It’s now been a week since we returned from Africa. I believe that all the members of our group are convinced that the trip, besides being a ball, was successful in achieving its basic mission – to improve healthcare delivery in an impoverished region of Africa devastated by the HIV epidemic.
In once again reviewing and enjoying the journal entries made by our team members, I realize that I need to make an apology. When I discussed my first days experience at Mt. Meru operating theater, I expressed discouragement and frustration. In Jon’s entry, he interpreted this as my questioning whether I personally did more harm than good.
Clearly the operations I witnessed and performed produced more good than harm. My disappointment was based on the compromises made on my ability to provide ideal surgical care because of limited equipment, supplies, and organization. Simple examples include my necessity to close an incision on a child with thick, inflammation-inducing suture material. While the wound will heal just fine, it will probably be somewhat unsightly as compared to a wound closed with ideal material. A similar concern was expressed by a Tanzanian obstetrician performing a c-section. He felt that his abdominal wall closure was at increased risk for development of a hernia because of the lack of appropriate suture. My low productivity was directly related to my failure to help organize a surgical clinic prior to our trip. In the future, patients with surgical needs should be identified ahead of time and then scheduled for operation.
Breaches in asepsis were present, not because of ignorance or laziness of the OR staff,but because of inadequate provisions. The performance of operations was made more difficult and potentially dangerous because of the paucity of adequate surgical and anesthetic supplies. The ability to efficiently perform the many procedures indicated in the region was probably limited by supplies but also by the above mentioned organizational issue.
By the second day, Vicki and I were able to improve the situation by simply digging into the supplies we all collected and transported from Pasadena. Our gowns and drapes, scrub brushes, prepping solutions, etc., improved asepsis. Scalpels with a sharp cutting edge, simple retractors, and suture material resulted in an operation virtually identical to one that I might perform at HH.
So what am I saying? Jon, thanks for your comment that awoke me to the misinterpretation that I created. I desire that my message not be one of discouragement, but one of an accepted challenge. We can easily supply our target hospitals in Arusha with “stuff” i.e., the equipment and supplies that would otherwise be discarded here at home.
While the physicians, surgeons, and hospital staff we met at Arusha were impressively well trained and competent, there are limited numbers of these professionals and gaps in coverage of specific specialties. Assisting and filling these gaps, at least temporarily, is achievable. That will require the recruitment of specialists and the assistance of our Arushan peers in assuring the appropriate patients and facilities be available for surgery when our Team is in town.
This is a significant challenge. Good! A greater challenge has greater potential for greater reward.