 |
Doing Surgery at Selian, Tanzania
Daily schedule
 8:00am - Start everyday with 15 minute chapel in Swahili – all staff attend + patients if they desire
- 8:15am - Morning Round – 30 minutes where key medical staff are updated about hospital patients and necessary details
- Discuss deaths – what condition, what was done, was there anything preventable
- Discuss critical patients
- Discuss important or interesting surgical cases about to go to theatre or operated the day before
- Discuss important or interesting admissions from day before
- The discussion has a focus on teaching
- Attended by all doctors, clinical officers and some nurses
- 8:45am –
- On Tuesday, this is followed by CME (Continuing Medical Education)
- Approximately one hour
- Teaching is rostered – rotating around the various departments. In addition to surgical topics, discussion has included areas such as congestive heart failure, infection control, blood, psychiatric interview
- On other days, the morning round is followed by a radiology session for doctors and clinical officers to review x-rays of the ward patients from previous day
(Note: Jenny has been working two days per week in these initial stages, enabling her to spend more time with Grace and Caleb. She has settled on doing Tuesday and Wednesday.)
Tuesday – after the above
- 10:00am - Ward Round of all general surgical patient
- Done by Dr Kisanga, accompanied by the intern
- Surgical clinic
- Started after the ward round
- Goes from 10 am until all patients have been seen
- 30 - 40 patients per day
- A mixture of surgical cases, including ‘ward follow ups’, thyroid nodules, burn contractures, abdominal pain, leg ulcers, enlarged prostate, preoperative patients etc
- Patients pay Tsh3,500 (NZ$3.90)
- Patients are referred either from Selian’s outpatient clinic, where patients come if they have an acute or chronic problem, or referrals from other hospitals in the region
- Types of Investigations conducted
- Ultrasound and X-ray - ideally done on the same day
- Blood tests - results may not be back until the following day
- FNA – patients go to KCMC Hospital for this procedure, 2hrs away– results back the following day
- CT, MRI and angiography are not routinely available to patients
- Mammograms can be conducted at KCMC Hospital but have not referred a patient there yet due to the cost to a patient
- Patients all arrive by 9am and wait until they are seen which could be anything from one to eight hours
- Patients are booked on an operating list at that time, as required
- Everything is recorded on paper
- Patient details are not available on computers. They do not currently have enough quality computers, software or qualified technical personnel to run a network.
- Referrals and Test Results are written on paper, often with carbon paper between sheets for duplicate copies
- The following referral services are also available to us:
- ENT surgeons who visit various Arusha hospitals on Saturday
- Neurosurgeons at KCMC
- Physiotherapist at Selian – especially for burn contracture rehab etc
Wednesday – after Chapel and Morning Round
- Operating theatre
- Theoretically from 9am to 3.30pm Wednesday,for general surgery with ability to go late with acute cases
- With the addition of ALMC this is all in a state of change.
- 3 operating theatres plus one endoscopy suite
- Shared on Wednesday with acutes,
- Kisanga operates at Selian. If there is a difficult case at either hospital or they need to learn a new technique or procedure on a particular case, Kisanga and Jenny operate together or teaching the other how to do some.
- In 2 months of attending theatre once a week, these have been the range of operations:
- Hartmans for volvulus
- Patient not well enough for primary anastomosis
- Laparotomy and washout for primary peritonitis
- Mastectomy for breast cancer
- Excision of 12 x 12cm lipoma of Right chest wall
- Laparoscopy and proceed 3
- Inguinal hernia 6
- 4 of these were with donated mesh from USA
- Lymph node biopsy 2
- Diagnosis – TB and lymphoma
- Head tumour – attempted resection and when realised it was eroding through skull into the brain – abandoned procedure
- Skin graft 3
- Have dermatome and mesher donated from visiting plastic team from USA
- Gastroscopy 15
- Predominately dx gastritis but gastric cancer 2
- Colonoscopy 2
- Cystoscopy 2
- Open prostatectomy 2
- Orthopedic 3
- 5 FU and kenalog injection for keloi
- Histology
ALMC (Arusha Lutheran Medical Centre)
- This is the new hospital that opened at the beginning of 2009 in the middle of the city of Arusha. The purpose of this hospital was to provide better health care and to fund other health initiatives. Jenny now works here two days a week
Tuesday
- 7.30am Doctors meeting with all the consultants and the overnight admitting intern to find out what was admitted in the last 24 hours and other matters arising
- 7.45 am Chapel with all the staff in the hospital
- 8am Ward round of all the surgical patients
- After this Jenny is relatively free until the clinic starts and is working on projects to do in this time which would best help the hospital
- 12midday to 5.30pm - Clinic
- Sees similar cases to Selian
- Are able to do blood tests and xrays or Ultrasounds
- Medical clinic at the time so Jenny can discuss medical issues with the physician
- Jenny is on call on Tuesday for General Surgery and Orthopedics for both hospitals. If calls come after dark the hospital car picks her up and drops her home
Wednesday
- 7.30am Doctors meeting
- 7.45am Chapel
- 8am Surgical ward round
- 8.30am Theatre list - at the moment Jenny is predominately doing endoscopy, skin lesions, circumcisions and other day cases due to funding issues
Thursday
- 8-9am Jenny attends the Doctors Meeting with all the other consultants and A+E doctors to discuss matters affecting doctors
Read More:
Interesting Cases
The Medical Scene in Tanzania
|
 |
