Moments with Winani
Having spent a day absorbing the incredible sights, sounds and smells of Tarime, I had my first taste of hospital work watchin Dr Winani pefoming procedures which he has carried out for over 40 years, D&C’s, tubal insufflations-injection of steroids & antiobiotics into the tube to clear chronic infection & scarring, the most common cause of infertility.
The theatre is threadbare, sterilisation happens over a parrifin burner, there is an acute lack of awareness around hygiene and sharps.
I learnt the ropes with Isaac, a medical assistant in training, interpreting for me both the Swahili language and the foreign medical tapestry – malaria, parasite infestations, gonorrhoea, HIV. “Common conditions are common” takes on a whole new meaning.
The reality of high infant mortality hits me with two stillborn babes due to obstructed labour beyond the help of caesarian section and no available ventouse or forceps extraction.
Due to their inability to pay for transport or services, many presentations are quite late. I assisted Winani with an emergency laparotomy for acute small bowel obstruction which was 3 days old. The kidneys had shut down and despite an amazing surgical effort to remove 2 metres of dead bowel, the patient’s kidneys did not recover and she died 6 days later.
I later assisted a visiting urologist to operate on a 2 year old child with bowel obstruction from paralysed bowel due to peritonitis, with no suction, diathermy, and instruments suitable for a hippo. He was able to achieve a good result and the child is making excellent progress.
Medications we take for granted such as codeine, morphine, up to date medication for diabetes, asthma, and arthritis are not available here. However, the most potent antibiotics and antimalarials are readily available on street corners.
The enormity of the task can be very discouraging, but when the husband of our laparotomy patient who died, embraced me the next day, I felt only the deepest appreciation and knew that every effort is worthwhile.
Dr Joe Tempone