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Gallery
Tanzania Bermuda Mission 2008
Dar es Salaam, Tanzania Project Change: Mission 208
Monday, November 24,2008
Today was a short day due to several patient being too sick for surgery. We did perform 3 surgeries: a cleft lip repair in a 12 year old girl, release and reconstruction of a burn contracture of the armpit of a 6 year old girl, and flap in the back of the throat of a 23 year old woman who had previously undergone cleft palate repair. She wanted to improve her speech though the likelihood of major perceptible improvement is low in this last patient. It turns out that this patient is the maid for a prominent black family in Dar. This family went to great lengths to make sure that their maid received a first class education. She is bright and afable and desperately wants to be better understood. We decided to give her a chance. We will give an update on her progress.
We finished at 2 pm and Dr. Tuzo arranged for us to meet with the head of Oral Maxillo Facial Surgery at Muhimbili University Dental School. We also had the pleasure of meeting with the Dean of the Dental School. Dr. Tuzo has been taking supplies to the Dental School for many years. Several Dentists in Bermuda have donated to this school. The Dental School of Tanzania boast 150 students. The reason why they need supplies is obvious. The Dean informed us that he had received his budjet for this academic year (albeit 6 months late): 1,000,000 Tanzanian Shillings = $1,000 US Dollars. This is hardly enough to but anything. Teaching young dentist hands on in this setting in nearly impossible. Most of their equipment is run down and in need of repair or replacement. Despite these challenges, these doctors perserve in their quest to educate Dentist for this country that is in such need.
The Maxillo Facial Surgeons took on ward rounds. The ward was filled with the most extreme examples of tumours and conditions of the face. Again, with limited equipment and supplies their ability to care of these patients is challenging at best. We made a commitment to return next year for a week of surgery somehwere between November 10th and Nov 21, 2009.
Tanzania was listed as the 160th of possible 175 countries in the UN's most poor nations. Though rich in natural resources, Tanzania has struggled to pull itself out of post-colonial poverty. At one point, under the reign of Nyere, it was one of the most educated countries in African with a literacy rate of over 90%. Now the illiteracy rate is estimated to be around 25%. Bermuda is at the top of the UN table, yet we complain about our medical system. Spending only one day at the major hospital in Dar has given me pause the next time I think about complaining about home.
Mikumi, Tanzania Project Change: Mission 2008
Sunday, November 23, 2008
No surgeries this weekend. I took the opportunity to come to the centre of Tanzania to visit one its National Parks, Mikumi. This beautiful wildlife refuge is nestled beneath Mount Ndongwa and the chain that extends up to Kilimanjaro. My guides were Saidi and Samwel. I saw numerous gazelles, hippos, giraffes, impalas, warthogs, wildebeasts, etc. The park is vast and a dry at this time of the year.
The great part of this adventure was not so much the animals but the stories that are told about the animals and how to avoid being injured. Saidi comes from the south of Tanzania and belongs to a tribe related to the Zulus. He gave me the basics of what to do if we have problems with various animals. He referred to the "big five": elephants, lions, buffalo, hippos, and rhinos. They are the top five killers of tourists.
I will summarise what I learned:
1. Elephants: by far are the most dangerous and likely to kill. Elephants are very near sighted and cannot see well. Their trunk, however, give them the keen ability to detect your smell. You must position yourself upwind and stand very still. The elephant will even pick up sand with its trunk and drop it to detect the direction of the wind. It will then charge in the direction of a scent. If you are upwind and very still, you will be safe.
2. Buffalo: These animals are aggressive but only when provoked. Most people have been killed have been hunting them. The best thing to do is to try to climb a tree but the buffalo will stay for sometimes days at the base. Have your cell phone handy to call for help.
3. Rhinos: Rhinos have very good vision but when they charge their head goes down to the ground and they kick up a great deal of dust. Thus, if you are being charged you should stand in front of a large tree. When the rhino is two feet from you, you move away quickly. His tusk will become embedded in the tree and allow you to escape.
4. Hippos: Hippos, despite their large girth can run fast and for at least 15 miles. Unless you are a long distance marathon racer, you will be caught on the flat. Because of their short legs, however, hippos cannot climb over anything and they are especially handicapped if the terrain is hilly and up and down. You must find this kind of terrain or step up on something reasonably high to avoid this ferrocious animal.
5. Lions: Lion attacks, are uniformly fatal. The best defense is to be aware of your surroundings. Picnicing near bush is not a good idea. If you are confronted by a lion, you must stand still and look him straight in the eye. This will usually keep them from charging. If you run, you will be attacked. Standing your ground is the best defense.
So many of these priniciples apply to everyday life.
Dar es Salaam, Tanzania Project Change: Bermda Mission 2008
Friday, November 21, 2008
Today was a short day as we prepare to relax over the weekend. We are in need of a chance to catch our breath and retool for next week. We performed 3 surgeries today: we separted webbed fingers on a 1 year old, repaired a cleft clip on a 2 year old, and removed a tongue tumour from a 4 year old girl with a disease called xeroderma pigmentosum. The children did well and again the joy that the parents express is worth more than gold.
I discovered this week that very few people know their date of birth. In this part of Africa birthdays are not celebrated. I noticed that all of the charts show birthdays of January 1 with the suspected year of birth. Most children are delivered at home by midwives. They do not report the birth to any government agency and the family remembers usually the year and the place and fullness of the moon on the date. If you ask an adult how old they are they will guess and hope that you accept what they say. Sometimes the answer is "I am just old - does it matter." It probably does not matter much.
I am hosted in Tanzania by Dr. Deobrah Tuzo and her organisaton AHEAD (Adventures in Health, Education, and Agricultural Development, Inc.). Ahead does so many things to improve health in Tanzania, they provide seondary scholarships for orphans and other vulnerable childrens, vocational programs: computers, electrical wiring, electronics, carpentr, horticulture, and tailoring; Health Outreach, and water purification. It is an extraordinary non-governmental organisation and Dr. Tuzo sits on its Board of Directors. Dr Tuzo is an orthodontist in Bermuda who also holds a Masters in Public Health. She has putting this degree in great use with Ahead for several years in rural Tanzania. Tuzo means gift in Swahili. She is known as Mama Zawadi (gift from God) by the scores of Tanzanian youths who consider her their adopted mother. Ahead was founded is masterminded by Dr. Irving Williams and Dr. Elvira Williams who are Americans who have worked in Tanzania for over 20 years. These two individuals struggle tirelessly to make a difference for the people of Tanzania, where they are held in high esteem.
Dar es Salaam, Tanzania Project Change: Bermuda Mission 2008
Friday, 21 November 2008
Yesterday was an extremely difficult day. We performed 2 beautiful cleft lip repairs on small children (4 month olds). One of the children's mothers had been operated earlier in the week for the same problem. She elected to go first so that she could care for her child and know what he would be going through. I have a photo of both mother and child together with their lips repaired. Will send later.
We are receiving the VIP treatment from the staff here. There are simply no words to describe how warm the workers are to us. What is clear is that these people understand how important this work is. They understand the part that they play. They simply love their people. On a shoestring, they give remarkable medical service and I am humbled by their dedication. Their dedication crosses the normal boundaries of tribalism, religion, and socioeconomic status.
The Father of the nation, Nyere, came from an extremely small tribe. When he was able to bring independence from the British to Tanzania, he preached against allegiance to tribes: a problem that devastated Kenya after their elections last December. He promoted Swahili as the first language of Tanzania because he felt that to use English rather than an African language for the country showed a lack a pride. All primary education is in Swahili and then English is mandatory at the secondary level. Add to this that everyone also speaks their tribal language. Imagine, despite the poverty, disease, malnutrition, most people here speak at least 3 languages (English, Swahili, and their tribal language). Why is it that in Bermuda and the US, with the privileges that we enjoy, most people do not learn other languages?
Dar Es Salaam, Tanzania Project Change: Bermuda Mission
November 19, 2008
Today was exceptionally warm. Torrential rain knocked out the power in the city and hospital, rendering our air conditioner in the operating room unserviceable. Nevertheless, we performed 4 surgeries, primarily on burn victims. The first patient, however, was a beautiful 4 year old who was born with a tumour of her buttocks. This was quite large and created a sizable hump, visable through her clothes. She came to the OR immaculately dressed. Unlike children that we take to the OR in Bermuda or the US, she was excited about getting rid of this tumour. She leaped on the OR table and willing held the oxygen that was eventually changed to inhaled anaesthetic. She drifted into unconsciousness with a large smile on her face. It took two hours to remove the tumour which went down to her coccyx and spinal cord. The next three children had all been burned in house fires as infants. Two require release of hand burns and one young man had a release of a neck burn which did not allow his head to extend. His mother insisted that we videotape the whole surgery because she was so proud that he was being operated by an American surgeon.
Tanzania has a population of 35 million people. They are an extremely tolerant society, which muslims living side by side with Christians, and anamists. The government has been stable for quite some time, though there is much corruption. There are over 300,000 refugees from Burundi living in Tanzania, a continued humanitarian crisis associated with the same dynamic that is going on the Democratic Republic of the Congo presently. I will be going to this region next week to help with the refugees that are fleeing from the Congo in Burundi. We are hoping the the UN or the US will step in and decrease the likelihood of another Rwanda massacre.
Dar es Salaam, Tanzania Project Change Bermuda Mission
November 18, 2008
Dr. Tuzo and I departed Bermuda on Thursday, Nov 13th. After landing in Gatwick, we trekked across London to Heathrow, with 5 crates of supplies in tow. We landed in England at 6 am and my flight departed for Nairogi at 10 AM. I made it just in time but 3 of the crates failed to arrive with me. Rather than continue on to Tanzania, I stopped in Kenya and waited for the flight the next night so that I could accompany the supplies. Tanzania is ablaze with excitement about its native Barrack Obama. Everyone is reading his books. They had a holiday on the Thursday after the election and everyone was given the day off to celebrate.
I arrived in Tanzania late Sunday night. We were taken to our lodgings which are clean but spartan. A swimming pool filled with swamp water and mosquitos looms ominously in the yard of our hostel. Tanzania is humid and hot and moving the supplies proved to be extremely exhausting. We arrived at our host hospital CCBRT Comprehensive Communinity Based Rehabilitation in Tanzania at 8 AM on the Monday morning. I assumed that I would be given a chance to unpack and settling in, however this was not the case. Three operations had been scheduled for me and I was wisked immediately to the Operating Room. I performed 2 cleft lips and a cleft palate repair / photos to follow. No lunch. No fluids. No air conditioning. The parents were grateful and pleased with the outcome. The people are extraordinarily kind and courteous here. A local man told me that it is Tanzanian tradition never to hold a grudge. He said that you could spit in a someones face one day and they would smile and greet you the neck. They just do not hold on to bad feelings.
Today was quite challenging. I performed a cleft lip repair on a tiny 4 month old. The defect was wide and the lips were extremely small. We were able to achieve an excellent result. Next I was given a patient who had defects that I had never seen before clefting of the upper and lower lips. An ear was missing on the right side but the parents absolutely adore this child. We were able to achieve an excellent repair and the parents were ecstatic to receive the child. Dr. Deborah Tuzo, a Bermudian Orthodontic Dentist, assisted me today and she showed that she has gifted hands. In fact, her organisation Ahead, has organised this entire trip. We work will local anaesthetists, nurses, and orderlies. This is our second year. The local team greeted us warmly and remembered so many little things about us from the previous year. For example, I loved a hit Tanzanian song last year called Mapenzi yako wapi Mama. Which means Where is your love, woman. One of the orderlies immediately started to sing this upon seeing me. It is refreshing to be greeted with a smile and have everything set up for me in this so called third world country.
Project Change Bermuda
C/O Dr. Christopher L. Johnson, MD, MSc.
International Plastic Surgery Associates
Sea Venture Building,
19 Parliament Street,
Hamilton, HM 02 Tel: 292-2000
info@internationalplasticsurgery.org
If you would like to sponsor our efforts, you can make a donation to:
Project Change Bermuda
Bank of Butterfield
Reid Street, Bermuda
Swift Code: BNTBBMHM
Intermediary: Chase Manhattan
CHASUS33
Account Number: 20006060422625100
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