Monday, September 24, 2018

Fears, hopes in the operating room

Medics at Nyakahanga Hospital go through a file

Medics at Nyakahanga Hospital go through a file in which they document issues related to Safe Surgery 2020 as part of the project to improve surgical care at the facility PHOTO | SYRIACUS BUGUZI 

By Syriacus Buguzi @buguzi sbuguzi@tz.nationmedia.com

For many years, Odetha Deus,27, believed that undergoing a surgical operation, bordered on meeting your death. But today, she bears testimony to another reality.

“Most people in our village don’t believe a person can recover from an operation…I have grown up hearing people say this...,’’ says Odetha, a resident of Nyarugando village, Karagwe District in Kagera Region.

Odeta spoke to Your Health recently, as she sat at the bedside of her newborn twins—Rayvann and Aggrey, at Nyakahnga District Designated Hospital in Karagwe—the district’s main hospital for over the past 100 years.

Odetha had just undergone a C-section because her twin pregnancy was at risk of complications. But, it was her first time in life to go under the knife.

To her, being wheeled into the operating room and coming out alive, is something she never believed could happen.

“I trembled when the doctor told me I was going to be operated on,” she says.

“But, before the operation, a nurse came to me, introduced herself and said it was not going to hurt. She explained to me in a clear and simple language…I didn’t expect this kindness…I have always heard from people that nurses speak bad language….’’ “I calmed down…,” she says.

In Tanzania’s Lake Zone regions of Kagera and Mara, nurses, doctors and anesthetists are being trained on how to carry out surgical operations in a way that doesn’t hurt or kill their patients. It’s called safe surgery.

The training, under the Safe Surgery 2020 project, is in line with the National Surgical, Obstetric and Anaesthesia Plan (NSOAP), launched by the government and stakeholders early this year.

Mr Langton Kishebuka, is an anaesthetist who has undergone the Safe Surgery training at Nyakahanga Hospital. As the anaesthetist, he is usually a little-remembered member of the surgical team, as most patients tend to remember the surgeon.

However, what the anaesthetist does during an operation has huge implications on patients’ safety-during and after the procedure.

The World Health Organization (WHO), in its report: Safe Surgery, says that mortality from general anesthesia is as high as 1 in 150 in some parts of Sub-Saharan Africa.

Mr Kishebuka says, “There is a lot that transpires in surgery, from decision time to knife time but there are small things that matter…ignoring them could cause harm or even death to the patient.”

“The drugs that we use to make patients not to feel the pain during the operation, are very powerful and any one of them could kill a patient if used in a wrong dose,’’ he explains.

Small things that matter

Mr Kishebuka says, “There is one simple, costless thing that if done, it could be more satisfying to patients than anything else...Such as, just introducing yourself to the patient...

“…and my job here is to make you not feel the pain, I will make you go to sleep, you are safe and in case you feel there is anything unusual, don’t hesitate to tell me...,” he recites what he usually says to calm down anxious patients.

“Each time we say these words to the patients, they tend to relax…when this is done, a patient feels respected and this reduces anxiety…”

“Besides, patients are usually very curious. There are questions that they usually ask about the procedure, that’s a moment to explain to them and calm them down…

“Before being trained on safe surgery, we could simply drag the patient to theatre, do the operation and that’s all…then, the patient could be left wandering, with too many questions…,” says Kishebuka.

The Checklist, the embarrassment

“There is what we call a Surgical Safety Checklist. Failing to observe it may cause embarrassment to the surgical team and harm the patient.”

“Staff who have worked for a long time, tend to think that they have the experience, so they ignore observing the checklist...

“It may appear a simple thing, counting all surgical equipment before the operation and after, but we know cases where no counting was done and the surgical team forgot a piece of gauze in a patient’s body,” he recalls.

To counter this problem, the WHO adopted the 19-item Checklist over 5 years ago to help surgeons and anaesthetists avoid making preventable errors, such as operating on a wrong patient or taking out the wrong kidney.

Do doctors adhere to it?

A surgeon at Buganda Medical Centre (BMC), Dr Geofery Giiti, who has been mentoring Lake Zone medics on Safe Surgery says, “There is a tendency of medical staff to ignore the safety checklist.”

“What we are doing now is to remind them through a series of training.

“We do it gradually. As you may know, some of our trainees are people who have been practicing for many years. It’s not easy to tune their mind at this stage,’’ he tells Your Health.

Through the Safe Surgery 2020 training, funded by GE Foundation—a philanthropic organization, surgical teams at hospitals in the Lake Zone are being empowered to stick to the Checklist.

Surgical teams are being trained to adhere to safety standards, such that a nurse could refuse to allow patients to leave the operating room until the checklist is completed.

Is it just about the checklist? No.

A theatre nurse at Nyakahanga Hospital, Ms Gladys Boas, says, “Before we were exposed to this training, it was business as usual, no documentation, no thorough preparations…the surgeon would simply call us for the Caesarian section operation. We would go and take the baby out. Period..,’’ she says.

“… we couldn’t even tell later on if there was any surgical site infection or not to the patient whom we operated on. These days, we document fully, and we follow up the patients even weeks later to find out if they developed any complications,’’ she says.

“Initially, we used to think this is someone else’s job…,’’ she says during an interview with Your Health at the hospital.

Spreading knowledge among staff

At Nyakahanga Hospital, medical staff from all departments have been exposed to knowledge on safe surgery and how they can work as a team to ensure that patients who undergo surgery remain safe, during and after the operation.

Dr Furaha Kahindo, the Chief Clinician and Gynecologist, says, “It makes a lot of sense when every staff gets involved with the patient. That all departments—from surgery to internal medicine and the nurses are all aware of what has been done to the patient.”

Strategies to increase participation in safety checks need to target professional communication practices and work processes such as workflow which curtail team members’ ability to participate, says a 2016 study in the BMC Journal.

Titled: Factors that drive team participation in surgical safety checks, the study suggests that team participation in safety checks depends on team attributes, communication strategies and checking processes.

Dr Kahindo says building team work spirit has been the cornerstone of the trainings under Safe Surgery 2020 and the aim is to improve leadership skills and help doctors do away with being conservative.

‘We are striving to change many things now, for the wellbeing of our patients.

“For example, in the past, we used to carry out C-section by making a longitudinal incision on the abdomen….from top to below the umbilicus…but during the safe surgery training, we learned that this approach has problems...

“…we have now adopted what we call the Joel Kohen incision. It’s a transverse cut which is good for women, cosmetically and its wound heals faster,” says Dr Kahindo.

Studies have shown that the Joel-Cohen incision has lower rates of fever, hospital stay, post-operative pain and blood loss. The operating time and use of analgesia is also less.

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