provider training including 2 Masters level programs, 2 Bachelors level programs, and 7 "Higher Diploma" programs (graduates of which assist surgeon-directed anesthesia). Research shows that anesthesia provider density has marginally improved, but that quality of care and outcome data has not.
I will be traveling to Kabale University School of Medicine, home to one each of the country's Masters and Bachelors level programs, where I will onboard and orient as a physician-educator faculty member. While I will participate in lecturing and curricular development for existing programs, I will also assist in developing a Physician-level Anesthesiology Residency Program, the first of its kind in the country. In this way, I intend to contribute immediately to the need for educators in the existing 3-tiered anesthesia training system in Uganda, and ultimately to the reshaping of the medical landscape surrounding perioperative medicine and critical care in Uganda.
Immediate benefit will be seen in adding diverse faculty with experience in anesthesia education and curricular development to the KABSOM Anesthesia Department. Long term benefit will come from participating in the development and administrative maintenance of Uganda's first physician-level Residency Training Program for Anesthesiology and Critical Care. Direct involvement with the Ugandan medical regulatory boards and anesthesia societies will hopefully lead to rapid expansion, leading to an increase in anesthesia provider density and quality of training.
The field of Anesthesiology has come a tremendous way in the past 100 years. Both safety and efficacy have skyrocketed as new technology and deeper physiological understanding of the postsurgical state have developed. Due to political unrest during this time, the Ugandan health system lost many of its physicians and higher-level providers during a period of rapid development in this particular field. Ugandan health officials have partnered with the international Anesthesiology community to assist in resource sharing, infrastructure building, and modernizing the delivery of perioperative and critical care medicine to its citizens.
I will onboard for two weeks steeping in the current culture, climate, opportunities, and challenges within the Kabale training program and hospital. Additional context for working within the Ugandan healthcare system and networking with those leaders will also play a crucial role in this project. Thereafter, I will serve as a distance instructor through developing curricular modules, giving lectures, and working collaboratively with Ugandan health officials to launch the country's first Anesthesiology and Critical Care Residency program.
Shortly after becoming a new attending, it became clear that my career trajectory was missing key elements I had always valued: direct teaching, service, and curricular design. I was fortunate to assume leadership of an Anesthesia Assistant training program at my institution, which partly fulfilled the teaching and program-building components. Yet the service piece—the opportunity to contribute beyond my own hospital—remained noticeably absent. I started exploring global health volunteer opportunities and quickly found Health Volunteers Overseas (HVO), which in early 2024 was actively recruiting support for anesthesia education in Uganda.
Uganda is currently facing a critical shortage in safe anesthesia delivery. It has one of the world’s largest anesthesia provider deficits, with 70% of public anesthesia posts unfilled. Most anesthesia is delivered by non-physician anesthetic officers whose training and experience vary widely. Perioperative morbidity and mortality rates in Uganda are up to 10% higher than in high-income countries, worsened by severe shortages in basic resources—such as endotracheal tubes, anesthetic drugs, and oxygen—as well as an unreliable power grid. The country’s surgical volume remains far below the Lancet Commission on Global Surgery’s minimum recommended threshold. Within anesthesia, inadequate access to monitors, airway tools, and emergency training exacerbates the crisis.
In response, the Association of Anesthesiologists of Uganda, supported by the Ministry of Health, has significantly expanded its anesthesia education programs. The most promising of these is the creation of an advanced non-physician anesthesia provider (NPAP) degree in anesthesia and critical care medicine. Two institutions now offer this program: Kabale University School of Medicine (KABSOM) in western Uganda and Busitema University in the east. KABSOM is distinct in that it not only trains new NPAP students but also runs "completion" programs to standardize the skills of practicing anesthetic officers. The institution is also planning a physician-level residency program in anesthesia.
KABSOM is based in Kabale, a rural town near the Rwandan border, not far from the conflict-affected region of eastern DRC. The town is small but densely populated and built into the steep hills of the Kigezi Highlands. Kabale Regional Referral Hospital (KRRH) serves a wide region and provides tertiary care including trauma and neurosurgery. It is also the primary clinical site for KABSOM trainees. HVO has been working closely with this system for years, sending volunteers to support a wide range of medical and surgical education initiatives, with anesthesia being a major focus over the past three years.
The clinical need is substantial. At present, five anesthesiologists support fifteen surgeons and nearly 130 anesthesia trainees. Of the five anesthesiologists, some are part-time, hold heavy administrative roles, or support the hospital remotely. This imbalance places an enormous strain on the system. While KABSOM and KRRH are training a growing number of providers, the educator-to-trainee bottleneck limits progress. HVO and the Dox Foundation have become critical partners in relieving that pressure.
In January 2025, I began providing remote academic support to KABSOM, but was quickly advised that a site visit was necessary to understand the environment and effectively contribute. In April, I traveled to Kabale via Kigali, Rwanda. The journey from Kigali’s modern capital through the border into Uganda was striking: manicured cityscapes gave way to unpaved roads, simple buildings, beasts of burden, and military checkpoints. After crossing the border, Kabale was another 20 minutes by car. The hospital sits above town on a steep hill and serves as a regional hub for medical care.
The hospital entrance is flanked by vendors selling food, crafts, and basic medical supplies like spinal needles and chest tubes—items patients must often purchase out-of-pocket. KABSOM itself is a modest courtyard with about 10 small offices and lecture rooms. Nearby sits the three-OR surgical theater, which includes a preop/PACU area and a locked store of higher-cost equipment. Scattered around the grounds are additional medical wards and outpatient clinics. Many family members live on-site in temporary arrangements, sleeping on mats and preparing food, unable to afford travel or lodging elsewhere.
Each day begins at 0700 in the preop area. Trainees review the day’s cases, seek advice from more senior trainees or anesthetists, and formulate their plans. Due to resource constraints, case preparation and patient consent can stretch until mid-morning. Once cases start, the operating room often fills with 20–30 people: anesthesia trainees, medical students, and surgical trainees. Equipment such as laryngoscopes and endotracheal tubes are reused. When procedural challenges arise, trainees rotate in or seek help from one key figure: Benny.
Benny has worked at KABSOM for 15 years. She started as a technician but trained herself in anesthesia and now is completing the advanced anesthetic officer program. She is the OR’s informal leader and educator, helping manage cases, secure airways, and even staffing the small four-bed ICU. She coordinates with the on-duty anesthesiologist—when one is available—and remains a key contact for trainees throughout a patient’s surgical course, including recovery and transfer.
The ICU itself is located downhill in a tin-roofed building. It contains four beds, four oxygen cylinders, and one ventilator. No mobile X-ray exists; patients cannot be moved for imaging. Gurneys must be physically lifted over grass and steep slopes to access the building. ICU care is managed by anesthesia and nursing trainees.
Educational limitations mirror the clinical ones. Lectures occur wherever space is available—sometimes in lecture halls, but often in tents or even under trees. Space conflicts and unpredictable clinical demands frequently disrupt scheduled teaching. Much of the education is self-directed. Successful trainees spend personal time mastering material from textbooks and actively seek out cases for hands-on experience, often competing with each other for opportunities.
Despite these constraints, the trainees are engaged and inquisitive. On my arrival, I was warmly welcomed by students and faculty, who immediately asked how best to harness my time. Teaching sessions were energetic and interactive. But I encountered challenges right away. My first lecture, on arterial blood gases, faltered when a trainee asked how to apply the content without access to an ABG machine—equipment they rarely had. It was a humbling moment that forced a rethinking of how to deliver relevant, contextualized teaching.
Soon after, Jonathan, a student leader in the NPAP program, took me to lunch and walked me through their full curriculum. He highlighted areas in need of reinforcement and emphasized the value of intraoperative education. I then met Dr. Isabelle Epiu, Chair of the Anesthesia Department and director of all four KABSOM programs. Dr. Epiu is a visionary leader with a fierce dedication to her students and an ambitious plan for the future. She described efforts to revamp the curriculum, stabilize the teaching schedule, and create new clinical and educational space.
From this point, our work accelerated. Jonathan and I restructured my lectures to focus on real-world cases and immediate clinical applications. Benny brought me into the OR and helped orient me to daily workflows. We began using a newly donated Butterfly Ultrasound device for ICU patient evaluation and procedural guidance. We introduced regional anesthesia techniques like TAP blocks. We stayed late, worked weekends, and implemented what we could. More importantly, the team showed me precisely where external educators could add meaningful value.
Before my departure, Jonathan and the class leaders coordinated a new remote lecture system that allows me to access the curriculum in real time and contribute regularly. This will relieve some burden on the local anesthesiologists and allow after-hours tutoring. Alongside a fellow HVO volunteer, we are now teaching POCUS to Benny and Jonathan, using the Butterfly’s cloud to review and critique images and plan further instruction. Benny is preparing to become the point person for POCUS education at KABSOM. Jonathan is forming a team to write up this project for formal submission.
Real progress was made during this trip—but it is only the beginning. Much more can be achieved through continued partnership, both remotely and with future trips to Kabale. HVO was absolutely right: there is no substitute for being physically present. Even after arrival, it took days to truly understand the realities, obstacles, and opportunities on the ground. But what I saw was clear—Uganda has the people, the passion, and the foundation to build safe, equitable anesthetic care for the future. I’m deeply grateful to HVO and the Dox Foundation for allowing me to be part of this work.
