Large team has big impact in Tanzania

Fifth International Hernia mission in Korogwee Hospital District in northwest Tanzania.
October 31 to November 8., 2015.

In 2015, the Spanish team, became an international team consisted of:

Dr. Enrique Navarrete, Surgeon in Seville and Team Leader. (6th Mission)
Dr. Francesc Marsall surgeon in Tarragona. (5th mission)
Dra. Pilar Council, Surgeon Valladolid (6th mission)
Dra. Cristina Gonçalves, Surgeon in Tarragona (5th mission)
Dra. Mar Felipe, Anesthesiology in Barcelona (3rd mission)
Dra. Mercedes García, Anesthesiology in Barcelona (1st mission)
Dra. Carmen Cagigas, Surgeon in Santander (1st mission)
Dr. Jurij Gorjanc, Surgeon in Slovenia and Austria (4th Mission)

For some of us it was the second time visiting Tanzania and Korogwee, for the rest it was their first experience in Tanzania. With the experience of last year, the Spanish participants, we decided to fly again with Turkish Airlines from Barcelona via Istanbul,which allowed us as in 2014, carrying 46 kg of luggage without charge. The trip was uneventful and landed in Dar es Salaam on Sunday 1 November at 03:30. In airport, Sister Avelina.Temba, chief surgeon at Hospital Korogwee, helped us to pass customs formalities atthe airport without any problems, thanks to her previous work with all thedocumentation requiered. In total we carried 14 boxes clinical material and medicines,with more than 350 kg, more baggage berween us.

Immediately, we travelled to the hospital, in a comfortable minibus, organized by Dr. Temba. The trip to Korogwee lasts 6 hours, with a small break for breakfast at dawn in the Tanzanian countryside. The weather is nice this time, with an average temperature of 25-26 degrees and low humidity. We arrived at the Hospital. About 12 pm, where we were greeted cordially by all staff.


After the reception, we split into two groups, one of them visited and triaged all of the patients. Dr. Temba was ready to operate, and patients were already admitted to the Ward. In total we saw 36 patients, diagnosed correctly, some of them young children. The other group stayed at the surgical site, organizing all the material: sutures, medications, clinical material, mesh, anesthetic material. About two hours later, everything was organized, and ready to begin our work the next day, Monday 2. After a small meal organized by the staff, with local food: rice, vegetables, potatoes, chicken, and held in a room close to the surgical area, we went to the local hotel, which is called "The WhiteParrot". It is a clean and simple hotel where the only problem is the low water pressurein the bathrooms. Sometimes it was very difficult to shower. It has a cafe / restaurant where you can have breakfast, lunch and dinner,and have a few cold beers after hardwork. The cost is 25-30 euros per day including breakfast.


In the afternoon, dr Jurij Gorjanc joined the group, who came to visit Tanzania and climbed Kilimanjaro!, on a short pre-holiday mission. He is a young surgeon, beautifully prepared, and experienced in this type of mission, and then we made friends with him. The transfer to the hospital, is solved by a minibus that the hospital provides us with a
very nice local driver. The first day Monday before starting work, we went through the building to greet the Council of Korogwe District Chief, and present our respects. Once in the hospital, we also welcome the medical director of the district, in a small building near the hospital.The surgical activity was similar every day, from 08:00 until 18:00-19:00 h, but on the last day, continued late due to the arrival of several patient stragglers. The surgical area of the hospital, has three operating rooms, two of them, properly equipped, lighted operating table, anesthesia  equipment, air conditioning and auxiliary furniture. There is only one oxygen supply between them. The third operating room is smaller, but has natural ventilation and sufficient to operate on small hernias and procedures under local anesthesia. The two largest theaters have electrocautery, and Dr. Gorjanc brought from Slovenia one Valleylab Force FX, which we used during the mission, and then gave it to Dr. Temba, for the small hospital near Korogwe. Every day, we made a small break for coffe at about 11:00, and a stop for lunch, at about 14:00. In the afternoon and after completing the surgical activity, we conducted a visit to the operated patients,  accompanied by Dr. Temba, Dr. Muya (local anesthesiologist), and the staff of the wards. Also triage of patients was performed for the next days.  . A total of 87 patients were reviewed and operated. The work environment was very good, and communicating with them went smoothly in a mixture of English and Swahili. It is important to remember that you have to make it very clear postoperative orders and leave the medication to patients of Ward. Otherwise many of the patients had

inadequate analgesia for failure to transmit information. At the end of each day, we tend to go a little time near the hospital building, where it offers WIFI, a while to connect to Internet and send and receive email and whatspps. Itis not possible from the surgical area. 


Fortunately we did not have any complications, and all patients were able to go home the same day or the next day. Only a few patients had to stay more days in the hospital,because they were very large incisional hernias, or inguinoscrotal, or bilateral, which was necessary to place drains.  The subsequent follow-up is performed by Dr. Temba and her team, who notified us that there have been no major complications.In total during the mission to operate 87 patients, making a total of 116 procedures: 27 children, aged 7 months to 13 years. Most, inguinal hernias, umbilical cryptorchidism, a hydrocele and appendicitis. All were performed under general anesthesia, some of them with cord. No perioperative problems.


The remaining patients, adults, were operated under local anesthesia, spinal or on occasion, general anesthesia. Curiously, on Wednesday, we had to operate the local anesthesiologist, Dr. Muya for appendicitis. He was operate on by Dr. Navarrete and Dr. Gorjanc, and was anesthetized by Dr. Felipe, with spinal. His postoperative recovery was smooth, and he was discharged at 24 hours. Almost all inguinal hernias were repaired by the Lichtenstein technique with polypropylene mesh. We ed14 Mosquito-net meshes In a few patients, Nyhus preperitoneal repair was performed. In three incisional hernias, we perform sublay polypropylene mesh repair or PVDF. The remaining patients had unilateral or bilateral hydrocele large, which were repaired with conventional technique. Many times, Dra. Temba was the chief surgeon, and many other times the main assistant.


We must acknowledge the important work of the entire staff of the hospital: Martina, Doreen, Rose, Maggie, Mary Sisters as surgical assistants, and Sister Filippa, as an assistant in anesthesia. Thanks to them and all the support staff, which made the task of cleaning and collection of material, sterilization and packaging, we make more than 100 procedures in just 5 days. Also our thanks to Dr. Muya before appendectomy. And all staff of wards, for his attention to patients and our team. After completion of the work week, we donated to the hospital more than 200 meshes, many sutures, anesthetic material, medicines and surgical material, for use by Dr. Temba and her team, and the Hernia International teams for future missions. On Friday, after completing the work, we invite the hospital staff and managers, for a fellowship dinner in the hotel restaurant. The next day, Saturday, the team split; Dr. Gorjanc, left for Arusha flying northwest from the local airport to Amsterdam and then to his country. We boarded the minibus whichhad brought us, with the same driver and marched to Dar es Salaam, where we arrived around 18: 00h. As the flight to Europe came at 04:30, we had organized a temporary stay in a hotel in Dar in the Indian district, with comfortable rooms to rest and shower when you leave for the airport.


In short, our second experience of the Spanish group in Korogwe, Tanzania was an enriching participation this year with Dr. Jorganc, with whom we have become good friends  and the summary might be: Great country to carry out such missions: good weather, safety, adequate basic support. Very good organization by the local medical equipment and excellent working environment and collaboration of all staff. Tanzania's population is lovely, and you're really leaving convinced you need these missions. I hope we return many times.

Dr. Enrique Navarrete
Team Leader.