Wild goose chase?

Today is Thursday and I have been trying to ingrain the habit of the Surgical Department Meeting actually happening every week. Unfortunately, this has resulted in me having to prepare and provide most of the material and drive. I am keen to engage the wider team in facilitating these sessions, but currently they are steadfastly resolute that I have too much to offer. This morning I was unusually completely unprepared – things have been pretty full on – and after briefly toying with the idea of just winging it (I am usually pretty good at doing such things now) I decided on my walk into the hospital that actually I was too tired and today we would just give it all a miss.

But sometimes you can be a victim of your own success.

Innovation?!

Whilst much to my relief, no one was present at 8am (the expected start time), just as I was preparing to sit down and have a cup of tea instead, one of the senior O&G surgeons arrived and started to arrange the furniture ready for the meeting. He was closely followed by the Hospital Superintendent who had come to find me to discuss the quote for renovating the theatre complex which somehow I had apparently requested (spare £1,900 anyone?!). After a very quick walk around to appraise the proposed work, the room had filled. Even three medical students had turned up. The hospital superintendent also decided to stay. I was cornered! When about twenty people are looking up to you in anticipation, there is really only one thing you can do…. Just get on with it. Thinking on my feet, I found a large cardboard box to use as a white board (I am working on finding one of those currently) and began to explore acute abdominal pain (a request at a previous meeting). Catering to an audience that includes theatre porters through to senior doctors is quite a challenge for such a topic. I think I managed to pull it off and make it relevant and interesting for all. It was certainly the most interactive session we have had to date (perhaps my efforts to encourage such interaction is finally paying off). I got the customary round of applause at the end (hands are rubbed together in a circular fashion and then three synchronised claps are sort of thrown at you) which always makes me smile.

The local team finishing off a hernia

together. I still scrub, but we're making 

great progress.

It was then mainly a day of operating, waiting to operate whilst emergency C-sections were fitted in, and having very entertaining impromptu Swahili lessons whilst eating Mandazi (a sort of unfilled Tanzanian donut). The main question I had today was why there were so many words for ‘this’ (hii, hiki, hili, huu, huyu). Whilst everyone (except for me) was completely clear when each version should be used – we had very amusing rounds of naming games – no-one could tell me any sort of rule which would help me know when to use each one (with the exception of ‘huyu’ which is used for people and animals). I am having such fun learning Swahili and my efforts clearly delight and amuse the staff in equal portions!

As well as these immersion language lessons, another real bonus of living and working in a community such as this is that I am being exposed to a fairly unique culinary journey. I have long since got past my paranoia of not eating or drinking anything that I hadn’t personally prepared or cooked myself (although I am still pedantic about drying my crockery and not eating dodgy street food). I can now even cope with the hundreds of tiny ants that get over anything even vaguely representing food or water. Black tea (leaves in the bottom of the mug) with a touch of sugar (I would never normally dream of touching the stuff) accompanied by several of these little critters (stop moving once the boiling water goes in) is something I actually look forward to! The staff have been expanding my palate by bringing me in more and more things to try; plantain (a cooked green banana that is delicious), breads, donuts, roasted peanuts, root vegetables to name but a few. It is a fantastic insight into their real-life, every day, culture. And it is generally delicious (and healthy!).

My schedule for the day was slightly derailed by the addition of a strangulated hernia at the end of the list (mesh case number 20). But after a quick team appraisal, we decided to pursue my slightly crazy proposed activity, albeit a little later than planned. The three of us (both the local surgeons came) jumped into the hospital car and went off in search of some missing data. It is at this point that I should probably state that I did wonder if you can be too committed to a cause. I am still mulling this question over. But two of the hernia patients had failed to return to clinic (over a month overdue) and I was disappointed about this. Firstly, I thought they still had sutures to remove (we have now developed or technique to include completely absorbable skin closure) and secondly, being a little OCD (more nodding heads reading that I know) I wanted to do everything I could to maximise the outcome data we were collecting from the mesh procedures. Unfortunately, the demographic data that is held in the patient records is very limited which had made contacting them impossible (we are now collecting telephone numbers). I had slightly tongue in cheek suggested that we could drive out to the villages to ask after them, and when this idea was not dismissed immediately it evolved into reality. So this evening, off we went.

The first village we went to firmly kicked this idea into touch as the ridiculous idea that perhaps it was. We went to the very plush health centre located there and even spoke to the village chairman (who would usually know of most people) but to no avail. Frustrating. Albeit predictable perhaps. But at least I could say that we had done everything we could have. Off we went, back down the bumpy dust road to Muheza and then out in another direction for the other village. The title of this post pays homage to how I was feeling as we made the turn to head back out of Muheza. 15 minutes later, I pulled off the main road and parked up. My colleague jumped out to ask around after our second patient. I was just in the middle of sending my wife a message to explain why I was so late home (it would be 7pm before I made it through the door) when he knocked on the window, beaming, with a slightly dishevelled and dusty man in hand. It was our missing patient! I was absolutely delighted! We had actually found him! Furthermore, he was doing brilliantly. An impromptu outpatient consultation ensued and we could fill some of the gaps in the mesh database. I was super stoked. What a great result. What good fortune. A totally bonkers idea, but it had worked. He might even come back to the special follow up clinic I’ve got planned for April before we leave (we did take his phone number though!).

It was a glorious sunset as we drove back to Muheza. I was in that slightly tired state of elation that can only come when a distinctly questionable idea turns out well. What’s more, whilst en route we got a phone call from the nurse at the health centre to say that remarkably she’d managed to track down the first patient we had gone looking for. Hopefully he’ll come to clinic on Monday.