17 March 2014

Tanzania: Health Sector Needs Modern Technology

Moshi — HEALTH sector is one of many others that need modern technology if health institutions and their corresponding practitioners are to successfully meet needs of the society.

Kilimanjaro Christian Medical Centre (KCMC), owned and ran by Good Samaritan Foundation (GSF) is located at the foothills of Mount Kilimanjaro and since 1971 it has offered service to millions of people from different corners of Tanzania as well as outside the country's borders.

One of current specialties at the hospital in over 40 years of its existence is General Surgery that has seen tremendous changes as far as surgical technique is concerned. Dr Kondo Chilonga is The Head of General Surgery Unit at KCMC, a surgical specialty that focuses on abdominal contents including esophagus, stomach, small bowel, colon, liver, pancreas, gallbladder and bile ducts.

Major achievements have been noted at the KCMC, not only domestically but also internationally, as the institution is acknowledged worldwide of its efficiency in implementing a modern surgical technique - Keyhole Surgery.

As opposed to the conventional procedure that was the only available at the hospital until 2005, Dr Chilonga says the modern surgery in the abdomen is performed through small incisions, usually 0.5-1.5 cm. It is also known as Laparoscopic Surgery or Minimally Invasive Surgery (MIS).

It makes use of images displayed on TV monitors to magnify the surgical elements. How comes the international community has recognized KCMC in this aspect then? Dr Chilonga says KCMC has been performing laparoscopic surgery since 2005 in collaboration with Northumbria Healthcare NHS Foundation Trust of United Kingdom, one of the country's top trusts.

It has since performed more than 450 procedures to patients and Dr Chilonga says they owe a lot to Nothumbria NHS, and in a special way Dr Liam Hogan who helped so much in the technique transfer to KCMC.

He expresses his gratitude to the organization and the surgeon for supporting the referral hospital in terms of training, materials, laparoscopic equipment and supplies. In the course of using the new technique, there are evaluations done on how each and every institution perform, if it is in line with the directions and if best practices are used.

Competent international health professionals do the evaluation and in this particular case KCMC has overshadowed about 196 institutions because it has emerged among top four out of 200 institutions worldwide paraded for BMJ Awards.

"It is true that out of 200 institutions implementing this modern surgical technique it is only four that have been shortlisted, everyone here is excited by this milestone and the ceremony will be held at on May 8, at the Park Plaza Hotel, Westminster, in central London," says Dr Chilonga.

BMJ is derived from British Medical Journal, an international peer reviewed medical journal that is one of the world's oldest general medical journals and has been described as among the most prestigious. The journal is published by the BMJ Group, a wholly owned subsidiary of the British Medical Association.

So the awards signify great achievement by KCMC in the field of General Surgery. Conceptually, the laparoscopic approach is intended to minimise post-operative pain and speed up recovery time, while maintaining an enhanced visual field for surgeons.

This modern surgery advantageous in comparison to the open one, as this reduces hemorrhaging, which in turn diminish the chance of patient needing a blood transfusion. Smaller incision means minimal exposure of internal organs to possible external contaminants thereby reduced risk of acquiring infections and also it has less post-operative scarring.

Overcrowding at the hospital is eased because after initiation of the Keyhole Surgery patients are discharged earlier, give room to others who need to be admitted and operated. The ones who have been discharged can return to work earlier than those who go through conventional procedure, hence engage in economic activities well in advance.

Laparoscopic Surgery was initiated in phases, the first one was for Northumbria NHS experts building capacity for some KCMC doctors and nurses who were trained at the hospital and also went for short courses in The UK. Dr Chilonga says the second phase was for Nothumbria NHS to donate materials, equipment such as operating tower (refer to the photo), laparoscopic instruments and supplies. How does it work?

The key element in laparoscopic surgery is the use of a laparoscope. There are two types, namely a telescopic rod lens system that is usually connected to a video camera or a digital laparoscope where the charge-coupled device is placed at the end of the laparoscope.

It illuminates the operative field, inserted through a 5 mm or 10 mm cannula or trocar to view the operative field. The abdomen is usually insufflated, or essentially blown up like a balloon, with carbon dioxide gas.

This elevates the abdominal wall above the internal organs like a dome to create a working and viewing space. Carbon dioxide is used because it is common to the human body and can be absorbed by tissue and removed by the respiratory system and also is non-flammable Regarding the costs of Laparoscopic Surgery, Dr Chilonga says patients do not feel the pinch of it because KCMC charge them at normal rates as if it was an open surgery.

"At the moment costs are affordable as we charge the same as normal procedures. We are offering to the community but this is a challenge because we have to replenish and maintain the same quality of services "In practice this kind of surgery is more costlier because items needed for this are different from for conventional one but we have tried to make sure what we offer to patients does not add costs to them. We still get support from Northumbria," says the surgeon.

Furthermore, The Hospital buys some supplies that are available in the country so as to be able to render proper services to patients who flow from every corner of the country and even across the borders.

Services offered through Keyhole Surgery include, but not limited to, removing stones in the gallbladder - cholecystectomy, appendicectomy, diagnosis of abdominal diseases, peritoneal adhesions, and many other surgeries. Good news about the procedure is that it does not need big manpower but it has to be done by well-trained personnel.

It is due to that need the courses are ongoing at KCMC and still Dr Hogan visits the hospital every year to train more people. In the same spirit, Dr Chilonga says, KCMC staff who are well versed with the procedure transfer the knowledge to others.

"We run workshops for this for staff from Muhimbili National Hospital, Bugando Referral Hospital, Mbeya Referral Hospital and hospitals in the northern zone - Mawenzi, Mount Meru, Babati, and Bombo.

"They come here and we train them, we have so far conducted six courses in which we have trained more than 20 specialists, more than 50 surgical residents (trainees on MA courses) and more than 100 nurses.

"What we do is capacity building so that they understand there is an alternative surgery and if they find patients with such needs bring them to KCMC and once their institutions get the required equipment they can perform the procedure," says Dr Chilonga.

He says it is in everybody's interest that the knowledge is imparted to as many medical staff in the country as possible so that in the future the surgery is done countrywide. "We like everyone to be knowledgeable in this.

Muhimbili have started and every year they bring their representatives here for these important courses. We are happy that those we train help the society.

"We need quality health services and it is only through knowledge and commitment we can achieve this. KCMC still receive the biggest number of patients for this kind of surgery than any other hospital in the country," the expert says.

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