Boys Road Trip! But then late for the Party.

Today (Friday), I arranged to go to Tanga and visit Bombo Regional Hospital (technically our first port of referral). I had been very keen to do this since arriving and begin to better understand how St Augustine’s Hospital Muheza (a designated district hospital) fits within the wider healthcare service of Tanzania. I was travelling with one of my Tanzanian surgical colleagues (head of department) who had worked in Bombo before and would thus prove to be a very a valuable guide. It proved to be an informative, insightful and most excellent day.

Before leaving, I managed to squeeze in a visit to see my post ops on ITU. I am pleased to say that they are both doing very well. The sun was shining (it almost always is) as we set off in one of the hospital cars. There was a buoyant and jovial atmosphere and driving down the road to Tanga in our big 4x4, chatting away, it definitely felt like a ‘boys road trip’!

We checked in with the hospital management and then met with the head of Surgery. We found him on his major ward round (happens every Friday) and then continued our very useful and pleasant discussions in his office. Bombo hospital felt noticeably more familiar to me as a ‘Western’ doctor, resembling in size and layout something not that dissimilar to what you might find at a small DGH in the UK. It was a multilevel and substantial set of buildings. That said, I also quickly established that what we had in Muheza was not that dissimilar to Bombo and whilst certainly smaller and perhaps a little more tired in some ways, in many was it was at least its equal.

I learned so many things today. I had a list of questions which were welcomed and discussed at length. We also went for a tour of several departments that I was keen to see.

Ø  The general surgical staff consists of two ‘specialist’ general surgeons, one MD doctor and one AMO doctor [both referred to as the registrars] and currently 3 interns [house officers] although they have up to 8.

Ø  The anaesthetic staff consists of one ‘specialist’ doctor, one AMO doctor and six nurse anaesthetists.

Ø  Surgical beds (shared with orthopaedics) 37 female / paediatric and 32 male.

Ø  No ITU currently, but a brand new unit is being kitted out and is to be opened in February (we went to look at it and it was stunning, almost what you would find in the west).

Bombo Theatre

Ø  Theatres are very similar to what we have in Muheza (although a slightly bigger building and certainly felt a bit newer / better maintained). They have 3 main theatres (although only two currently in use as the anaesthetic machine for the third theatre had been moved to a new obstetric theatre on the obstetric ward) and a minor theatre (a concept we don’t really have in the UK) for procedures either without anything or with local anaesthesia.

Ø  SSD is very similar to what we have in Muheza, reinforcing how impressed I am by this aspect of what we have.

Ø  Their instruments sound similar to what we have in Muheza (perhaps ours are better now that I have replaced many). They are short on self retainers, clips are not always that good, scissors are often blunt and needle holders worn.

Ø  They do have diathermy (lead surgeon very proud of this), but they don’t use it for every case and have trouble with the sterilisation process. When I explained what we were doing in Muheza, he was very interested.

Ø  They undertake a very similar case load to what we are doing in Muheza currently with me present. They don’t do any ENT. They do not have laparoscopy. They can do mesh surgery but don’t very often as the mesh is so expensive (250,000-400,000TZS [£83-133GBP] – this is a massive amount of money for the average Tanzanian).

Ø  Prices: all major surgery (hernia, laparotomy, mastectomy, thyroidectomy etc) 250,000TZS (£83GBP); minor surgery requiring GA (lumps & bumps) 150,000TZS (£50GBP); cases under local anaesthetic 50,000TZS (£17GBP). This means that a hernia repair with Mesh costs 250k for the mesh and 250k for the surgery = 500k. In Muheza we are currently doing this procedure for just 84k [£28GBP]. He was very interested to hear about what we are doing with the mosquito net mesh and I am sure that some collaboration is imminent (which is very exciting).

Ø  They seem to have better access to sutures and I was keen to learn more about their procurement process.

Ø  They have much better access to blood tests – FBC, U&E, LFTs, TFTs, G&S / CM, HIV, malaria all easily available. Some virology. They don’t have clotting. I am looking into further collaboration in this regard.

Ø  They have good X-ray services and can do IVUs. They have 3 specific ultrasonographers (one AMO and two nurses).

Ø  Pharmacy: very similar to our experience although they do have more drugs in stock than we do.

Ø  They don’t have an endoscopy service (there is a private hospital that can do OGD & colonoscopy 250k &400k respectively) but they are keen to try and establish this service.

ITU bay under construction. 

Lots of new 'Gucci Kit'

All in all it was a very interesting day. I also met with the lead anaesthetist who is frankly a remarkable lady. She is driving through the development of the new ITU whilst overseeing all theatre activities too. She gave us a lot of her time today, showing us the new ITU and giving us the anaesthetic perspective in theatres. She was very interested by the Hereford visits, informed me of a developing network in this part of Tanzania and was very keen for future collaboration.

Driving home at lunchtime, my mind was buzzing. I headed home for lunch and to consider all the many thoughts swirling through my mind. It was the hospital party tonight and I was pleased to have some time to process my day….

Operating in the dark!

Except I didn’t! I was called to see a patient with a strangulated hernia. He needed surgery. The plus side was that it went well, we operated in time to salvage the colon, terminal ileum and appendix in the sac and got another patient for our mesh series (now up to 16). The down side was that of course it took a while to get him to theatre, we had a power cut (thank goodness for my head torch) and by the time we finished we were late for the party. How typically surgical!

Early movers and shakers!

But what a party it was. The hospital had been awarded four stars at a recent government visit, the highest rating they have had (sort of the same idea as our CQC visits). As a thank you to all the staff the hospital threw a most excellent party, providing music, food and drinks. Africans do know how to party. Dancing, dancing, dancing. Speeches. Drinks. More dancing. Awards. More dancing. And finally some food (at 10.30pm). An absolute privilege to be there and an experience we certainly had not expected to have. We were allowed to take the childers and they loved it! Late night though. All to bed after 11pm. But perhaps an opportunity of a lifetime for them. And perhaps another something for us to learn from in the West too!