And so it begins. As the rooster crowed this morning, I rolled out of bed and prepared for the first day. My instructions were to meet at 0730 at Surgical Two.
I confidently strolled to the hospital and up to the ward. Unfortunately, no one seemed to be there or to have heard of orthopedic rounds. After several failed inquiries, I bumped into a smiling face. He introduced himself as Dr Frank. He is an intern and spoke confidently of how much I would teach him. He explained that rounds start at 0730, but today was different and rounds would start… soon.
No problem – hakuna matata. I began an exploratory stroll through the ward. Immediately, the overwhelming need for services and space became apparent. Beds and stretchers are packed into nooks and crannies, but not a single complaint was to be heard. Families were nursing their loved ones. Staff was performing their duties. Everyone was using the available space to the best of their abilities.
Morning rounds began. Approximately 30 personnel – medical students, interns, residents, and staff packed into the “residents room” and admission from the past several nights were reviewed. The holiday season – as expected – had brought a slow down to the hospital and multiple cases were to be reviewed.
Tanzania has a surplus of motorcycles and small taxis (3 wheelers). While they provide cheap and fuel efficient transportation, they are a vehicle for orthopedic disaster when mistakes are made. Fractures reminiscent of my days from the trauma center in residency were displayed across the surprisingly modern PACS system. Admission records were reviewed and emergent care was reviewed. Plans for definitive care were discussed.
As an aside – in the US a debate is raging over health care benefits and rights. A simple walk through the wards of Tanzania would quell those debates as we all realize how lucky we are. The simple fact of supply and demand drives the healthcare process in Tanzania. There is simply not health care dollars available to care for those in need. In no way does this reflect poorly on the providers, there is just no availability. Emergent care is provided for all who enter and then the waiting process begins. As cases can be paid for, treatment is provided. Blood banks are taxed – cases were canceled today because no blood was available. There is much waiting. BUT – again, there is acceptance. Pain medicine is tramadol (a non-narcotic), and it serves for all injuries – pelvic trauma, open fractures, & multiple limb injuries.
The holiday schedule meant the OR schedule was light – somewhat due to blood supply concerns and somewhat due to staff availability. I was invited to join a femoral nailing – a two week old sub trochanteric fracture. Obviously, early callous had set in and the reduction was difficult. In addition, the nailing was done without fluoroscopy using a variant of the SIGN nail system. I was impressed by the OR team’s deliberate approach and ability to improvise in the face of equipment concerns.
To conclude the day, I found my earlier friendly face – Dr Frank. I shared my contact information and encourage him to call when his on call duties put him (a new intern) in a challenging spot.
Tomorrow we begin again.