Day one - Saying 'Jambo' to old friends
Thursday, November 19, 2015

Despite arriving late last night, the team were up and out early this morning keen to make the first visit to the hospital.  For two members of the team, theatre nurse Kirsty and international support officer Emma, it was their first time ever visiting KCMC. There are only five of us here so far with the others arriving in the coming days.

When we first entered the hospital, it seemed surprisingly quiet but after entering the wards and waiting areas we soon realised this wasn't because of a lack of patients. In fact people were sitting everywhere we looked but it was because they were literally being 'patient' - waiting quietly with their loved ones waiting to see a doctor or nurse. We had a quick tour of the hospital and met Dr Kondo, head of surgery and a very good friend of the link, who introduced us to his colleagues and warmly welcomed us. We were also delighted to meet the new CEO, Dr Masenga, whom has worked with Northumbria for many years on an ultrasound project. Dr Masenga updated us on what had been happening in KCMC and again, we were made to feel very welcome. 

On our way around the hospital there were also lots of other familiar faces and people seemed to embrace us "Jambo" in every department. They all knew Brenda Longstaff, our head of charity development and international, very well and were thrilled to see her and the burns nurses return again this year. Everyone seemed to know Northumbria and were over the moon to see familiar faces.

Whilst moving around the hospital, it wasn't long before we were informed that one of the queues we had seen earlier was in fact a queue of patients waiting to see our team undertaking the burns project. The queue was full of children, including 16 year old Frankie and little Pascalina, who had been seen by the team the year before. We couldn't believe they'd returned. It was great to see them smiling and healthy.

A triage session soon commenced with burns nurses, Catherine and Meg, heading to the ward to meet patients and begin triage in preparation for the plastic surgeon Mr Rawlins arriving in the next couple of days. Triage on the ward was tough as the children had some very, very severe burns. One little boy in particular, Hattibo, had suffered horrific injuries all over his body and was in a very critical condition.  As Meg and Catherine needed to take a look at their injuries, we soon became their least favourite people. The children, naturally, d were frightened they were going to be "hurt". However, after some very careful care to undress their wounds, along with a few lollipops dished out by the team, they eventually calmed down. It's never nice to hear a young child cry but I think it will stick with us all. On a positive note the team were delighted to see that the nurses at KCMC were now using Vaseline gauze as standard practice, which means the patients would be so much more comfortable and their wounds heal much quicker. It seems the previous year's training was truly starting to pay off!

Triage continued with 17 patients presented to the team with a burns injury, many of which had resulted in disability and infection and were really concerning to us all. Some people had lived with severe disability for years  and were hopeful to have life changing surgery. We all felt anxious to discuss the patients with Jeremy and although it was only day one, we knew this was going to be a tough couple of weeks. 

Day two - Lights, camera, action in Moshi town
Thursday, November 19, 2015

The rest of the team arrived today; two surgeons, an anaesthetist, a psychologist and a surgical registrar along with a film production team of two (Dave McPhee and Dom Dunn) from Aurora House Productions, Teesside University.  The production team had been invited to join the team to document the Northumbria-Tanzania partnership. The film will later be used to share information about the link, KCMC and the many projects we've undertaken together over the years.

After Mr Liam Horgan, Consultant Laparoscopic Surgeon, and the film crew arrived we headed straight over to the hospital to meet up with Dr Kondo and other staff in the hospital that had been integral to the success of the link's laparoscopic project. We first met Sister Philimena in sterile services department who was overjoyed to see  Mr Horgan. So much so she insisted we stay for a cup of chai and bread and catch up. Whilst chatting, Sister Philimena told us about some of the problems they'd been having in her department including the fact they were currently relying on one autoclave for the whole hospital (!) which must make it incredibly hard for them to keep on top of the demand for sterile equipment. The potential for KCMC to afford to purchase another was low as it would be a very, very significant amount of money.

Later that morning we all headed in to Moshi town to see the local area and buy some groceries for in our accommodation. It was a great opportunity for the film crew to take some shots of local life. Moshi was bustling with life and colour, with lots of food stalls selling wonderful exotic fruits, vegetables, rices and beans as well as clothes. There were so many people selling lots of lovely things to buy.

After shopping, we went for lunch in a local hotel. Not only was the local food fantastic but to everyone's absolute delight, the hotel had wifi available too! I think it was the first time there was silence amongst the group since we'd got there. Everyone was head down, focused on their phones, busy catching up with family and friends back home. It made us all realise how much we'd come to depend on the online world and how much it interrupted normal "conversation' around the table taking place. In KCMC we'd never gave it a thought but back in the UK we feel we "need" it all the time.

 

Day three - teamwork
Thursday, November 19, 2015

It's a beautiful morning and the burns team use the opportunity to discuss the triage outside in the gardens. Some of the patients had very distressing, worryingly bad burns injuries so at least the beautiful flowers and surroundings outside helped to keep everyone in high spirits to start the day. It was great to watch the different team members, burns nurses, a theatre nurse, surgeon and anaesthetist from all over the world work together (some of whom had only just met for the first time!) to discuss the patients and do their best to deliver care. This is testament to their incredible skills and training.

Dr Kondo arrived around 11am and informed us that two critically ill patients, a husband and his wife, had recently been admitted with 50% burns from an accident involving a petrol explosion. To make matters even worse, Dr Kondo then also further explains that the lady is 26 weeks pregnant. It was clear that these two patients needed urgent care and attention and the burns team rushed to the hospital to see them.

The patients had been taken to ICU and after assessing them, consultant plastic surgeon Mr Jeremy Rawlins said it was clear that the lady needed urgent life-saving surgery and intense care if they were going to make it through the evening. It was incredibly sad to see a young couple lying side by side in hospital in what must be such intense pain. The staff at KCMC hurried around the hospital trying to make plans for the burns team to access a theatre. As this was an emergency case and one that was going to take a very long time, there were no theatres currently available so it was going to be a long wait to get confirmation for the operation to go ahead. However, with the help of the staff, arrangements were made within hours and the team headed straight to theatres to do what they could.

The efforts of both the burns and laparoscopic teams that evening was just phenomenal. Without much advanced warning and little equipment they all set to the very complex task ahead without question and worked right through the evening to do what they could.

Day four - Difficult decisions
Friday, November 27, 2015

The team had a very busy day ahead as the surgeons were beginning their planned theatre lists. Everyone was feeling anxious  as we were very  aware of the surgery some of the patients were going to have to go though in order to get better. For some, it was a fight for survival.  

Little four year old Jackson was the first patient to undergo surgery with Jeremy and Mohammed. Unfortunately the burns on his lower arm and hand and the level of infection and disability which had resulted, meant that he was going to need an amputation in order to live a healthy life in future. He is such a quiet and cute little boy with huge beautiful eyes that just melt your heart.  Although we all felt incredibly sad about his situation, we knew that this surgery was going to give him the best outcome.  

The burns theatre team (Jeremy, Mohammed, Kirsty and Adrian) later explained that Jackson’s surgery went really well and that he should recover quickly, but carrying out the operation and anaesthetising him had been a challenge. Listening to them talk about  other operations  they'd done,it sounded like they'd had a pretty trying day, both emotionally and physically. To add to this, Jeremy  was currently considering whether he should operate on 10 year old Hattibou (whom we met when we first arrived). Hattibou's condition was very critical and, as he was so young and his injuries so severe, surgery would be very difficult and it was thought the anaesthesia alone may be too much for him to go through.  Operating on a patient like Hattibou could be possible in the UK because high-tech specialist equipment is easily accessible, but it would be incredibly challenging in Tanzania with  huge barriers such as lack of specialist plastic surgery instruments. The fact that we had no running water or electricity for the past few hours was a strong reminder of this. As awful as it felt, it seemed that for Hattibou, the comfort of his bed, good dressings and the care of the nurses and his devoted father was the best care for him. This must have been an incredibly difficult decision to make.  

One patient that never failed to put a smile on our faces was Pescalina. She  had been operated on by Jeremy last year and had returned to undergo further surgery to release a contracture in her arm. Lots of patients that had had previous surgery seemed to suffer contractures and the team agreed there was a need to work more closely with physio and occupational therapy to try and prevent this from occurring.

Over in the Surgical Sterile department, the film crew were busy with laparoscopic surgeon, Mr Liam Horgan, and Dr Kondo as they sorted through equipment that would be needed the following day. Dr Kondo was delighted by the equipment and incredibly grateful for all the items which had been donated by Mr David Campbell of Sigmacon UK and Storz UK. It was great to watch them both chatting, laughing and discussing their plans for the service. Clearly their professional relationship had evolved into a firm friendship over the years as they’d worked together to introduce laparoscopic surgery to Tanzania.  

Day five - What a difference a day makes
Friday, November 27, 2015

There is still no electricity or water this morning – and now there are some interesting hairstyles starting to appear amongst the group!

Meg and Catherine are first to be up and out today as they have been invited to teach nurses about the importance of hand hygiene. Catherine has brought a glow box which uses a UV light to show any remaining bacteria on a person’s hands after washing them.

In theatres, Liam and Dr Kondo were about to make history once again as they prepared to undertake the first ever day case surgery. They had met with the patients the day before and discussed their surgery and the plan to discharge them on the same day. The concept of going home on the same day after an operation seemed a little confusing and worrying for the patients as they were so used to having to stay in hospital after any operation. However, the two surgeons had explained the procedure thoroughly and explained how going home the same day would actually reduce risk of infection, help them to become mobile and feel much better, sooner. The fact they could return to their family later that day seemed to reassure and comfort them.  

The surgery went really well and even made the local news - this was a big step forward for KCMC and Tanzania! Later in the day, we went along to the ward to visit one of the patients before she was discharged and it was incredible to see her sitting up in bed looking happy and in very little pain. Her family soon arrived through the door and they all seemed amazed at how she looked and the fact that she was able to go home with them straight away.

It was fantastic to watch healthcare in Tanzania be transformed by that one operation and see the patient go home with her family. The delight on Liam and Dr Kondo's face certainly summed up their thoughts about the day’s events. 

To further increase on the successes of the day, Catherine and Meg’s  training had gone very well too. KCMC asked if they could acquire a Glow Box as they wanted to teach this on a regular basis- great progress! Adrian Taylor, Consultant Anaesthetist, and Kirsty McVay, Theatre Nurse, had made great  progress in their operating theatre too. They met two doctors, Dr Kaino (head of anaesthesia) and Emmanuel (surgical registrar) who were proactive and keen to learn. This was despite being under much pressure (Dr Kaino had managed anaesthesia’s across 6 operating theatres simultaneously and somehow found time to administer anaesthesia on the ward to support the burns nurses too!). Getting them involved in the burns project would help to bring the much needed skills, drive and determination to make a functioning well prepared burns unit seem like a very good possibility.

We're all feeling in much higher spirits following today's events and to make us feel even better, the water and electrify returns at last ....what a difference a day makes!

 

Day six – Meeting Tanzania’s first ever day case patient
Friday, November 27, 2015

We all march along the road up to the hospital carrying huge sacks on our backs of donated equipment and gifts. Kirsty and Adrian have lots of anaesthesia kit to donate to theatres, the nurses have heaps of toys for the children on the surgical ward and Brenda and Emma have lots of knitted blankets and clothing to donate to the maternity ward.

When we distributed the items, the staff and patients at KCMC were absolutely delighted,  and it wasn’t long before  the children on the ward all blowing like crazy on their paper trumpets and the tiny babies were being wrapped up in blankets by their mothers in maternity. I don’t think there was a dry eye in the house after seeing how grateful everyone was.

Later, we went with Mr Liam Horgan and Dr Kondo who had been invited to visit the first ever day case patient, Mdenengo, in her home nearby the hospital. After travelling along some very dusty winding roads, we arrived at Mdenengo’s lovely home where she greeted us all with a huge embrace. She looked fantastic!

Mdenengo described how great she felt following her surgery,  and even insisted that she wanted to go the shop to buy us all a drink! We met Medenengo’s mother  And we all had a laugh as she described how she had kept her operation a secret from her mother as they didn’t want to worry her. Usually undergoing surgery in Tanzania, meant days in a hospital bed and feeling unwell. On the morning of her surgery, she’d told her Mother she was simply going to work as usual and would see her later in the day …and she did. Except, rather than working (Mdengo is a nurse at KCMC), she went to KCMC and underwent surgery and was still home in time for tea. When her Mother found out what she had actually been doing that day, she couldn’t believe it. 

Day seven – Community work
Friday, November 27, 2015

A few of us are on the road up to Kibosho early, heading up Mount Kilimanjaro to the communities that live out in more rural areas. We’re going up to Kibosho school to teach burns prevention and first aid to the local children. This is a really important part of the burns project. Educating children about fire safety and first aid can help to save so many of them from suffering burns injuries in the future and it also empowers them to be able help themselves and others in an accident, which could help save lives. Amina, a local teacher and long-time friend of the Link, joins us to be our interpreter.

KIbosho is a beautiful area, green and lush, and we all feel it’s a really nice place for children to grow up in. When we arrive at the school there are hundreds of children, all dressed in beautiful royal blue coloured uniforms, running around the playground and nearby field.

To help the children understand what Meg and Catherine plan to teach about burns, and to make it a little more fun, Catherine applies lots of make-up to Emma’s arm to make it look like she’s had a really severe burn – it’s amazing what you can do with a bit of Vaseline and face paint! We have lots of props too, like a mini fire made of crepe paper and a mosquito net to demonstrate how easily a burn can happen.

There were over 150 children at least, in the classroom where we taught. Emma acted out scenarios, such as burning herself whilst cooking or catching her candle on a mosquito net whilst Catherine taught the children how they should respond. The children roared with laughter at Emma’s theatrical skills and they were all really keen to take to the stage and have a go themselves when Catherine asked for some volunteers to help. At the end of the session it was great to hear the children all shouting “stop, drop and roll” in Swahili when they were asked what they should do if they were caught by fire.

When we returned home later, we were met with the rest of the team and an amazing dinner prepared by Frida, the house-keeper. She’d prepared lots of wonderful local food and we had a great night reflecting on the past events of the week and watching some of the footage filmed so far by the film crew, David and Dom.

Day eight – Planning for the future
Friday, November 27, 2015

Liam and Dr Kondo were up and out early this morning to meet with KCMC’s CEO, Dr Masenga. They were meeting to discuss current and future plans for the laparoscopic project. With the first day case operation being a huge success, KCMC were incredibly excited about what this could lead to. Patients staying for one day would help save the hospital and the patient money, time and resources which would be hugely beneficial for everyone. It seems the laparoscopic project still has so much it can do to help KCMC and the future of it is still very, very exciting.

Meanwhile the burns team were either in theatre undertaking final planned operations or presenting in a burns symposium, held by Northumbria. Seeing the team weave in and out of projects, clinical and academic, was testament to their skills and ability to handle multiple situations and prioritise their work.        

Over 40 people attended the symposium, some of whom had travelled from miles away, to learn more about caring for burns. The symposium covered prevention, treatment and after-care of burns to give a comprehensive programme of care. Mohammed Farid, surgical registrar, taught about fluid resuscitation and Jerome Marshall, clinical psychologist, spoke about recovering from trauma for example so that the audience could benefit from learning about a wide range of elements involved in the healing process.  

Day nine - Graduation day
Friday, November 27, 2015

It’s Saturday and a very important day for KCMC and the university as its graduation day. The University has been covered with flowers, lights and gifts for those graduating and the ceremony began really early in the morning. We could hear the music from 7am.

Yesterday evening Professor Namita Kumar, Dean of Postgraduate Education, arrived to join us for the weekend so it was perfect timing for her as she is able to attend the graduation ceremony and see the medical students become doctors. The parade was fantastic and there were hundreds of students parading through the streets wearing their gowns. It was particularly special for Brenda as there were 6 students graduating who had been sponsored by Friends of KCMC, a charity that Brenda chairs and which has supported our partnership work with the hospital for many years.  There were also many familiar faces amongst the crowd, such as Eusebious Maro and Bonnyfass Temo whom had undertaken professional fellowships in Northumbria. It was proud day indeed!

After the graduation we met up with some of the team to introduce Professor Kumar and show her around some of the hospital. Professor Kumar was delighted to meet the burns nurses, Catherine and Meg, on the ward along with  their patients. We all talked about the different issues and challenges healthcare professionals faced in these environments compared with the UK. as Mohammed and Kirsty in our team had seen this for themselves  being faced with very difficult cases and experiencing situations that many healthcare professionals working in the UK would never ever see. Despite only being at the very beginning of their careers they remained motivated, focussed and demonstrated immense resilience, taking on any challenge that was put to them.

Unfortunately our day at the hospital ended with a final harsh reminder of the realities of the issues faced by people living in countries like Tanzania when we met a young boy, Peter, sitting outside the hospital. Peter’s foot was bandaged up and as he sat intrigued at the production team’s cameras, we couldn’t help but ask him what had happened as his foot as it looked very painful. He told us he was ten year’s old and he was soon to be going home after being diagnosed with Kaposi Sarcoma. Jeremy explained that this is a tumour caused by Aids. Peter spoke very clearly and matter of fact about his situation, it seemed his illness had made him  older than his years. We all wanted to check on Peter the next day and make sure he at least got a gift from us before we left to help cheer him up – a Newcastle United top seemed to do just the trick!

In the evening, Liam and the film crew were leaving for home. It was time for one last team photo and a few hours to reflect on the activities of the week