This World Patient Safety Day we look at the works of Ms Mhairi Collie OBE, Consultant Colorectal Surgeon at Edinburgh’s Western General Hospital, and chair of the Uganda Childbirth Injury Fund.
The theme of the 2021 World Patient Safety Day is ‘Safe Maternal and Newborn Care’, and Consultant Colorectal Surgeon, Mhairi Collie, is the perfect embodiment of this theme. Recently awarded an OBE in the Queen’s birthday honours for services to medicine, and a recipient of the Global Citizen of the Year Award, Miss Collie has dedicated a substantial part of her clinical time to the surgical repair of pelvic injuries post-childbirth in resource-deprived settings. As chair of the Uganda Childbirth Injury Fund (UCIF), Ms Collie and a team of dedicated healthcare professionals have worked to improve the lives of hundreds of women affected by the sequelae of traumatic childbirths.
Mhairi is one of 12 general surgeons working in the busy Western General Hospital in Edinburgh. The decision to pursue a career in general surgery was an easy one. She was drawn to the wide variety of operations, the desire to treat patients of different ages and genders, and the fast paced, ever-changing clinical environment. Colorectal surgery in particular gave her clinical experience that was pertinent to her clinical interests, both in the UK and abroad. She is grateful for the opportunity to travel, meet people and have incredible experiences that have defined her as a clinician, and as a person. Outside of clinical life, she is a married with two children, and is a great lover of the outdoors, enjoying walks, swimming in the sea, paddle boarding and canoeing.
Despite catering to all genders in both her emergency and elective practice, Mhairi is particularly passionate about women’s health, and has tailored her clinical practice to benefit women globally. She has particular compassion for the young mothers she has met who are totally debilitated by birth-related pelvic injuries. Her specialist interests, apart from complex pelvic fistula surgery, include gynaecological surgery, prolapse and incontinence. She also does major abdominal resections for cancer. Her favourite operations include a low anterior resection for cancer, and difficult vesicovaginal fistula repairs. She feels these operations allow her to work hard and use the various surgical skills that she has learned during her career, while making a big impact on the patient’s quality of life.
Ms Collie initially started travelling for fun as a medical student, and in later life, for work. After medical school at the University of Edinburgh, she went to Birmingham for her senior house officer years, and then down South to London for research. While based in Brighton as a registrar, she was given the opportunity to work for Medicin Sans Frontieres (MSF) for 1 year, travelling to Sri Lanka and Ethiopia. She recalls this time as an amazing medical and surgical experience, and a key period in which she saw her surgical resourcefulness grow. It was at this time she also met her long-time friend, colleague and mentor, Brian Hancock, a now retired Colorectal Surgeon at the Hamlin Fistula Clinic in Addis Abba. Mr Hancock subsequently invited her on her first trip to Uganda, and laid the foundation for the work in fistula surgery she does today.
The Uganda Childbirth Injury Fund was born from a desire to streamline the fantastic work Mr Hancock had already started early on in his career. Brian Hancock had been travelling to Uganda for most of his life, even completing his house officer years there. While working as an NHS surgeon, he would travel often to Uganda, and set up surgical camps for treatment of colorectal disease (particularly fistula surgery, which was rare in Uganda at the time), and to train local medical staff. These camps, while beneficial, where not very streamlined, making it difficult to fundraise. So after a few trips with Brian to Uganda, Mhairi, with the help of friends, family and colleagues at MSF, established the Uganda Childbirth Injury Fund with Brian. Their mission is to ‘provide or assist women afflicted with childbirth injuries in Uganda’.
As a registered UK charity, the UCIF is able to fundraise and claim GiftAid on any charitable donations. Mhairi, along with her team have worked tirelessly to raise money for the 2-3 visits they make to Uganda each year, staying on average for a week at a time. During each visit, they aim to perform 40-50 operations. Charitable donations usually come from private individuals, often mothers, who are moved by the plight of the women that the UCIF serve. The UCIF has also been fortunate to receive several grants over the years. Apart from funding surgeries, the money received by the UCIF goes to supplement the salaries of the local Ugandan surgeons and medical staff, who give up their time to work and train at the camps for often little or no future financial gain due to the non-lucrative nature of fistula surgery.
The UCIF has evolved dramatically over the years. The current team is made up of 4 surgeons from the UK, Norway and America, nursing staff from the UK and America, and a local Ugandan team. Nurses form a vital part of service delivery, fostering a caring atmosphere for patients, some of whom have not been touched in years due to the stigma associated with being wet or smelly because of a birth-related fistula or injury. Initially, there were few Ugandan surgeons and nurses available to do or learn fistula surgery, however this has now changed. Indeed the foreign counterpart of the UCIF has evolved over the years, from being teachers of the local team, to being collaborators, with some of their initial cohort becoming trainers themselves. Despite the significant growth the UCIF has experienced, recruitment can still be challenging. Fistula surgery is not lucrative - it is difficult and takes a long time to learn. In addition, it has a 15-20% failure rate. However, in time, Mhairi hopes that through the UCIF, enough local surgeons, nurses and professionals will be able to be trained so that the foreign part of the UCIF can withdraw from Uganda and establish camps in other resource-poor countries.
Being awarded Global Citizen of the Year was a huge honour for Mhairi, and one she did not expect given the other inspirational individuals who were nominated for the award. She is extremely grateful to the entire UCIF team, and is humbled to have worked with such amazing people over the years. She feels validated to be recognised as a fistula surgeon, and hopes this award and her OBE will specifically bring some much needed publicity to the plight of women all over the world affected by birth-related trauma. She also hopes it will inspire other surgeons to become interested in fistula surgery and pelvic trauma, and spotlight those already working hard in this field.
Like her mentor Brian Hancock, Mhairi hopes to continue to operate in and travel to resource-poor settings after she retires as an NHS surgeon. She is inspired by the work ethic of surgeons like Paul McMaster, a liver transplant surgeon who has worked tirelessly for the MSF for over 20 years. However, her biggest inspiration is her father, who she recalls fondly as a lover of life, and of people, and who made the world better with his positive attitude - that is the sort of person she strives to be. She is also a big believer in the power of perseverance and curiosity in achieving one’s goals.
For more informational about the Uganda Childbirth Injury Fund, visit www.ucif.co.uk
Written by Miss Sesi Hotonu, Paediatric Surgery Registrar for NHS Education Scotland