October 2012 - Week Four - William Schecter

Jessica Beard completed her four-week rotation this past week.  She will continue to do her research projects here in Tanzania, one of which involves teaching laparoscopic skills in trainers to Tanzanian residents and faculty members.  We had a ceremony handing over laparoscopic instruments for the training program donated by MedShare, an organization which Doug Grey and I helped bring to the Bay Area.  We have a 20,000 square foot facility in San Leandro loaded with medical equipment which we ship to hospitals and clinics in the developing world as well as free clinics in the United States.  Lawrence Oresanya will begin the rotation today.  Eveline Shue will continue in the fourth week of her rotation.

Midpoint Evaluation

We had a formal meeting with the faculty and residents last Thursday.  All of the remarks were very positive.  Of course, this is a very polite society but I do think they are pleased to have UCSF residents and a faculty member here.  Everyone has been particularly kind and friendly to me and both firms (the one to which I am attached and the other one as well) continue to invite me to scrub on their difficult cases.  The Tanzanian faculty heard my concern about the integration of our residents into the call schedule.  They stated that starting this week, our residents will be on call with a Tanzanian resident and will alternated “first call”.   That means that our residents will be called first one day and if the case is an operative case, our resident will do the case, with the Tanzanian resident assisting and in general I will be supervising (especially since the Tanzanian faculty do not usually appear at night for emergency cases).  On alternate days, the Tanzanian resident will be on “first call” and our resident will assist them.  This seems like a fair solution to our concern and both the Tanzanian faculty and residents have been very gracious I think in accommodating us.  We will see how it works in practice.

Academic Program

In addition to the usual academic program outlined in previous reports, our group had three presentations this week: 1. Abdominal Tuberculosis—Jessica Beard, 2. Typhoid Fever—Surgical Complications – Eveline Shue, and Burn Care—Bill Schecter.

Recreational Activities

The days are long but there is down time on the weekends.  There is an island reachable in 20 minutes by a Dhow with a nice beach, safe swimming and small restaurant serving grilled fish which is quite good.  The spice island of Zanzibar is a 20 minute flight or a hour ferry ride.  Last weekend, Gisela and I went to Zanzibar and stayed overnight at a beach hotel.  It was very easy to arrange.  We took a fascinating guided tour of Stonetown which has extensive Arab influence.  I ran into some excellent Arabic speakers, which was a relief because my Swahili is still rudimentary at best.  Stonetown was the last active slave market which closed only in 1873.  You will learn a lot about the history of the slave trade and its abolition.  Since I have been in East Africa, I have also increased my understanding of the Middle East since I did not previously appreciate the extent and duration of the close ties between Arabia, the Levant and East Africa.

There is also a town called Bagomoyo, the previous capitol of Tanganika before the development of Dar Es Salaam.  It is 1 1/2 hours by Daladala (an overcrowded bus which is a fascinating experience but not for the faint of heart).  The cost is less than $2.00.  We stayed at a beach resort.  You see Dhows cruising off the coast, either fishing or transporting produce to and from Zanzibar to Bagomoyo.  We took another tour which was also very interesting and further increased our knowledge of the slave trade.

After you finish your rotation, it is definitely worth staying an extra week and taking a safari if you haven’t done it before.  Last year we took a one week Safari to Lake Tangire, Lake Manyara, the Ngorogoro Crater, Olduvai Gorge and the Serengeti Plain.  It is an unforgettable experience.  Gisela, who has basically finished her TB work and is now in Swahili School, will take another Safari with her brother for a week while I am working.

Dining in Dar Es Salaam:  There are reasonable Indian, Ethiopian and Thai restaurants in town.  All are a cab ride away from the Kalenga House where we are staying.  The Serena Hotel serves a good meal on an outdoor terrace.  The food is good but if you are used to San Francisco cuisine, you are not coming to Dar Es Salaam to eat!

Overall Impression

We are continuing to have a very positive experience, are seeing a lot of cases and doing a reasonable amount of surgery.

Case List

Diagnosis                                       Operation
Graves Disease                              Near total thyroidectomy       
Enterocutaneous fistula                Takedown of fistula and small bowel resection   
Goiter                                             Left Thyroid lobectomy
Cancer of esophagus                    Diagnostic rigid esophagoscopy
Anal cancer                                   EUA and biopsy
Anal cancer                                   EUA and biopsy
Gangrene of left foot                    Left below knee amputation
Soft tissue sarcoma leg                Wide local excision
Wound dehiscence                       Laparotomy and drainage of intra-abdominal abscess
Cancer of breast                         Right modified radical mastectomy