Halfway to….

We have been in Tanzania now for 75 days. We have another 75 days to go. Blimey!

The malarone calendar!

Today, I will start with some news on the home front first. For it is hugely important news indeed! Our most sceptical child, who has had many a tear at being here (bless her), has this evening declared that she actually now quite likes it in Africa and is indeed pleased we have come! Two excellent days at school have definitely settled her. Whilst I suspect we are far from being ‘home and dry’, both parents agree that we will bank it! Sometimes my heart wants to explode with pride. Our children have weathered this demanding adventure so very well. It has been far from easy for them, but we are optimistic that it will, in the long run, be hugely beneficial to them. Of course, there is also the possibility that it might in fact scar them for life…. only time will tell (joking aside, for anyone who would consider doing such as thing as this, it is definitely worth it).

On the work front, today I have concluded that there is only one of me.

Morning rounds were brief (I delighted in discharging the perforated gastric ulcer laparotomy) and then I escaped to the home ‘office’ before clinic to pursue the increasingly demanding clerical / logistical work facing me. I was corresponding with the UK, India and distant parts of Tanzania in my pursuit of ensuring sustainability of the mesh project. We are so close to a viable model that I have become increasingly aware could be rolled out throughout the country. So far, every hospital that I have visited have been extremely interested in this endeavour. It is a project gaining unexpected momentum and whilst this substantially increases the workload and ‘stakes’ of such work, I am increasingly excited by the potential of it too. The reality is, that if the momentum continues, it could rapidly transform hernia surgery throughout Tanzania over the next couple of years. But I resist getting carried away with such things. Every little step.

When I arrived in clinic, we were midway through another marathon. We topped 40 today. Bonkers. Whilst very demanding, the flip side is that the opportunity for learning for the local team (as well as me) is huge. A great example was the older lady with a multiply recurrent incisional hernia for which a mesh repair would be ideal. She had been seen a number of times and brought back specifically to see me. However, her symptomatology did not fit with the clinical findings. I concluded that we needed to consider other possibilities (like rectal cancer). Indeed, clinical examination revealed exactly that. So, hernia repair off, she needs a CT, MRI and colonoscopy. Except that we’re not in the UK. It is nothing like that simple here. Where as in the UK, these tests would all be done in most local general hospitals, here…. We have referred her to the National Hospital in Dar es Salaam in the hope that she will be able to get there (we established she has family in the city) and be able to afford and have these tests (I think an MRI is unlikely). Hmmm.

In amongst many other interesting patients (you are certainly never bored in these clinics), I received a call from one of the surgeons I had met last week in Dodoma. They asked if I could return to perform three laparoscopic cholecystectomies with them next week. Gosh. My mind was already spinning from trying to work out how we were going to get all the cases planned for this week done. It was already spilling into next week and after that, we are planning another little adventure… But what an opportunity. Wouldn’t it be fantastic to help them start their laparoscopic journey in General Surgery. So much to consider, so much to think through. Next week would be seriously pushing it though. There is only one of me…..