Today is Thursday and has been a much better day all round. It started with
the surgical / theatre department meeting. It was well attended. We talked
about the concept of adverse events. An obvious topic you might think given the
content of some of my blog posts! I was keen that we could learn from our
experiences here. The concept of Adverse Events / Critical Incidents / Near
Misses / Serious Untoward Events (etc, so many manes for the same thing) is
strongly ingrained into Western Healthcare culture. A huge amount of effort ‘in
the West’ goes into what is a very important process (albeit one that has
perhaps evolved into something overly onerous and at times punitive). The team
were very receptive to the concept and were fairly good at identify and
discussing such matters. At the end of the meeting we agreed to start some sort
of system to record and capture adverse events, which I think will be a huge
asset to the department (and hospital as a whole if it can catch on).
A very pleasant ward round then ensued. I am delighted to
report that BOTH boys from yesterday were doing great. They had already been
outside and playing. A wave of relief passed through me, it caught me a little
off guard to be honest. There is something very emotive about the well-being of
children. Seeing the second boy bright eyed and playing was just brilliant.
We then had just a single surgery to do, a hernia repair
with mesh. Interestingly, it was not the one I was expecting. That patient,
with a very large hernia (difficult) had originally been admitted acutely (as
an emergency). Things had settled somewhat and as his surgery was now
technically elective, he was required to pay the bill before we were allowed to
proceed. He had gone home to accrue the necessary funds. Whilst a flicker of outrage
/ injustice flared within me, it was quickly dampened down by a wave of relief
that todays surgery should be both relatively straightforward and swift. I
could do with some respite after the last few days.
This case proved to be an important milestone in our hernia
project. It was performed by the two local surgeons together. I was scrubbed,
but had minimal input really. I made a couple of suggestions, but these were
mainly about refining technique rather than anything more. The end result was
fantastic. A technical result I was very pleased about, more than that I was
proud of what the guys had achieved. It was an easy case perhaps, but it was a
clear indication of how far we have come.
We were done and dusted before midday, which meant I could get
home for lunch and a bit of rest.
The afternoon was the hospitals annual meeting which I
dutifully went to. Unfortunately, we slipped a bit with African time. It was
supposed to start at 13.30. I was there on time. There was only one person in
the room. I checked by text that I was indeed in the right place. The hospital
superintendent arrived 15minutes later. Still very few people in the room. Over
the next 15 minutes the room filled to bursting. It was nice to see just how
many staff the hospital had, and also how they interreacted. There are strong
friendships across all the staff groups, between doctors, nurses, managers
(there are very few!), tradesmen, groundsman, cleaners, mortuary staff. It
seemed to me to be a completely different hierarchy. Sure there was clear
respect for those with the higher levels of training (and the importance of
this to clinical care), but there was much more respect from a generational
perspective. Shikamoo’s (respectful greetings) from doctors to grounds-folk
were aplenty. Again I was struck by an element of Tanzanian culture that we
seem to have lost in the West, where money (and perhaps education) seems to
breed a sense of self-importance, to the detriment perhaps of more traditional values?
The next two hours were interesting, although to be honest I followed very
little as it was all in Swahili. I could make out a lot of words, but little of
the actual conversations. What I did observe was that successes were shared and
the challenges for the next year discussed. All the staff groups got to have
their say, each contributor politely listened to in full, before response from
the hospital management.
It was then home ready for dinner with some Australian Medical
Students. If you are interested in their experience you can read a blog of one
of them here:
But I spoke too soon. No sooner had I arrived, than I was called
to see a patient on the ward. An acute abdomen they said. I went and reviewed him, he looked sick and
was peritonitic. To theatre it would be then. I walked the short distance home
whilst the arrangements were made for his surgery. Kate and the students
expedited supper and I managed to have a cup of tea and some food before being
called back to operate. I am pleased we did, he had a perforated prepyloric gastric
ulcer. The team once again delighted with such pathology. The ulcer felt benign
(and with no histology available). Whilst lots of options ran through my mind,
from several traditional procedures (including gastrectomy, pyloroplasty and
vagotomy), I decided to go with a modern western approach and used an oversew
and omental patch technique (hoping that the oral PPI would be enough to
support the healing with no IV preparations available). It went very well, but
he was very sick. We will have to wait and see how he recovers.
I was back in time to enjoy a glass of wine with our dinner
guests. I must say I felt I deserved it and enjoyed it immensely!
Tomorrow I am going to visit Tanga to see what services are
offered at the closest regional hospital.
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