First mission in Tanzania Team Report from Korogwe District Hospital, Tanzania. Oct-Nov 2013 From Karl Moser.
Teaching mesh repair of inguinal hernia
We arrived on the 25th October in Dar Es Salaam International Airport. In order to work as a doctor in Tanzania it is mandatory to have a temporary medical licence. This licence was issued from the Regional Office of the Ministry of Health of Korogwe District for free, with the enormous help of Rashid. Usually the temporary medical licence would cost 300 USD per physician! With this document one has only to apply for a tourist visa at home or at the airport. As the custom officers in Tanzania are very strict, it is also advisable to send Rashid a list of all medical items and drugs which you plan to take with you. Rashid will then ask the customs for clearance in advance. With a letter of the Regional Ministry of Health in his hands, it was no problem to pass the customs with 250 kg of medical equipment within a minute. As we arrived late we stayed one night in Dar Es Salaam. As the travel distance to Korogwe from Dar Es Salaam is equal to the distance from the Kilimanjaro Airport it seem to me more advisable to fly to the latter. There is a direct flight from Amsterdam to Kilimanjaro Airport whereas to Dar Es Salaam one is usually forced to stop over in Nairobi.
On the 26th October we arrived in Korogwe Hospital after 4 hours’ drive over an acceptable road in two Landrovers. We were welcomed by the Hospital Staff. We were guided to the office of the head of the Hospital. There the Surgeon Sister Dr. Temba had prepared a speech were she told us that she performed 125 hernia surgeries last year with a recurrence rate of 25%. At this moment we already suspected a possible systematic mistake. Then all 65 patients who were scheduled to be operated the following week were presented to us. The hospital staff had already grouped the patients according to their day of operation. While one part of our team examined all patients, the other group set up the OR.
In the Korogwe District Hospital there are two very well maintained operating rooms with a functioning air condition, emergency generator, cautery in each room (Erbe) and 1 brand new anaesthesia machine. For our materials a metal rack was prepared, where we could store our items safely. In summary I had never experienced such an excellent organisation in Africa before! On the 27th October we started operating. The patients were excellently prepared. The correct side was marked, every patient had an infusion running and 2 infusion bottles next to him. Due to this fact the turn over time for each operation room was incredibly low – around 10-15 minutes. Our anaesthetist was supported very professionally from Dr. Muya .
Dr. Temba showed very much interest to learn the newest techniques in hernia surgery. We taught her the Shouldice technique and the correct Lichtenstein technique with mosquito meshes. The meshes we brought along, were sponsored by Prof. Dr. Kingsnorth. After a very short learning phase Dr. Temba did very well and was able to perform these operation on her own safely. When we operated the first recurrent hernia we found out, that the hernia sac was only reduced to the inguinal canal and the external ring was then closed with non-absorbable sutures. This resulted in a very heavy scarring around the external ring and caused – of course- the high recurrence rate. As the recurrence rates were equal in the whole Korogwe District Dr. Temba informed the other surgeons in her district and invited one colleague to learn the correct technique from us.
The hospital staff under supervision of Mrs. Shangwe supported us every lunch time with an excellent meal and during the day there was never a shortage of water, coffee and tea or nuts – even better than at home. As nobody was hungry or thirsty, we managed to operate – due to this excellent organisation – 64 patients -including 12 children- in 5 days in a very comfortable, warm atmosphere. The night we spend in The White Parrot Motel, which was very clean, had good food and bar. The best rooms are however on the ground floor, where the water-pressure for the morning and evening showers is acceptable. All rooms are equipped with a TV, air-condition and mosquito net.
During my stay I was lucky to have my birthday. I celebrated with the hospital staff and my team (38 people in total) a real African Birthday! This was marvellous and an extraordinary experience!! Therefore I highly recommend that more teams should go to Korogwe district Hospital!!! I hope that all administrative barriers are now taken. The Medical Officer of the Korogwe District said following clear words, when we addressed the issue of the fee for the temporary medical licence:
“We think that we have gained more from you, than you from us.”