The following entry was written by Dr. Doug Grey, former MedShare Board member and current Western Council Member, about his work at Muhimbili University Hospital in Dar es Salaam, Tanzania.
Things have gone well the first three weeks at Muhimbili National Hospital in the Upanga District of Dar es Salaam. We have participated in, assisted on, and performed many operations. We’ve experienced highs and lows, depending on the circumstances and the outcome, sometimes both in the same day.
The retired Chief of Surgery of San Francisco General Hospital, Bill Schecter, began this program with the premise of having a cadre of surgeons spend a month at a time helping with operations, making rounds, giving advice, and providing examples of how surgery is practiced in the US. The adage, “You can’t solve a problem that someone doesn’t know he has” comes into play. Bill visited many facilities in Africa and Muhimbili had interesting cases, some interested staff, and a pre-existing relationship with University of California, San Francisco. The Dean at UCSF had spent time in Dar and had actually helped sponsor a donated building to the medical center. So here we are. We have provided about 20 months of surgical assistance over the last four years for MNH.
The Scrubs and Gowns…
The surgical scrubs at Muhimbili are an experience. There is a sewing room where all the scrubs are hand sewn. Ordinarily, surgical scrubs come in a few sizes, are made of cotton, and have pockets for storage. They are extremely easy to put on. At Muhimbili, the sewing room has received some very durable new material that is more like tent canvas. It is hot. The gowns made from this materiasl are so undersized that removing them almost involves the Jaws of Life. They have a loop of cordon that is difficult to tie. They may fall down if the cordon knot loosens while walking. The pockets sometimes have holes in them and things fall out. But the older versions are thinner, cooler and do the trick. Many of us ended up using shirts that we brought and washing them at home every day.
Surgical gowns are typically fitted to put on easily, they have tapered sleeves and gathered wrists for ease of gloving, and are impervious to blood. The MNH surgical gowns are a different experience. They are of varying age, some new, some old, and are porous cotton fabric. Surgeons wear a plastic “butcher’s apron” underneath to prevent blood getting through. They are taped in the back to keep them closed. The sleeves are straight and have no wrist gathering. Donning gloves with these are a challenge, as nurses and surgeons glove themselves. Maintaining sterile technique is tricky, but thankfully absolute sterility here has not been a necessity, as was the case during the Ebola epidemic. The infection rate is extremely low, so what is done seems to work.
Disposables in the OR…
One curious aspect of the conduct of operations is the near total absence of expensive disposables during surgery. Things such as drains, catheters, sterile covers for cautery, etc. are all absent. These are replaced with lower budget common items. The disposable glove, in addition to being a glove, can be used as a drain, a surgical cover, a collection container, a specimen bag, and a bag for generating airway pressure. There are probably many more uses. The amount of anesthesia supplies in a typical hospital closet can be massive. But here, it is a few drawers of IVs, a few buckets of IV solution, and some intubation equipment and medications. They have learned to do without.
It has been a privilege to work this month at Muhimbili National Hospital.