We arrived at our accommodation at KCMC late in the evening
Visiting Machame Village Primary School
Specialist nurses Meg and Catherine go to the burns ward
Visiting intensive care
Preparing for plastic surgery patients
The team is complete
The weekend arrives and it’s time to catch up with old friends. I’m heading off to Bomong’ombe which is an hour’s drive from Moshi to say hello to the family of Dr Kimaro, a close friend of our link with KCMC. Dr Kimaro sadly passed away from renal failure five years ago – such a tragic loss as Tanzania does not offer dialysis treatment. This reminds me of just how lucky we are to have so many healthcare services in the UK. Dr Kimaro had led a project to develop a modern accident and emergency department at KCMC. It was great to come back this year and see building underway to bring his vision into practice. This would mean lots of planning around training plans to support the launch of this new service. It was really good to know that things are moving along. Sue and Tony set off to meet one of the medical students to provide some support for his studies and others set off to explore the local safari parks. Jeremy, the plastic surgeon, finally arrives from Australia and has spent a couple of hours going through the patient notes with Sue to understand the challenges ahead. With so many patients it was going to be really difficult to choose who would be selected for life changing surgery. The decision was postponed until the following day when Jeremy would meet the patients face to face. Late at night the final member of the team, Keith the anaesthetist, arrived so now our team is complete.
Patients assessed for surgery
Early in the morning the team set off for the hospital to meet the patients. With photos and patient notes in hand, they go around all of the patients who had been triaged on Thursday and Friday, as well as the existing burns patients on the ward. Jeremy and Dr Kondo, head of surgery, discussed each case in turn and Keith the anaesthetist assessed fitness for surgery, including possible obstructions to airways. There were concerns that the electrical burn patient would not be able to open his mouth sufficiently to have the anaesthetic tube safely inserted. However despite his severe injuries he was passed as fit for surgery. His case would be very challenging but it was unlikely that he would survive without surgical intervention. Some children were also assessed and soon a surgical list was drawn up for the week ahead. In the afternoon we visited an old friend, Amina, who runs a local orphan charity and school. After a delicious lunch of rice, cabbage and vegetable stew, all grown in her garden (shamba) we bought some of the crafts and items of clothing made by the charity to support their work. The previous day some of the team had been treated to a visit to the classroom with lots of singing and dancing to welcome them. There is something quite special about 50 schoolchildren throwing themselves enthusiastically into the Macarena, complete with dance moves!
The big day had arrived – the first day of surgery. Having been selected for surgery, the electrical burn patient was the first to be taken to theatre. It was amazing to see so many students eager to witness really challenging plastic surgery. The scrub nurse, Sue, worked closely with the Tanzanian theatre nurses to co-ordinate and support activities. Everyone was aware that this was a particularly challenging case and Jeremy the surgeon had a lot of work to do with a six hour procedure. What a relief when the operation went well and he was wheeled back to intensive care all bandaged up ready for a good night’s sleep. The rest of the team set off to do teaching in the school of nursing. Jerome found the students very lively and enjoyed answering their questions about multi-disciplinary working. Peter and Catherine delivered training on first aid for burns to the final year BSc nursing students. The heavens opened that night and the rains beat against the roof of the accommodation with rivers running down the windows. However not even the constant rain stopped the dogs from barking and the cockerels from crowing!
Achieving great results and setting budgets
The team set off for the hospital trudging through the mud caused by last night’s rains. Catherine and Meg call in to see the electric burns patient in intensive care and were pleased to find his cheeky sense of humour still intact. Once his pain medication had been adjusted and dressings checked it was clear that he was very comfortable. Over to his right it was lovely to see the little girl with the tummy burn sitting smiling on her bed. Quite a different child to the last time when we had tried everything to distract her when changing her dressings. Now, one week later, she was ready to be discharged home. A great result! First on the theatre list was a man who had been knocked over by a car and suffered friction burns causing damage to his left hand and right elbow. It took some time in theatre to free up the elbow and apply skin grafts so that he could fully extend his arm. This would make such a difference to his mobility, enabling him to return to work and earn a living to support his family. The second case was a five year old girl who had suffered injuries from the open cooking fire. Although some of her injuries had healed well, her left arm was bent at the elbow by scar tissue and needed releasing. Once recovered from the operation she would be able to go out to play with her friends and once again hold a pencil to do her homework. It is amazing how surgery can transform lives. With the others in theatre, Catherine and Peter returned to the school of nursing to deliver training about emergency management of burns to the nurse students. Meanwhile Jo is also at the school of nursing delivering teaching in financial management. The students were broken up into groups to consider preparing a treatment plan and costing for three separate fictitious patients. They each had to prepare a budget for approval by one of the group members who was nominated to be the director of finance- much to their surprise. With funding so limited for the hospital often difficult decisions would have to be taken. The electricity was still off which made it difficult to prepare teaching for the day ahead. It seems as though we have to go back to a whiteboard and pens! We have a long night ahead of us to transfer lecture notes onto flip charts.