Second team has success in Tanzania


Korogwe, Tanzania, 12-20 May 2014

Team Leader: Tim Brown

Team Members: John Garvey, Kelly Shine, Katharina Wentkowski (Anaesthetist) , John Whitaker (Surgical Trainee), Nick Mowbray (Surgical Trainee).

After an extremely successful first mission to Korogwe District Hospital lead by Karl Moser, our multi-national team had a lot to live up to. Under the leadership of Tim Brown, we assembled in Dar es Salaam. We had travelled from Australia, USA, Switzerland, England, and Wales. Dr Rashid Said, the District Medical Officer for Korogwe, was at the airport to greet us and take us to our hotel in Dar es Salaam for the first night. The following morning Rashid's trusty driver, Omari, drove us in, the obligatory Toyota land cruiser, 6 hours north to Korogwe. The town is situated in the Tanga region of Tanzania, at the foot of the Usambaras Amani Mountain Reserve. The hospital serves approximately 300,000 pepople. On our arrival we had a formal introduction and welcome from Rashid and the Hospital's heads of depart-ment. We were also introduced to the devoted Sister/Dr/Surgeon Avelina Temba. As Head of the Hospital she gave us a warm welcome and a short report on the accomplishments of the previous mission.

 

 Eager to get started, we surveyed the 3 operating theatres and organised our equipment. There were two large theatres equipped with air-conditioning, a mobile theatre light, diathermy and one contained the relatively unused anaesthetic machine. The third theatre was a small room containing none of the above equipment. This room was reserved for more basic procedures (small epigastric hernias, and simple/small inguinal hernias). Hernia International had supplied us with the hernia mesh (pre-packed sterilised mosquito net), and we had brought a selection of gloves, masks, and hats. As we unpacked our assorted donations however, it became clear that we had a finite supply of appropriate sutures.

The last task of the day was to see the pre-op patients. The group was struck by how much organisation had occurred prior to our arrival. All the recruited patients had been screened for HIV and had a recent haemoglobin level. On the Nightingale ward, they were all gowned and in beds ready for us. We turned very few patients down for surgery.

For 5 days we operated from 0830 until approximately 1830. We operated on 73 patients,repairing a total of 81 hernias (68 Inguinal, 8 Umbilical, 3 Epigastric, 1 Femoral, 1 incisional). Many procedures were undertaken using local anaesthetic only. 38 cases were done using spinal anaesthesia. The 4 paediatric cases all had a General Anaesthetic (GA). There was 1 planned adult GA and 3 unplanned adult GAs; two were for a spinal anaesthetic not working correctly, the third was for a large recurrent sliding hernia containing the caecum and about 30cm of small bowel. This particular episode highlighted a crucial element of our team, our Anaesthetist, Katharina. She was well prepared with a selection of medications, spinal needles, syringes and the best head-torch in the group. Katharina was able to teach Sister Temba and the local anaesthetist, Dr Muya, to do spinals. It seemed as though there was no problem without a solution, and when a neonate needed resuscitation immediately post caesarean section, Katharina was on hand to deliver the life saving CPR.

 

The surgical operating duties were shared by all surgeons. Each day a room was allocated a Senior surgeon and either Sister Temba or a trainee. The trip represented a unique training opportunity for the two surgical trainees. To have such focused supervision on a large volume of cases in succession is the ideal environment to develop their surgical skills. There was no shortage of more complex hernias for the Senior surgeons. Although we made the most of the limited, and varied, simply of available sutures, more prolene and monocryl should be a consideration for future trips. Due to our conservative use of the mesh we were able to leave a significant amount for Sister Temba. With regards to other medical supplies, the previous trip had brought a significant amount of materials with them. There was somewhat of an expectation, or at least a hope from our Tanzanian hosts, that we would have donated more equipment.

All of the hospital staff worked extremely hard to keep us nourished, the patients moving and the equipment sterilised. There were snacks and refreshments throughout the day, and a traditional hot lunch daily accompanied by a delicious fresh fruit salad. This was all done with a huge smile and so to show our appreciation on the 5th and final day we invited all to our hotel restaurant for dinner. Rashid and the staff showed their appreciation for our trip and after some food and a bottle of Serengeti, we all embarrassed ourselves on the dance-floor.

 

The hotels in Dar es Salaam and Korogwe were of a reasonable standard and included air-conditioning. The accommodation costs were born by the team members, approximately $20 USD per night, with evening meals a further $10-15 USD per day. The team also covered the fuel costs of approximately $150 USD and the usual personal expenses of flights into the country, travel insurance and Visas (best and easily arranged in advance).

The last day was spent travelling back to Dar es Salaam but we arrived purposefully early to spend a few hours on a beach in Kigamboni. A white sandy beach and a chance to swim in the Indian Ocean, the perfect end to a productive and rewarding trip.


Nick Mowbray