Herbalist recalls cheerful moments during surgery

Dar es Salaam. Being a herbalist for decades now, Mr Hussien Hoza was always intrigued by what medics usually do to heal their patients, but, he desired for one more thing—to behold the surgeons at work in an operating room; with scalpels cutting through the body, diagnosing and treating a patient.

Hoza, 75, had undergone a series of surgeries in the past but, never had he got a chance to witness—by his naked eyes—the intricacies of surgery, only until last week.

Last Monday, he faced the knife on his arm while awake at the Muhimbili Orthopaedic Institute (MOI), thanks to the institute’s newly introduced technique used to control pain during surgery, known as reginal block anaesthesia.

It was now time for him to witness—in real time and on his body—as the surgery process went on.

But, it was another moment of progress for MOI as it introduced a service that, if rolled out in most other hospitals, could boost surgical care and pain management.

Only until this year, not many Tanzanians were able to access this service and it wasn’t popular. The scarcity of anaesthesiologists has contributed to its being a rare procedure in Tanzania.

With less than 30 practicing anaesthesiologists serving over 55 million people in Tanzania, the efforts to training more of these experts remain wanting.

A 10-day training by experts from the University of Latvia at MOI last week is geared at creating more experts in the field, said the MOI executive director, Dr Respicious Boniface as he announced the commencement of regional block anaesthesia services at the facility.

Mr Hoza is one among those who have undergone surgery under regional anaesthesia at MOI, setting a stage for more patients.

How it’s done

Patients with a surgical problem are operated on, by numbing the body part that requires surgery. The nerves that supply to it are blocked.

At MOI, where it was recently announced to begin, experts say it’s being carried out in a more advanced way, whereby doctors use Ultra Sound technology to target and block the nerves in real time.

“With this kind of anaesthesia, if the surgery is performed successfully in the morning, a [...] patient could go home soon after surgery and return to the hospital only for check-ups,” says Dr Albert Ulimali, an expert in anaesthesiology at MOI.

Hoza’s new experience

Hoza remained awake throughout the surgery in which doctors were removing an implant from his ailing left arm. The implant had been placed during previous surgeries to treat his arm.

“I could see… [the surgeon] cut through my arm, push the bones and rearrange everything…later I left the operation room as if nothing had happened to me.”

“I was waving at the doctors with my right hand. I think I was excited as I came out of the operating room,” recalled Hoza as he went on to narrate his past ordeal.

“For the past three years,” he says, “I have had trouble with my arm and doctors had to operate on me twice, but I was always unconscious during each surgery,’’ says Mr Hoza, a resident of Tanga Region.

“I desired to know what happens during surgery. Contrary to what I was already used to…this time around, when I arrived at the hospital, my doctor assigned me to experts from abroad who told me that I would go through a whole new surgical experience,” says Hoza.

“It’s now three days since I underwent the surgery and I can lift up my arm, something that I haven’t been able to do in a very long time,” he said, as he sat on his hospital bed, flexed his arm and took a breath to narrate his tribulations to Your Health.

His story of illness dates as far back as three years ago, when he sustained injuries in an accident and another incident last year when he was attacked by a donkey on the streets in Tanga town.

“Many years ago, a load of 15 tons fell on me and broke some of my ribs and collar bones,” he began narrating.

“Since then, my fingers on the left hand lost function. I stayed for a very long time without being able to hold things,’’ he says.

“But things did not just end there, last year, as I walked on the street on my way from the mosque, I was attacked by a donkey.”

“The donkey knocked me and I fell on the ground…and it started biting me all over my body. I was only rescued by a Masai man who showed up and struck the donkey’s nose and that is when the donkey finally let go.”

“I left the scene with my wrist on the left arm…I could not lift my arm anymore.”

Hoza was then referred from Tanga to Muhimbili National Hospital (MNH) where he been receiving since then. Thanks to the growing investment in anaesthesia services in Tanzania, he has been able to undergo a better surgical experience but countrywide efforts to improve anaesthesiology are still needed.

Reports show that most anaesthesia and intensive care is carried out by nurses, or by partially trained Anaesthetic Officers in Tanzania.

Details obtained from the Muhimbili-Karolinska Anaesthesia & Intensive Care Collaboration show that the knowledge and skills of these staff were largely gained during their initial vocational training.

A lack of in-service training and educational material results in knowledge that is old and out-of-date, says their report titled: Anaesthesia & Intensive Care in Tanzania, published on http://www.mkaic.org.

Working alone, without supervision and incentives, the anaesthesia practitioners are poorly motivated, it says.

Neglect from policy makers and a lack of research capacity means anaesthesia and intensive care is absent from the national health agenda.

Furthermore, old and poorly functional or even absent equipment as well as a limited selection of drugs contribute to the critical state of anaesthesia and intensive care in Tanzania.