There is a shortage of trained surgeons in Tanzania, it is estimated that 70% of all operations in the country are performed by people who are not doctors. Some of them may be quite good, but complex surgery is difficult, and post- operative care can be complicated by lack of knowledge as well as resources. On this trip we saw many patients referred for post-operative complications from recent surgery performed at other facilities . Patients at MUHAS/MNH typically present late in the course of their disease which creates unique challenges for visiting Alliance surgeons and our Tanzanian colleagues

In addition to our work on the Wards, in the ICU and the Operating Rooms, the Alliance Team gave a number of Courses for surgeons. At the request of the Obstetrics and Gynecology Department, Dr. Schecter gave a two day course in Surgical Intensive Care to OB-GYN residents. A second two-day course on “Vascular Surgery for the General Surgeons” was well received. The course was designed to familiarize General Surgeons at MUHAS/MNH with the basic principles of Vascular Surgery.

The Department leadership had also requested a course on Surgical Skills for the MUHAS Residents in training. Dr. Ed Kim and Ms. Wendy Fong, from the UCSF Surgical Skills Laboratory helped us put together 20 training kits for delivery as a donation to MUHAS Surgery Residents. The kits have surgical instruments, sutures, and tools for use in practicing surgical skills related to knot tying, suturing and performing anastomoses. Many of the instruments and some of the supplies were provided by MedShare, an Atlanta based nonprofit with a warehouse in San Leandro. Critical to our trip were boxes of sutures (many post expiration – ideal for training), as well as stainless steel instruments that are perfect for training purposes. The boxes were stored in a fabricated storage crate with wheels that could also transport the kits to Tanzania.

We had two initial sessions for the residents and young attending surgeons from MUHAS, (Training the Trainers) but once the Residents attended one of these classes, they wanted to schedule four more classes. The two hour classes could last as long as four hours with no one wanting to leave!!!.

Dr. Barak Levit training Tanzanian Surgical Residents in Basic Surgical Skills

Prior to the Course in Vascular Surgery, we were asked to evaluate a 13 year old boy with a large ulcerated mass on his right lower leg. An above knee amputation had been planned with a working diagnosis of malignancy. We encouraged a CT angiogram which fortunately demonstrated a pseudoaneurysm of the anterior tibial artery. We were able to evacuate the large amount of blood clot (which masqueraded as a tumor) and ligated the base of the aneurysm. The subsequent wound benefited from the experience of our Plastic Surgery colleague, Dr. Moti Levy. He fabricated a wound-closure device with zip lock ties, based on a wound closure system in use in Israel. The wound was already showing signs of improvement when we left Tanzania.

Drs. Schecter, Swallow and Grey with the patient and his mother following surgery for a pseudoaneurysm

During the last few days of our visit, we visited the Catholic University of Health and Allied Sciences (CUHAS) at the Bugando Medical Center in Mwanza on the shores of Lake Victoria . One of the previous Alliance trainees at MUHAS, Dr. Gideon, invited us to give a two -day course on Surgical Critical Care. The course was well received and we plan to visit Mwanza next year and provide additional courses, including the Basic Surgical Skills Course which was so successful at MUHAS.