A Conversation with Global Surgical Initiatives - Kyabirwa Surgical Centre Director Anna Turumanya Kalumuna
Part 1.
We sat down with #KyabirwaSurgicalCentre (#KSC) Director Anna Turumanya Kalumuna to gain a deeper understanding of how KSC functions daily and the biggest problems it is solving, plus Anna’s involvement in the Centre from the get-go.
“On a personal level, when my niece was treated with a cochlear implant by Dr. Marin and the team at Mt. Sinai, I first thought: “Who are these people that are helping random strangers?” It was so fulfilling to see people work and think so selflessly that I initially wanted to do anything I could to give back. We hear so many stories of those in the community that need care or support, and it’s so empowering to know that we can help,” states Anna, as she explains what keeps her motivated to work at KSC.
Read part 1 of the Q&A below!
Photo taken by Allen Yu (part of KSC and Mount Sinai Surgery): GSI-Kyabirwa Surgical Centre Director Anna Turumanya Kalumuna
1. Can you share a brief history of the Kyabirwa Surgical Centre (KSC) and how you became involved?
I first learned about Kyabirwa Surgical Centre (KSC) in 2017 through my husband Dr. Charles, who introduced me to Dr. Michael Marin – the Chairman of the Board at KSC and a friend of my husband. I was familiar with the work that Dr. Marin and the Mt. Sinai hospital team were doing in New York because my niece with hearing impairments received a cochlear implant by Dr. Marin there. Fast forward to 2019 and an almost-finished surgical center, Dr. Marin was looking for a Manager and Administrator to help get KSC up and running. Following a brief conversation, he approached me to lead the establishment of the Centre, which included establishing organizational structures and systems, identifying Human Resources, procuring medical equipment, overseeing remaining construction work, and developing the organization ethos. I also worked on setting up the daily systems and helped finalize the last-minute cosmetic details of the Centre, all while ensuring the vision of the donors was brought to life. It’s been exciting to work with KSC from the start, and through each phase, to where we are now.
2. What does a typical day at KSC look like?
We start each day with a Quality Assurance Meeting, where representatives from each department spend 15 minutes discussing the wins and challenges from the previous day. It’s a great way to connect as a team while aligning on our performance and learning what we can do better – topics include time management (for both our team and the patient’s wait time at the Centre), output quality, communication, IT, etc. After the morning meeting, I conduct a routine in-person visit to each department to check in with the team, help troubleshoot any issues, and make sure everything is running smoothly. Once I know all teams are set up, I generally attend to administrative tasks or our external stakeholders – this includes sending reports to donors, receiving local stakeholders at the Centre, liaising with regulatory bodies, overseeing high-level functioning, and ensuring all systems are running cohesively.
3. What are the biggest health challenges you and the KSC team are solving?
When it comes to our biggest challenges at KSC, I can categorize these into three key elements: access, perception, and cost. In terms of access to safe and affordable surgery, there are oftentimes no options for the average Ugandan – and our region is no different than any other rural community across the country, or even across Africa. From high cost of services and lack of available public healthcare to little access to on-site surgeons or medical-related supply challenges, surgical centers are often incapacitated in one way or another (even when removing cost from the conversation). For example, when we started, we had a 200 person wait-list of those that required surgery at a neighboring clinic. Beyond access and affordability barriers, one main challenge was the community’s perception and beliefs around surgery – the Knowledge Attitude and Perception (KAP) gap. Many people held stereotypes and false beliefs concerning surgery, which limited treatment seeking and meant that they only looked to surgery very late in their disease trajectory.
4. How did these initial challenges motivate you and the team at KSC?
From this starting point, we knew we wanted to offer high-quality, safe, and reliable care for our community while targeting those who make less than one dollar per day – the majority of those living in the direct community here in Jinja. However, we quickly learned that our role was not only to conduct the surgery but also to educate our community on the many safe and long-term benefits of surgery. We saw an opportunity to partner with other healthcare providers across the region to tackle the myths and preconceptions of what surgery entails. An underlying lack of information meant that we needed to focus on community education and on establishing sensitization activities to ensure those in the direct regions were comfortable with what surgery is and can offer. From these efforts, we now see local patients accessing surgery as early intervention, rather than as a last resort, allowing them to live longer, healthier, and more fulfilling lives. Some of these individuals have even become patient ambassadors.
To minimize long-term catastrophic health expenditures, we also wanted to make surgery as affordable as possible. Our goal was to avoid having someone come in for surgery, and subsequently never recovering financially from the life-saving procedure. The ambulatory approach to care we use at KSC is a day-in-day-out surgical care model, which helps reduce costs related to long-term stay. Furthermore, our ‘Recovery at Home’ program offers post-operative follow-ups and monitoring at the patient's home, ensuring that our patients fully recover and do not incur any further out-of-pocket costs.
5. Has the perception of surgery changed since KSC has been open?
Since data is at the forefront of what we do at KSC, we have been able to research, collect, and track progress so we can confidently share the Centre’s impact and story. Initially, our no-show rate stood at 40%, indicating that out of 10 patients, four would fail to attend their scheduled surgeries. When we unpacked why this was the case, we learned that one of the many reasons was that patients would have a change of mind leading up to their surgery. This told us that educating patients and the community was a priority. Over the years, we have seen the number of surgeries grow from 500 per year to over 1,000 per year, with a current no-show rate of less than 30%. On top of that, we are seeing improved and more timely health-seeking behaviors from the community, with patients looking towards surgery not as a last resort, but as a viable option for care.
6. What keeps you motivated and excited to work at KSC?
On a personal level, when my niece was treated with a cochlear implant by Dr. Marin and the team at Mt. Sinai, I first thought: ‘Who are these people that are helping random strangers?’ It was so fulfilling to see people work and think so selflessly that I initially wanted to do anything I could to give back. Now after working with the Centre, I have watched it grow to what it is today, including onboarding and working with all 53 employees. We hear so many stories of those in the community that need care or support, and it’s so empowering to know that we can help. Putting a smile on so many faces and helping to change the course of someone’s life is what keeps me motivated and energized – it’s incredibly gratifying!
Part 2 is here!
The Director Anna Turumanya Kalumuna highlights how GSI-KSC works cohesively with the public healthcare system in Uganda, the health and economic benefits they provide for the community, and what’s next for her and the team at KSC.
“From the beginning, the partnership between KSC and the community has made our programs the success that it is today. Unlike many other donor-funded organizations, KSC and our programs are completely Ugandan run from the top down. Equally as impactful, the land that KSC is located on has been leased from the community – so not only is KSC locally run but it is also locally owned. This presents an exceptional advantage,” states Anna when explaining the community’s involvement and support in KSC.
Read part 2 of the Q&A below!
Photo taken by Allen Yu (part of KSC and Mount Sinai Surgery): The KSC team.
1. How does KSC collaborate with the public health system?
The Uganda public health system operates as a decentralized model, from the top national hospitals to district or regional hospitals and health centers, to village health teams and community centers. In an ideal world, the whole health system works cohesively, referring upwards from the community level for specialized care needs and back down to the community once tertiary care is completed. However, issues arise when services are not available along the referral chain. This is where we step in, offering intermediary links between, and support for, the public healthcare services. This type of collaboration takes a great deal of work, so we have programs set in place to help facilitate an alliance between both parties. This includes Continued Medical Education (CME) programs to support training for public sector doctors, partnerships with hospitals and healthcare workers to raise awareness of what KSC does and to encourage patient referrals, and collaborations with healthcare workers in training.
2. Can you provide a specific example of how your work overlaps with public sector healthcare workers in the local community?
When we introduced endoscopic surgical services in 2020, we also decided to work directly with local doctors in training. At the time, only one other hospital in the region offered endoscopic services and charged very high fees – creating further access issues for an already vulnerable population. After receiving the equipment and noting the regional gap, we conducted a week of hands-on endoscopic training with Dr. Jerome Waye, former President of the American Society for Gastroenterology (ACG) with both KSC doctors and public sector doctors from all over the region. Continuing his mentorship online, Dr. Waye and the KSC team continue to be trained and mentored by some of the most prominent endoscopic surgeons to this day.
3. Can you explain the relationship KSC has with the local community?
Unlike many other donor-funded organizations, KSC and our programs are completely Ugandan run from the top down. Equally as impactful, the land that KSC is located on has been leased from the community – so not only is KSC locally run but it is also locally owned. This presents an exceptional advantage. As the Centre Director, when I am not here or when the Centre is closed, there is always someone from the local community looking out for KSC and its grounds. For example, and especially in the beginning, we would get calls from the community asking about a car driving on the property – Do you know about the car? Is it ok for it be there? The local community took ownership of KSC and was excited to support in any way that they could – and this support continues to this day: when we needed to move electric lines, they jumped in to help; when we needed extra land, they were willing to sell us the land nearby. From the beginning, the partnership between KSC and the community has made our programs the success that it is today.
4. With a 100% local staff, is there significant interest from the community to work at KSC?
One way that we give back to the community is through our non-healthcare employment, or jobs that do not require extensive qualifications such as housekeeping, security, and construction. For these roles, we always look towards the local village and community. For example, when we first started, our team consisted of seven local people from the village, all of whom needed a job. Each of them has been trained and they have grown with the Centre as we expand. We need to ensure these jobs are going to members of the community – and this includes the professional healthcare roles as well because of language and location access, and to help ensure stability and consistency of healthcare services at the Centre while retaining local talent.
It is also important to note that KSC has brought some much-needed life to the local village. An old tourist attraction nearby used to bring a buzz to the area, however, it is now being used by the government for hydroelectric power. Once KSC opened, however, we attracted people to the area and spurred local economic redevelopment. Because of our close ties with the community, if local individuals are still unable to afford surgery, we ensure they have access to our services – it’s just one more way that we work together. I can honestly say it is a pleasure to be on the journey with such an incredible community.
5. What are the secondary healthcare benefits that KSC provides for the local community?
I am pleased to say that we have many stories of how we provide for the community. For example, during the COVID-19 pandemic, communities were uncertain about how to handle the growing situation, so we handed out protective gear including masks and sanitiser to the community. We also built awareness, which included holding educational sessions and sending scouts on motorbikes with megaphones announcing how one could protect and prevent the spread of the virus. This type of involvement with the community was not limited to COVID-19 – we have worked with the region for many other outbreaks, such as Cholera and Ebola.
Additionally, we have many touching stories about people who had given up on life due to no access to, or lack of funding for, proper surgical care. I can think of one woman with breast cancer who required surgery but could not afford treatment, but when she came to KSC we were able to perform the surgery and support her with a successful care program. We also see many mothers with children who cannot afford necessary care, and we are thankfully able to support them and help the families get back to work and school. In this way, our impact extends beyond direct healthcare benefits to real social and economic improvements.
6. Beyond healthcare, how does KSC further impact the community – for example, in terms of education or economics?
In terms of educating the community, we aim to teach individuals how important healthcare is. In the beginning, we saw many people who had chosen to not act on their diagnosis – they simply watched their diseases progress. Thankfully, this has changed through our outreach programs and community education. We are pleased to see people prioritizing their health, and not leaving it as a last resort.
On an economic level, we recognize that even when we charge very little for care, some people still cannot afford it. Our social work department has established a flexible financing mechanism that allows patients to pay off their care in instalments, allowing everyone to receive care but not bury the borrower in significant amounts of debt.
We have also engaged the local government, bringing political attention to KSC. For example, only two months ago we hosted the Minister of Health of Uganda, Honorable Dr. Jane Ruth Aceng at KSC, which has increased political attention to our work. With our meaningful healthcare work in the community acknowledged, the advantage now lies in the continuous enhancement of amenities and infrastructure across the region – a positive outcome that extends beyond the realm of healthcare.
7. Do you see interest in replicating the KSC model in other areas of Uganda and implementing it across various healthcare centers?
We are delighted by the fact that many other centers hear about KSC, then reach out and request to send their doctors and nurses to benchmark what we do. We have hosted medical students on rotation, as well as nurses from large hospitals across Uganda. We also plan to welcome nurses from the Kigali Hospital in Rwanda who are interested in learning about what we do and how we do it. Given the scope of surgeries that we perform, their high success rate, and that many centers are not specialized in ambulatory surgical care, it is not unexpected that many want to learn our best practices and replicate our framework.
The vision-bearers of KSC have thought about replicating the model elsewhere and have spoken to policymakers to see if it can address some of the surgery-specific challenges in other areas. Data is at the core of these conversations and is a very important tool that influences and informs policymakers – thankfully we can provide full records of our success story, so our model can be used in other healthcare centers. Because of this interest, we are opening a simulation lab that will focus on training external professionals, such as public health sector healthcare workers, to ensure our learnings and skills are transferred to other parts of the country, and beyond.
8. What’s next for KSC?
The first two years at KSC were all about hiring, getting the systems running smoothly, learning the business dynamics of the sector, and equipping the Centre with everything we needed. Now that we are past this phase, we are now interested in expanding, increasing space and capacity, creating bigger laboratories, and getting the training simulation lab off the ground. We are also in the process of creating a lodging for healthcare workers and other support staff at KSC since we are in such a remote location. Hopefully this project will be completed by Q2 of 2024, and we can concentrate on scaling up our services while minimizing costs and maximizing output – from growing our key partnerships to improving capacity across the board. In the short-term, we will continue to utilize all the equipment and space we have to create maximum impact, while in the long-term we will look to replicate KSC’s model and success elsewhere.
Under the leadership of Director Anna Turumanya Kalumuna, GSI-Kyabirwa Surgical Centre has emerged as a catalyst for positive change in healthcare, navigating challenges and creating a community-driven model. As KSC charts its course towards expansion and replication, it not only transforms lives through surgery but also sets a powerful precedent for holistic, sustainable health solutions.