Swiss Team opens new site at Kitete hospital, Tabora, Tanzania.

 

 Mission Report Tanzania March 22 to April 3

Background and starting point

Two of our Nigerian missions, originally planned for autumn 2014, had to be cancelled due to recent developments regarding security, health and political issues in the country. The main two reasons being the precarious security situation with an increase in terrorist attacks by the radical Islamic Boko Haram group, as well as the rapidly evolving outbreak of Ebola in West Africa. The upcoming presidential election in March 2015 also contributed to a volatile and unpredictable political situation and therefore no further missions were planned in Nigeria during the first half of 2015. Towards the end of 2014, SST was approached by Prof Andrew Kingsnorth, the founder of Hernia International, inquiring whether we could send a team to Tabora, Tanzania to do Hernia surgery at the Kitete Hospital. At the board meeting of November 29 the members decided to accept this proposition.

Preparation

The Mission was planned for March 2015. Being a pilot project, this mission preferably had to be joined by more experienced members of the SST. This turned out to be a somewhat challenging task as we had another mission, planned in Tajikhistan at that particular time and subsequently needed more team members than usual at the same time. But in the end we succeeded in finding suitable team members for both projects.

The team travelling to Tabora consisted of following members:

Peter Nussbaumer, surgeon

Lana Fourie, surgeon

Jörg Wydler, surgeon

Michael Minck, anaesthesiologist

Elvira Hospenthal, scrub nurse

 

The contact person and coordinator in Tabora was Dr. Rashid Said, who has previously also coordinated another mission of Hernia International. The e-mail correspondence with Dr. Rashid proved to be unproblematic and reliable from the very beginning. Thanks to his support we received our temporary work permits on time and were able to travel the 450 km to Tabora without any interruptions. Because of the geographic situation and great distance from Dar es Salaam to Tabora we decided on a flight via Amsterdam-Nairobi-Mwanza instead of a direct flight from Zurich to Dar es Salaam.

Mission location

Tanzania is a country in eastern Africa, which is bordered by the Indian Ocean in the east, Kenya and Uganda in the north, Ruanda, Burundi and the DR Congo in the west and Zambia, Malawi and Mozambique in the south. Since gaining its independence on December 9th 1961, Tanzania is a member of the Commonwealth of Nations. It covers an area of 945'087km and has about 45 million inhabitants. Tanzania is one of the poorest countries on earth (Human Development Index about 0,488 - position 159).

Tabora is the capital city of Tanzania's Tabora Region, which is one of the biggest regions in the country. The Kitete Hospital is the regional referral center and has to cover for about 2.3 million people. Being built during the time of the German colonialism, the infrastructure is starting to show its age. During the rainy season it is common to find water pouring through the damaged roof of the operating theater forming puddles on the floor. The 350-bed hospital consists of several clinical departments including Surgery, Medicine, Pediatrics, Obstetrics and Gynecology, Psychiatry as well as a Laboratory and an X-ray Department. Furthermore they offer a wide spectrum of outpatient care. Although the lack of medical equipment and consumables is similar to most African health institutions, the Kitete Hospital plays an important role in the medical care of the region and therefore has a decent number of permanent employed local doctors and even a few specialists.

 

The Mission

We arrived in Mwanza after an uneventful night flight from Zürich. Thanks to the courtesy of KLM, the charged cost for our excess baggage weight (150kg) was limited to the flight distance between Nairobi and Mwanza. At customs we had the usual delay due to critical enquiries concerning the medical aid we brought with us. Fortunately Dr. Rashid was already waiting for us at this point and he resumed the discussion with the authorities. Two hours later we were allowed to collect our entire luggage and carry on with our journey.

Both the transport from Mwanza-Airport to Tabora as well as the hotel accommodation close to the hospital was perfectly organised.

Upon arrival, we were directly taken to the Kitete Hospital where we met with the hospital management and had a short tour of the operating theatre wing. We were welcomed in a friendly manner and all the senior staff members seemed to be in favour of the mission.

Joined by three of the Tanzanian surgeons, we operated throughout the following 7 days. As part of our preparations for this mission, the decision to mainly perform inguinal hernia surgeries was carried out the local community by an information campaign prior to our arrival. It therefore came as no surprise to us, to find about 200 patients waiting for the preoperative examination. Due to the limited time we had, it was impossible to treat all the patients but we did manage to perform 93 surgeries on 83 patients, without any complications.

Thanks to his experience in paediatric anaesthesia, our anaesthesiologist enabled us to perform hernia surgery on 19 children, aged 1 year or older. The local doctors at the Kitete Hospital generally do not perform surgery on these small patients, reasons being a lack of practical experience in paediatric surgery as well as inadequate equipment.

  

Despite our short length of stay, we succeeded in instructing our Tanzanian colleagues in the technique of inguinal hernia mesh repair under local anaesthesia. Prior to our departure, they performed two procedures by themselves with mere supervision on our part. By using the medical aid (sutures, meshes, medication) we left behind, they should be able to treat further patients in the same technique.

Peter Nussbaumer

President Swiss Surgical Teams