Global surgery: the musings of a travelling surgeon
02 May 2019
Mr Mark Szymankiewicz
4th January 2019: The team this week didn’t seem to have got the memo that I wasn’t an anaesthetist. For the second time in two days I intubated a patient*. This time it was halfway through repairing a massive inguinoscrotal hernia. Whilst almost unheard of for a surgeon to perform this intervention in the UK, it was necessary to save the life of the patient who was going to die on the operating table unless I did.
I arrived in East Africa to volunteer as a General Surgeon at St Augustine’s Hospital, Muheza, in November. This is a fairly rural, district hospital in Tanzania, with 270 beds. I came with my wife (a GP) and our three daughters – who are aged 11, 9 and 5. We are now coming to the end of our 5 months here, having set aside our comfortable lives in Dorset to come and work in a very different place.
Why did we come? Altruism, I guess, you could call it. Growing up in the 1980s, watching my Ethiopian peers dying from famine on the news, sowed a seed of desire to try, in some way, to redress the balance in global healthcare. There is, of course, never a good time to do these things and so it has taken a while for this seed to germinate.
Having worked in the NHS for 15 years, I recently completed my higher surgical training in General and Colorectal Surgery. I dabbled very happily in an acting-up-consultant post, but we decided as a family that such an endeavour was long overdue. Whilst far from easy, we made the arrangements and came. I am so pleased that we have. The need is great.
I have been working as a General Surgeon alongside two local AMO surgeons (Advanced Medical Officers). With minimal dedicated training in surgery beyond accrued experience, their training is a far cry from our extensive UK programmes. Whilst some specialist surgeons do exist in Tanzania (MD doctors with another 3 or 4 years of surgical training), they number approximately just 150 across all specialties for the whole of the country. (The UK has approximately 8,000; and all have done 8-10 years of specialist surgical training). Tanzania has a population that is 85% that of the UK but a land mass that is about four times larger.
The remit of a General Surgeon in Africa is vast, but my focus has been very much about helping the service to grow and develop sustainably (such as training them in hernia surgery using mesh, our biggest project). I have also undertaken a lot of paediatric (children’s) and major general surgery (such as laparotomy - a procedure that unzips the abdomen to sort out whatever mischief is found inside). However, without the necessary equipment or support staff, many of my specialist surgical skills (such as keyhole surgery) have been left dormant.
Working here is a world away from the NHS. The resources are very limited and staff numbers a fraction of what would be expected in the UK. However, the workforce is innovative and dedicated. What is achieved with the resources available is impressive. Special kit that would be considered basic in the UK is sparse. We are lucky with what we have, for example, one working diathermy machine (electrocautery – the modern version of a red-hot poker that reduces bleeding during surgery), one anaesthetic monitor (enables safer anaesthesia), one suction machine (shared between the surgeons and nurse anaesthetists) and a couple of mediocre oxygen concentrators (allowing patients to breathe more oxygen). We aim to emulate Western practice and standards. I think we do extremely well with what we have.
However, life here hangs from a very tender thread. Death is common and the morning death report can be difficult. Most of the cases would undoubtedly survive in the UK, many of them are children. But we do what we can and have achieved a lot. There are many successes we have enjoyed. The reality of coming is every bit as hard as we expected. It is also every bit as rewarding as we’d hoped.
Returning to the UK in a few weeks’ time, I will start a new job as a Consultant Colorectal and General Surgeon at Salisbury NHS Foundation Trust. I also absolutely intend to continue to support further work in Tanzania. There is so much opportunity to improve the lives of people living here. A small amount can achieve a great deal. I would encourage anyone thinking of undertaking such work to follow through on those ideas. I can honestly say that these five months have been the most fulfilling of my medical career. Albeit the hardest too.
I will miss this beautiful country and its people. Whilst life is undoubtedly difficult, it is one of the most culturally rich and happiest I have experienced. I genuinely believe that there is so much that Western society can learn from places like this. I am already planning my return.
*a procedure to put a tube into a patient’s throat to allow them to breathe in certain situations. In the UK this would be performed by an anaesthetist.
Keen to raise the profile of Global Surgery, Mr Mark Szymankiewicz has offered to share a blog he is writing about his experiences in Tanzania. Find a detailed account of his time at https://shimsurgicaladventures.blogspot.com/
He can also be contacted by email: shim@doctors.org.uk
Mr Szymankiewicz is a Fellow of the RCS and has recently been appointed as a Consultant Colorectal and General Surgeon at Salisbury NHS Foundation Trust.