Mukinge Hospital visit 2014 Report for the AAGBI International Relations Committee

Transcription

1 Mukinge Hospital visit 2014 Report for the AAGBI International Relations Committee Following my fifth visit to Mukinge Hospital I am pleased to report on another enjoyable and productive period. As in previous years the aim was to reduce the workload on the local anaesthesia provider, Sr. Proctor and contribute to safe anaesthesia care in more complex cases as well as offering teaching and training as requested. This shorter visit was none the less busy; there are now two full-time surgeons at the hospital. Not only this but there were three other doctors and a medical licentiate covering medical wards and outpatients which enabled the surgeons to focus on their own ward and operative case-load. Thus I undertook 63 cases in just over two weeks, in addition to the 51 cases anaesthetised by the resident anaesthesia provider (appendix attached). This increase in workload certainly challenges the current infrastructure with two operating theatres (one of which is a minors room with only basic monitoring and no facility for inhaled anaesthesia). Clearly also there is a need for more dedicated anaesthetists whether local or expatriate. There is a plan to re-build Child with a 4 month history of facial abscess for incision and drainage (taken with parental permission) the theatre facility with increased capacity (five theatres) and a formal recovery area (music to my ears!), pending funding. The head of the nearby nurses training school this year requested me to deliver teaching on anaesthesia, giving an overview of the subject and specifics about drugs and equipment to the second year nursing students. While a challenging brief, it was interesting to prepare and deliver and I found them to be engaged and encouraging to teach. I had not anticipated covering the physiology of the neuromuscular junction as became necessary following questions about neostigmine and pancuronium! I also enjoyed teaching an Australian medical student on his elective who had asked to spend a week attached to anaesthesia during his visit. In-theatre training included an introduction to TAP blocks and optimal airway positioning among other topics. Themes which struck me this year included the interaction between a wellregarded but remote hospital like this and the many wider organisations which impact its functioning. The nearest referral hospital at Solwezi has closed its operating theatres for renovation and as a consequence we received a number of referrals from them; on one occasion four in one ambulance, all of whom required emergent surgery. Government inspections and NGO projects alike offer great opportunities but demand manpower, frequently at short notice which can challenge the hospital s day to day functioning.

2 Planning for disaster was also uppermost in many minds. In fact I was impressed to see the response to a bus crash with about 40 casualties. When I was asked to attend the outpatient/emergency department to assist, the team already had a clear and functional structure in place for triage and management. This was clearly borne of experience as multi-casualty accidents are sadly common on the roads. Additionally much thought is being given to the hospital response in the event of the Ebola outbreak reaching Zambia (which is more probable from the Congo than from West Africa). Already local communities are concerned about the issue with some starting to implement their own vetos on handshaking outside church, for example almost unheard of in a culture where greeting and hand-shaking are fundamental courtesies. Traction for femoral fracture (with patient permission) A note on oximeters: both theatres have non-portable pulse oximeters as part of their monitors. However there is still a need for portable oximeters not only in the event of power failure but also for monitoring patients post-op (they currently recover in the theatre corridor) and pre-op (for the children given oral ketamine sedation). The value of measuring and acting on pulse oximeter readings is becoming apparent in the wider hospital and consequently the two portable machines are now shared with wards and the maternity units. Provision of Lifebox oximeters would still therefore be of great value to the theatre unit. I am very grateful to the International Relations Committee of the AAGBI for their continuing support of this project, also to Craig Oranmore-Brown of Mercy Flyers, Flying Mission Zambia, Oxford University Hospitals NHS Trust and most of all the team at Mukinge Hospital and its Director, Mr Fumpa who continue to welcome me and, more importantly, provide compassionate care to those who come to them for help.

3 Appendix: case summary Date Age Sex Operation Anaesthetic 2-Sep M Laparotomy ischaemic gut 3-Sep M ORIF patella 3-Sep F C/S placenta praevia ETT 3-Sep F R BKA and L leg debridement 3-Sep-2014 Paed F MUA tib/fib fractures and POP 4-Sep F Burn debridement 10% 4-Sep F Burn DSD 4-Sep M Prostatectomy and TAP 4-Sep F Evisceration eye 4-Sep M I&D penile abscess 4-Sep F I&D finger abscess LA 4-Sep F I&D abscess head 5-Sep M Laparotomy appendix abscess and TAP 5-Sep F E/O trochanteric mass Laparotomy typhoid 5-Sep M phlegmon 5-Sep F Laparotomy ectopic MUA and POP ankle 5-Sep M fracture MUA and POP ankle 6-Sep F fracture 8-Sep M Hydrocoele repair 8-Sep F DSD MUA and collar and cuff 8-Sep-2014 Paed F fractured radius and TAP PO + IM ket 8-Sep F Skin graft for burns 8-Sep-2014 Adult F Amputation arm and ISB 8-Sep F D&C 9-Sep F D&C 9-Sep F C/S breech and fetal distress 9-Sep M DSD PO ket F C/S CPD F Skin graft leg M Bladder stone removal F C/S fetal distress

4 M Arrest bleeding post circumcision F D&C F C/S CPD and fetal distress M R/O sutures from eye PO ket M DSD and Ex-fix ankle PO ket F D&C M MUA and POP fracture tib and fib M I&D facial abscess M Prostatectomy F D&C F I&D brow abscess F R/O FB vagina IV F D&C F C/S multiple previous SB M Wound cleaning and femoral traction pin and FB M DSD and pin resite PO ket M Traction pin for fractured femur and FB M Leg wound debridement F C/S FTP F C/S FTP and IUD F Laparotomy post-cs bleeding M DSD PO ket M Completion amputation index finger PO ket 16-Sep F Laparotomy removal of packs and BTL ETT 16-Sep- 38 F Laparotomy removal of

5 2014 packs and BTL 2014 Adult F C/S bleeding and fetal distress mon ths F I&D abscess behind ear M Attempted urethral dilation F BTL M Debridement wound PO ket M DSD leg F Laparotomy E/O pelvic cyst PO ket + IM ket