I started today on high, managing to get out for a run before
breakfast and walked into the hospital full of enthusiasm. Unfortunately, the hospital
meeting brought me crashing back down to reality with the daily death report which
included a 12 year old girl that died over the weekend of…. well we don’t really
know. She had a positive malaria test, was quite anaemic but also had a very
high temperature. Probably severe malaria, but possibly another source of
sepsis. With limited investigations and treatment options, what was clear to me
was that her chances here were much lower than if she’d been in the UK. All
very sad and sobering. Particularly when so close in age to my own children….
Giving presents always provides a healthy dose of ‘Pep-Up-Potion’
and I headed to theatres to present my Christmas offerings for the staff. I had
had some theatre hats made in town for the whole team (just 18 in total!). They
were delighted with them and that was certainly a boost for me. The smiles and
chattering as they sifted through the various designs to choose which one they
each wanted was great to watch.
It was then off for a ward round before a few other tasks,
then clinic. I was quite time constrained to fit in all my various activities
for the day and felt honoured by the way I was treated in such high esteem. In
a somewhat professorial fashion, I was whisked around the wards, taken to see just
the patients that the team considered required my review – four hernias for
theatre this week (two pretty straight forward ones and two biggies), a couple of
children, my long stay patient whose wound looks fantastic – still needs a bit more
TLC though – and a couple of diagnostic dilemmas). I felt very well looked
after and it was quite good fun actually.
I then headed off to my meeting with the pharmacist, who is
responsible for ordering all medical ancillaries, not just drugs. In my bid to understand
the ‘supply chain process’ for getting ‘African sutures’, I had established
that this was a key individual. I believe it is important to work within the
constraints of what is easily available in the hospital (rather than, for
example, the adhoc supplies from UK visits), but have been desperate to find some
alternative sutures. I wanted a suture that was less of a needle-stick hazard than
those we are currently using to close the skin. I never imagined that this part
of the operation (that is often delegated to the most junior team member for
training) would ever cause me such anxiety!
I certainly learned a lot about another process I would probably
never be involved in to such detail back home. Whilst many of my questions were
not easily answerable through the internet portal we were using (like the cost
and availability!), the fact that there were other sutures on the system was
very promising. I have provided my wish list of two sutures (2/0 vicryl [the
real thing and not the fake vicryl we are being forced to use in the UK!] and something
that might be a monocryl equivalent). Watch this space. On the drug front, I
also had the opportunity to discuss getting Tamsulosin and Finasteride in stock
(good for the patients with big prostates and good for the hospital) and this
looks very promising too.
I then had to pop back home to meet some of the Fundi (tradesfolk)
who were there to help with some of the unresolved house ‘improvements’. A
quick ten-minute job turned into over an hour of sweat, dust and toil as I ended
up drilling a new hole for our gas supply to our new cooker. I have been waiting
to do this for over two weeks now – the first effort done in my absence had the
gas tubing sitting against the hot back of the cooker…. it started to melt.
Fortunately it occluded before it exploded…. This task would have been very
straight forward if I could have just popped into my own garage to get a
suitable drill and drill bit…. Instead I had to struggle with a bit that was
far too thin. Grrrr. But being bloody minded (as I can be at times), I eventually
got the job done as I wanted it. So hopefully I can connect it all up tomorrow
to have a fully functioning hybrid electric / gas cooker. Its only taken four
weeks.
Whilst I did skip lunch, a quick shower and cup of tea was
needed before heading off to clinic for which I was woefully late. However, I probably
did in fact time it perfectly. Forty patients today and all that was left were
11 that they had saved for me. It is not often you get called special (well in
a positive way), but today it happened. Whilst it may be one of those slight
translational peculiarities, it certainly made my day. However, in follow up to
that statement, in no uncertain terms I was told that seeing a Muzungu Surgeon
was considered to be the very best possible opinion. When I laughed, the staff
made it quite clear that not only was it true, they wholeheartedly agreed. Crikey,
I’d never thought anyone would think like that. I have never been the type of surgeon
to have a ‘god complex’, far from it in fact. Throughout my time here, I have
always considered myself just another member of the team. One that has a wealth
of experience not available here in Tanzania perhaps, but certainly nothing
more special that that. Humbling. But I would be lying if it didn’t make me
inwardly smile. And I’ll take it too. I’ll bank it and use it to help fuel my remaining
time here. Of which I am sure I will find many more a challenge.
We also saw four more of the mesh patients for follow up
today. They have all recovered brilliantly (including the incisional hernia
repair) and are delighted with their surgery. I am delighted with their
recovery! A great relief to me and a real boost to our efforts here.
So a great way to close out 2018 – I never thought I’d be
here at the start of the year….
Here’s to a great 2019!
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