2nd day in Tanzania. Yesterday we screened patients who possibly could benefit from – and for whom we could safely perform – surgery. Today was the first operating day, so it was early to rise. At 6:00AM at the Lodge, you arise to a quiet pleasantness – the nighttime sounds have stilled, and the morning birds begin to chime in.
After we arrived at St. Elizabeth, the major task for the morning was deriving an operating room work flow – coordinating safe anesthesia and surgical care with a newly formed team of surgeons, surgical residents, and anesthesiologists. After some early bumps in the road, the rhythm smoothed out, and the operating room was buzzing along by the end of the day.
In the St. Elizabeth Phil Simon Clinic Operating room, some aspects of the experience are quite similar to any OR in the US, with the same frustrations and the same enjoyment. One of our operating rooms was delayed by several hours as several of the local surgeons needed to perform urgent procedures for their obstetric patients – an experience any operating team will relate to the world over. The camaradarie, team mentality, and operating room banter – jovial, with a healthy dose of teasing – was as pleasant and familiar as any in the US.
Surgical decision making is somewhat altered in Tanzania, as the context and limitations of a short-term subspecialty surgical mission must be accounted for. We have evaluated a number of patients suffering from severe burn scars that are deforming and often functionally limiting due to the dense contractions that scar limbs together and limit range of motion of joints. We are limited to offering surgical treatment for only the functionally limiting scars for the most part, where in our practices in the US we would consider offering a more extensive, invasive, and risky intervention. This translates to conditions outside of scar as well – before we offer surgical intervention, we must determine that the patient is healthy, that we can safely perform the procedure, and that the patient can receive the appropriate postoperative care.
Today’s surgeries included a cleft lip repair, a palate and pharynx procedure for a young girl, and several burn scar releases.