Chapter II
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Two months here already...
17.12.08
| I’ve now been in Tanzania for just 2 months. It’s truly an amazing place. The people are so friendly and welcoming, and the landscape is beautiful. Where we are, in the north of the country, it is relatively green, especially in the hills. The towns are and roads though are dry and dusty. We’re waiting for the short rains to come – we had two days of rain a couple of weeks ago, but nothing since. It’s very hot with daily average temperatures in the 30’s, and I’ve had to learn to slow down! Life in anaesthesia continues to be a challenge. Anaesthesia is provided largely by a combination of nurse anaesthetists and assistant medical officers (AMOs). There are between 12-15 doctor anaesthetists in the country, and the majority of those are apparently nearing retirement age. Most of the nurse anaesthetists train in the hospital in which I am based, Kilimanjaro Christian Medical Centre (KCMC). There is one other school for nurse anaesthetists in the country, which is probably training less than 10 nurses per year. We have 33 nurses training this year, on a one year course. They will then go back to work in their local hospitals. As far as I can tell, there are no AMOs currently in training, and possibly one or two doctors, although accurate data is hard to come by and I may be wrong. This is to serve a population of 34 million. |
Mt. Kilimanjaro, from the parking lot of KCMC Hospital in Moshi, Tanzania |
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Kilimanjar
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At KCMC there are 5 main operating theatres, ENT, urology and obstetrics. The staff do an incredible job. They are expected to anaesthetise a wide variety of different cases. The anaesthetic equipment used consists of an endo-tracheal tube, hand- ventilation via a T-piece for a child and a ventilator (often a Manley) for adults, pulse oximetry is in most theatres, an ECG, BP monitoring for adults and a very useful pre-cordial stethoscope for children. We have a truly multinational lot of different donated monitoring equipment, and I have been learning how to set a BP machine in Swedish! Truphatek kindly gave me a full reusable laryngoscope set to bring with me, which is now used daily. There seems to be a high incidence of infants with spina bifida defects, with meningo-myeloceles requiring repair at various levels on the back and neck. Most of these babies are operated on within the first month or two of life, and many also require VP shunts. We anaesthetise these patients using a T-piece and halothane, with hand ventilation. Again, the pre-cordial stethoscope is a most valuable monitor. I don’t practice neonatal anaesthesia in the UK as a consultant, but fortunately I did some extended training as a specialist registrar, which is proving very useful now! We also have a constant run of head injuries requiring burr holes from the dangerous roads. The general surgeons cover all of these cases, and are extremely skilled at turning their hand to everything. |
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I’ve spent the last couple of days writing the mid-year exam for the nursing students. Its interesting trying to choose relevant questions, as so many that I originally think of are not relevant. For example, questions on capnography or agent monitoring are not appropriate to this environment. Enough of work! The children have all settled in well to their school and made a lot of new friends. We’re off on safari next weekend. I just checked the weather forecast back in the UK and it was sleet, rain and fog. I know where I’d much rather be!
Any feedback, comments or advice – please contact me via the Truphatek contact email. Dr. Naomi Goodwin |
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