INTERPLAST HOLLAND MISSION ZANZIBAR 21 February 8 March 2014

Size: px

Start display at page:

Download "INTERPLAST HOLLAND MISSION ZANZIBAR 21 February 8 March 2014"

Stephany Hutchinson
5 years ago
Views:

INTERPLAST HOLLAND MISSION ZANZIBAR 21 February 8 March 2014 Team members: Rein Zeeman Ruth Lester Liam McCarthy Gijs Witte Ingrid Hollander - Mus Agnes Derwa - team leader

Mnazi Mmoja Hospital / Zanzibar Town Check-in on Friday evening in Schiphol went smoothly. We had a transfer in Nairobi where we met Ruth who had flown in direct from London.

Our luggage was loaded and we set off for Ocean View hotel though, unfortunately, it turned out to be fully booked because of all kinds of meetings.

1 INTERPLAST HOLLAND MISSION ZANZIBAR 21 February 8 March 2014 Team members: Rein Zeeman Ruth Lester Liam McCarthy Gijs Witte Ingrid Hollander - Mus Agnes Derwa - team leader and plastic surgeon NP (report) - plastic surgeon (Birmingham) - paediatric urologist (Birmingham) - anaesthetist - anaesthetic nurse - operating theatre nurse Hospital: Mnazi Mmoja Hospital / Zanzibar Town Check-in on Friday evening in Schiphol went smoothly. We had a transfer in Nairobi where we met Ruth who had flown in direct from London. We went on together to Zanzibar where Dr Rama (Ramadhan Suleiman) was waiting for us when we arrived. Our luggage was loaded and we set off for Ocean View hotel though, unfortunately, it turned out to be fully booked because of all kinds of meetings. Instead we had to move to a newly-built apartment complex which was also on the coast. Dr Rama was presented with the new laptop, which we'd bought for him at the last minute a few days before our departure, and this pleased him enormously. Front view of Mnazi Mmoja Hospital 1

We were allocated three apartments with two bedrooms each but otherwise the place was bare. Maria, who was to look after us, did some quick errands for basics like bread and water etc.

2 We were allocated three apartments with two bedrooms each but otherwise the place was bare. Maria, who was to look after us, did some quick errands for basics like bread and water etc. For the rest it was very hot! SCREENING on Sunday On Sunday we were picked up by the driver Makame and Dr Rama who had the lists of all the patients. The patients were seen in sequence. Again there were a lot of boys with hypospadias or urethrocutaneous fistulas, primarily the result of poorly performed circumcisions. Diverse other plastic surgery problems also needed operating. A team from Interplast Germany had been in Zanzibar in the previous August for a week and had operated on most of the cleft lip and/or palate patients. An extract from the 2013 report! There is certainly something wrong with the circumcisions being performed here. From what I have seen so far too much skin is removed but fistulas also occur frequently, though I ve no idea how. In other Muslim countries, for instance in Yemen, where circumcisions are common, I have never seen anything like this before. I am trying to find out who performs the circumcisions here. It turns out that this can vary from operating theatre personnel to cleaners and older people in the villages. There is financial gain to be made from this. We got through the screening in reasonable time. During lunch in the hospital restaurant we drew up the programmes for the coming week. Then we went on to set up the operating theatres with our equipment. Little had changed since our last visit in OPERATING Monday to Friday As in previous years we operated in two rooms, one for the plastic surgery cases (Zeeman) and one for the boys with hypospadias / fistulas (Lester and later McCarthy as well). After spending a few days in the apartments we were able to move to the Ocean View hotel on Wednesday. Liam McCarthy flew in on Thursday and came direct from the airport to the operating theatre where he immediately set to work with Ruth. He is a children's urologist from Birmingham and he was extremely keen to operate so many young patients with hypospadias and/or fistulas. We did ward rounds every morning and afternoon when we'd finished operating. The children's ward was soon full. It was perfectly normal for there to be two children to a bed Children s ward 2

Dr Rama performed most of the skin grafts for major deformities arising from burns or tropical ulcers.

3 Saturday After the ward rounds we visited Stone Town and the museum on the history of slavery. Sunday Day off. Monday Wednesday The last plastic surgery operations were on Monday. Dr Rama performed most of the skin grafts for major deformities arising from burns or tropical ulcers. He has become very dextrous with the handheld dermatome achieving a success rate with skin grafts of above 95%. Dr Rama with graft on Tropical Ulcer To manage all the young patients with hypospadias and fistulas Ruth and Liam each operated in a room on their own on Tuesday and Wednesday. 3

The undersigned was occupied with organising the workshop that was to be held on Thursday: Workshop on Post Circumcision Fistulae and Hypospadias Ocean View Hotel, Thursday March 6 th 2014 Various

4 The undersigned was occupied with organising the workshop that was to be held on Thursday: Workshop on Post Circumcision Fistulae and Hypospadias Ocean View Hotel, Thursday March 6 th 2014 Various matters had to be arranged together with Dr Rama such as booking a room in the hotel, having certificates and programmes printed etc.. Participants workshop Thursday - the day of the workshop The day was a big success with good attendance and a press contingent of no less than eight! Various speakers gave presentations during the morning session and the afternoon sessions were devoted to discussions in working groups. The Principle Secretary of the Ministry of Health, Dr Mohamed Jiddawi was present during the entire morning and, of course, at the press conference. Dr Jiddawi has been involved in the Interplast Holland project in Zanzibar since the outset in The director of Mnazi Mmoja Hospital, Dr Jamala Taib, spent the whole day at the workshop and presented the summaries of the discussion groups in the afternoon. Altogether there were 32 participants from all over Zanzibar, hospital staff, operating theatre staff and others. People asked serious questions and were enthusiastic participants in the discussions. 4

hospital. Few ladies were present unfortunately because they are not allowed to go out alone in the evening.

5 Press conference: from left to right, Dr Lester, the Principle Secretary Dr Jiddawi and Director Dr Taib The successful workshop was followed in the evening by a farewell dinner with the local hospital staff of the hospital. Few ladies were present unfortunately because they are not allowed to go out alone in the evening. We did not make a night of it and after the traditional group photographs we said our farewells. Theatre staff 5

6 Friday We checked virtually all the patients who had been operated, changing dressings if necessary under anaesthetic. There were a few complications: - 1 or 2 cases of wound dehiscence after a hypospadias repair - 1 graft infection - 1 partial wound dehiscence after palate closure Total number of operations: 85 Plastic Urogenital Post burn contractures: 15 Hypospadias: 28 Clefts: 5 Fistulas after circumcision: 13 Mesh grafts: 6 Circumcision: 2 Other: We embarked on the evening return flight via Nairobi, this time paying the airport tax out of the blue! We said farewell to Liam in Amsterdam. Ruth had flown to London direct from Nairobi. Conclusions These missions to Zanzibar do have a very special character, the focus is now fully on the urogenital surgery. This can only work with surgeons with extensive experience in this particular area. A successful trip that went well with few complications! We agreed on the following: - Next year there would be no German Interplast team otherwise there are too few cases to justify a plastic surgeon on the team. - Liam McCarthy was very enthusiastic and wants to go again (with scoop). Teaching on the job 6

7 7

8 Cleft lip before and after surgery Dr Liam McCarthy and Agnes Derwa 8

9 Dr Ruth checking the boys Post Burn Contracture links axilla before and after surgery 9

Interplast UK Mission to Holy Family Hospital, Rawalpindi,Pakistan 10th Sep - 23rd Sep 2016 Registered Charity Number

Interplast UK Mission to Holy Family Hospital, Rawalpindi,Pakistan 10th Sep - 23rd Sep 2016 Registered Charity Number On Saturday 10th September the majority of the Interplast UK volunteers arrived at