Dedicated teams

Dedicated teams

When evaluating our first week in Sengerema it became clear to us that adapting in Sengerema Hospital was an important issue. Not only for the six Dutchies, but also for the hospital staff which were again confronted with a few new wazungu (white humans) besides Erik en Jiska.

3 important factors

Where ever you are in the world, optimal surgical results depends on the assessment of 3 critical factors. The first important factor is the condition of the patient: is he/she able to recover from the additional trauma caused by surgery? Second, is the surgeon able to perform the operation and solve unexpected problems? Third, is the environment ready to provide the surgical care, not only peri-operative, but also postoperative. Could it treat complications?

The first factor is hard to measure. But some clinical experience helps to decide upon the condition of the patient. In most cases Tanzanian patients have more potential to recover from surgery when compared to patients from the Western countries. Though hard to argue, it might be due to a stronger challenged immune system and much more physical activity in daily life. The second factor, during our mission in Sengerema, has to be established by the surgeons themselves, because they have to decide if they can perform the surgical procedures. Even sometimes a surgeon has to decline a procedure that he already started. This could be because of unexpected problems that he is not able to solve, either due to his own expertise or because of the 2 other factors.

The environment

The third factor is multi factorial. It includes the hospital, such as the equipment and the professionals working at it. In the case of our mission, we had basically all we need to perform safe surgery. The theatre, the instruments and supportive equipment are well known before we set out. We even knew before we travelled to Sengerema that the device for electro surgery was out of order. We were happy to get an ERBE machine which we could bring with us in a suitcase, which works perfectly well.

Dedicated teams

While Erik treated several patients with more or less orthopedic procedures, Bart dealed with the patients who need general surgical treatments. Until now this latter group consisted of small children from 6 kg with hernia or soft tissue tumors in the neck region as well as adults with large goitre to be resected or colostomy to be closed and reestablish colon continuity. Every day Bart had the same theatre staff to support this variety of surgery.

Steven took care of the anesthesia together with Irma. Gabriel was the scrub nurse in nearly every operation. From preparing the patient until he was brought to the ward this team supplied optimal support for maximal results. We started with a time-out according to WHO-standards before the patient was anesthezised. Steven has very good skills even in the smallest childs and in deviated airways in goitre patients. Gabriel had in the mean time the proper instruments selected before we started and had already the necessary suture materials at hand. During surgery, when Bart thinks about the proper English name for the instrument he want to use next, he only had to look at the hands of Gabriel who already had it in his hand before naming it. When Steven was elsewhere, for example looking after the previous patient, Irma was caring for the anesthesia. Gabriel, who works also works as anesthetic nurse in Sengerema Hospital as well, was helpful to advise Irma while he was assisting the surgeons in the meantime

This dedicated team made working a pleasure and the results of surgery optimal. It is like working in our own hospital with some of the best staff. Although some western specialists consider a dedicated team as an efficient group of supportive staff which allows a quantitative higher output, we think that an optimal qualitative output is the most efficient result anyway. It is a privilege to have the opportunity to work with them all week long. And looking forward to next week working with such a team again!

Bart