Campaign in Korogwe, Tanzania, from November 24 to December 5.
Team Leader: Cesar Ramirez
General Surgeons: Cesar Ramirez, Javier Moreno, Marta Roldon,
Anesthesiologists: Gloria Hernandez, Carlos Avila
Nurse: F Gomez, María Dolores Castro Fdez
The total number of patients who have undergone surgery has been 102, and 133 surgical procedures have been performed, distributed as follows:
1.- Twenty-four cervical endocrine surgeries (which included 13 total and 11 partial thyroidectomies) with no major complications recorded, the patients all being discharged within 36 hours after surgery. No cases of hypocalcemia were recorded in the mid-term follow-up, with only 3 patients presenting immediate dysphonia and in one case a reoperation was necessary due to bleeding through the surgical wound in a patient who had undergone surgery for a giant endothoracic goiter with a large retrosternal component.
Sixty-three patients have undergone surgery for hernial pathology, distributed in 43 inguinal hernias (including 5 that were reproduced and 9 of them bilateral), 16 primary hernias of the linea alba (pure umbilical or epigastric) and 7 eventrations (of which 4 were large and were treated with associated abdominoplasty). Eleven of these hernia surgeries were performed on children under 12 years of age.
3.- Twenty-four patients were operated on for hydrocele of different sizes, of which five were bilateral, and two orchiectomies were performed for testicular tumor pathology and two surgeries for cryptorchidism in boys of 7 and 9 years of age. Finally, 3 emergency surgeries were performed, two of them appendectomies for advanced acute appendicitis and one perforation of the hollow viscera with biliary peritonitis due to blunt acute trauma requiring a double intestinal resection. An exploratory laparotomy was also performed on a 17 year old boy with an unfiliated abdominal mass that turned out to be an extensive peritoneal carcinomatosis of probable sarcomatous origin that was sent for biopsy.
It is important to mention that thanks to the collaboration of Mr. Santos Velasco, a licensed pharmacist from Malaga, it has been possible to provide Tanzania with LT4 substitute thyroid hormone for almost 2.5 years for the 13 cases of goiter in which total thyroidectomy was performed, as well as 60 boxes of oral calcium in case it was necessary and 100 boxes of Ibuprofen 600 mg that were given to each patient operated on for the home treatment of postoperative pain.
MEMORY OF THE CAMPAIGN
Korogwe is a city of just over 60,000 inhabitants located in the Tanga region of northwestern Tanzania. Its communications with the main airport of the country, the Julius Nyerere International Airport located in the populous and ancient capital of the country, Dar Es Salaam, are by land through an irregularly paved road along almost 300 km and that becomes endless in the almost 6 hours of travel that occupies. The most feasible connections from Spain to Tanzania are via Istanbul and normally it is possible to arrive from our country with only one stopover
Korogwe’s model of religious profession reproduces that of the country, so that 80% of the population is divided between Muslims and Catholics and the remaining 20% are Anglicans and Lutherans. The country has a republic government and the situation there, despite the proximity of Somalia to the north, is quite calm. Korogwe is home to an important Catholic congregation, the Congregation of the Sisters of Our Lady of the Mountain of Usambara, which was established in 1954 and plays an important role in helping the local society, including the coordination of medical care through Dr. Avelina Temba, who is also a surgeon and a person who gives 24 hours of her life to help the people who need it most, with special emphasis on health.
The physical space where the campaign took place is the Korogwe Town Hospital in Magunga, founded in 1952, which is a fairly basic hospital typical of developing African countries. It has two basic spaces that can be used as a consultation room and a waiting room, as well as a nursing area with separate spaces for men, women, children and postpartum women, and a surgical block with two operating rooms. Both operating rooms are equipped with an electric scalpel that works properly and only one of them has a general anesthesia machine that has been valid during the days of the campaign, except for specific moments when there were power outages and it obviously gave way. The two operating rooms had air conditioning systems that were intermittently turned on when it was hot and made our work there quite comfortable. Sister Avelina Temba is the person who swims and runs the Hospital, being widely respected by all the staff, and throughout we have had local doctors and two surgeons from the region working closely with us, with special mention for Dr. David Siwiti who has accompanied us as well as Sister Temba every day in and out of the hospital. In the surgical area there are basic changing rooms with latrine and a third physical space that can be used for emergencies and caesarean sections, as was the case during our stay. The previous coordination and preparation of the campaign by Sister Temba has been done directly with me by whatsapp and e-mail in the three months prior to the campaign, so that we have been registered and our temporary registration licenses as admitted doctors by the Medical Council of Tanganyika; all the surgical material was also registered in a donation letter to Korogwe Hospital to favor the administrative access of everything we have brought.
About 15 minutes drive from the Hospital there is a small hotel where we stayed and which is usually the reference for the teams that carry out the cooperation campaigns. We had booked 4 double rooms for the 8 members of the team and we can say that it is a quite acceptable and comfortable place since the rooms have a king-size bed and a bathroom with toilet and hot water to take a shower. With the help of Sister Temba we had already booked a half board with breakfast and dinner, so that the price per day and person in this regime was 45 Euros (120000 Ugandan shillings) and both breakfast and dinner were quite good, as they prepared it for us on the fly after request from the hotel menu and included carbonated drinks and beer without limit in the price. Regarding the food, we always had lunch in the surgical area and in groups, so as not to interrupt the surgical activity, and we alternated the local food that was offered free of charge by the hospital with local products (basically cold meats and preserves) that we had included in the luggage we had brought with us.
The mission team consisted of three surgeons (César Ramírez, leader of the campaign, Javier Moreno and Marta Roldón), two anesthesiologists (Carlos Ávila and Gloria Hernández) and three nurses (Francisco Gómez, María Castro and Verónica Fernández). Except for Gloria, who came from Madrid, all the other members of the team live in Malaga and we met at Malaga airport on November 24, 2022 and from there we flew to Istanbul, where we stayed overnight to take the flight to Dar es Salaam the next day at 19.30 hours, arriving at the airport at 3 am on November 26, where Dr. David Siwiti was waiting for us with two vans. David Siwiti was waiting for us with two vans to take us and the transported material, a total of 390 Kg that included a Ligasure donated by Medtronic for the campaign and the usual for its development (sutures, sterile surgical fields, single-use and sterile gloves, gauze and compresses, sterilizing solutions, more than 150 sterilized meshes of different sizes, 50 Ligasure terminals and 4 boxes of surgical material for endocrine surgery that are our property and always accompany us). The process of arrival at the airport and going through customs was quite painful, as they kept us waiting for two hours at dawn and made us open all the suitcases and packages despite the fact that they were perfectly labeled, numbered and documented with the certified letter from the NGO of cooperation of Surgeons in Action.
The very day of arrival, Saturday, November 26, we spent it evaluating the patients that Sister Temba had previously selected according to the criteria we had agreed upon: hernias of all types (including children from the age of 4 years), hydroceles, soft tissue tumors, goiters and abdominal masses, as well as any adult pathology that could require surgery. On that day we selected 80% of the patients to be operated on and the remaining 20% came in the following days. There were a total of seven days of surgery, starting on November 27 and ending on December 3, all of them full days, except for Saturday, December 3, when the activity ended at 5 pm. During these seven days, the routine was quite scheduled: we met in the hotel dining room at 7 am for breakfast and we were picked up half an hour later to take us to the Hospital. At 7.45 am we would start the preparation of the operating room and at the same time the ward rounds of the operated patients, in order to coordinate the start of the actual surgical activity at 8.30 am. Although Sister Temba told us that ideally we should finish the work day at 6 pm (since it was the time of nightfall and the staff had to leave the Hospital and go to their homes, most of them on foot and sometimes “not short” distances), I explained to her that to carry out all the activity we needed to operate until later and we finished at an average time which was 9.30 pm. As compensation, we have thanked the staff for their collaboration with a donation of 1000 US dollars that we have given to Sister Temba to be distributed among the workers who have collaborated with us. We have worked every day taking advantage of the space of the two operating rooms, and giving preference to the general anesthesia for goiters and more complex hernias. On the afternoon of December 3, Sister Temba took us to visit her convent and to pray in front of Our Lady of the Mountain, and afterwards we were entertained with a snack made by the sisters themselves; for us it was a great experience to share that space of life and prayer with the sisters and it is something we were very grateful for. In the evening of the same day we organized a dinner at our hotel where we invited all the hospital staff who have worked with us and we shared a very pleasant farewell. It is interesting to point out that it is always advisable to bring your own surgical instruments because the process of washing and sterilization of the material is sometimes not very operative and can be a handicap to have a high pace of work.
It is very important to emphasize the high degree of collaboration and good atmosphere that we have had at all times and that we have tried to reciprocate by operating on as many patients as possible and having in each surgery the collaboration of at least one local surgeon (if not two) as a scrub assistant.
We have taught as much as we could and have offered to assist local surgeons in training, who have performed some less complex procedures. Without a doubt, Dr. and Sister Temba is an example of how to organize a campaign and I hope that soon we will be able to return there to continue helping people in need.