A final flourish

Today is my last Monday in Tanzania and it has been pretty full on. The hospital is a hive of activity and it has been an eventful and pleasing day.

Yesterday we were delighted to welcome some friends from the UK; a Surgeon / Anaesthetist couple who brought their 15month old daughter with them. Having been involved with lots of work in Africa in the past, they are both midway through training in their chosen specialties and were keen to try out the reality of Africa with a child! They had somehow managed to co-ordinate their on-call rotas and leave requests, managing to make it out here. It’s a big thumbs up so far. Their daughter seems to love it. And she certainly likes the new big friends she has found in our chidlers. For us it has been really nice to share some of our time here with such people.

Somehow, a few weeks ago I had agreed to pay for the redecoration of theatres. Expecting it to require just a modest amount of funding, the quote turned into something more substantial. £1,500 might not sound a lot, but here that’s a massive amount of money. Hesitation to commit to such expense personally (given that we are scraping the bottom of our barrel currently) was soon to be overcome by the generous offer from family to make contributions as a birthday gift. Before I knew it, the whole thing was financed, and the work was commissioned. I was genuinely delighted. One of the best birthday presents I think I have ever received.

I had hoped the work might have been completed during our stay in Zanzibar. Unfortunately, whilst it was started at the weekend it is now midway through and walking into the theatre complex today made me rethink the reality of the weeks operating schedule. Dust, plaster and paint everywhere. Operating this week might be a little lighter than I had anticipated! But I am absolutely delighted that this work is underway. It will make a massive difference to the department. Not only will it make it easier to keep clean (improving sterility), it should reduce the likelihood of flies in theatre and will certainly have a nicer feel for the staff who work there. Another small but significant step to raising the bar of surgical care here. A herculean effort is underway to get things finished….I am being open minded…. (rest assured, we have moved emergency work into the previously dormant theatre in the obstetric ward, but we really do need to reserve that for unplanned work only).

Fan repaired, hole persists!

And so on to the main event for the day – outpatients. I knew it was going to be a huge clinic as I had integrated a special mesh follow-up clinic for the majority of those in our series. I felt it was important to encourage a robust system of feedback for the local surgeons, as well as capturing important data to validate what we have done here. As I walked through the door, I immediately noticed the now working ceiling fan – what a great omen for the day – it would be a comfortable marathon at least. Whilst a mammoth 44 patients were seen, the majority were follow-ups and doing brilliantly.

If ever I needed a final reminder that what I have undertaken here has been worthwhile, this was it. It felt a little like an indulgent success parade, with patients modelling beautiful scars and a significant number regaling delight in the outcome of their surgery. Whilst all the mesh patients were fantastic to see, the highlight for me was a couple of the children who I had brought back to review before I left. To see them thriving was such a pleasure. The little boy who had had a big recurrent hernia was particularly special for me. Motherless, his grandmother smiled broadly as she showed me his now near normal inguinal region (groin). Whilst the original broad scar was a clear indictor that he had had surgery, our little fading pencil line was only a hint that we had ventured back in. All the inevitable post-operative swelling had disappeared and I felt an enormous wave of satisfaction that my work here has been done well. Such things will probably make a real difference to this child. I feel he could certainly do with a few better deals of the cards.