Helpful reminders.

It is quite easy to overlook or forget quite how much we have done and quite how far we have come. Today I was asked a question by one of our UK medical students that made me take a moment to consider such things. When I think back to what I came to in November, or even back to when I first came in July, things in Muheza have moved forward substantially.

Beyond the progress of the mesh hernia work (which features heavily throughout this blog) the beep, beep of the anaesthetic monitor brought by the Hereford team in July is now a familiar sound in theatres here. It is used all the time and we have gotten very used to it. In fact, when I think back to what was done before, it is a massive step forward (they might have used a pulse oximeter). But it is best not to think too much about such things, as when two theatres are running (as happens fairly often with emergency caesarean section) there is only one monitor. And thus one patient goes unmonitored. Even this situation is also potentially fragile when you consider that there is no backup currently if it were to break….

That can also be said for the diathermy machine we now use for almost every case (previously redundant except for occasional use by a visiting ENT surgeon doing tonsils and adenoids). The team are so familiar with its use now that they know to set it up for bipolar when we are doing paediatric cases. Today I looked over to see that the wires were in the right sockets, the bipolar selected and the other settings were correct (bipolar means that the electric current is not transmitted through the body, which in smaller people is safer).

The ‘WHO’ checks are now done as routine (even for cases overnight) and the swab count has become second nature. These are just a few of the things that immediately came to mind, and each of them make surgery safer and better quality. And there are many more things I could add to the list.

Furthermore, when we had a bit of ‘excitement’ whilst anaesthetising the child for the first case of the day, the problems were dealt with calmly and efficiently. It was a world away from some of the situations I have recounted previously, having unfortunately found myself part of during my time here.

But it is not all roses. Yesterday there was another neonatal death, this time due to a cord prolapse (the umbilical cord pops out before the baby and is compressed which cuts off the blood supply (and thus oxygen). Whilst I am not an obstetrician, I think I can remember some simple measures that might have resulted in a better outcome. Things like this remain pretty heart breaking. I am encouraging discussion around this case (and other adverse events) which I hope can maximise the learning and minimise the chance of them happening again. A cornerstone of the modern approach to healthcare perhaps, but this requires a cultural shift across many different staff groups, and it will always be a slow process.

On the home front, Kate went to Tanga to renew our visas. They were due to run out today, but I was told that many discussions had already taken place, everything was agreed and that I should remain in Muheza to continue to operate. So it should have been an easy process…. but of course it wasn’t. I am delighted that I am sitting at our desk this evening writing this and not driving madly to the Kenyan border or to Dar es Salaam to find a flight home. The renewal was indeed granted, but only for another month which means we will have to return to Tanga once again in the hope that they will allow us to stay for the final 8 days until we are due to depart! I guess life might be tedious without such excitement to keep us on our toes and it certainly seems that this might be considered another Authentic African Experience.