TELEMENTORING
from here to Kilimanjaro, like the one we have from here to Newcastle.” I pointed out that, unlike Newcastle, Kilimanjaro was about 5,000 miles away, and that in all probability had no telecommunications infrastructure, or at best an extremely problematic one. “Yes, that’s why we need you,” they said in unison.
Could it be done?
My first response was that it couldn’t be done. It just couldn’t. A satellite service was hugely expensive, much more than the charity could possibly afford. Even half a dozen ISDN lines would cost too much. But even as I spoke an idea began to form in my mind… could we use the Internet? Foolishly, I thought out loud, and almost before the words – really no more than a vague notion – were out of my mouth, Liam smiled broadly and said, “If you say so, great. Glad to have you on board.” Me and my big mouth. A few days later, I received an email from Brenda Longstaff, project manager at Hexham General Hospital, who had arranged my trip to Tanzania with that breathtaking efficiency that, as I came to learn, defined everything she did. Without me expecting it, looking for it, or even really welcoming it at first, the chance of a lifetime had come my way. Next stop – Mount Kilimanjaro.
Laparoscopic surgery The specific reason behind the transcontinental telecommunications link, or just ‘the link’ as we called it, was to train the surgeons at KCMC to carry out laparoscopic procedures themselves, a sea change in the system that was then underway at the hospital, where surgeons from the UK and other ‘first world’ countries visited for a couple of weeks to do as many surgeries as possible before returning home. The work they did was brilliant, but it was a sticking plaster on the wound. The hospital was already carrying out open procedures for the medical conditions we were targeting, and had all the facilities they needed in
Setting up the link between hospitals nearly 5,000 miles apart.
place, however crude they were compared with the resources of our own brilliant NHS. However, laparoscopic or minimally invasive surgery could improve things dramatically: following such surgery, the patients are returned home the same day, meaning less bed days, medication, and the associated costs of doctors’ rounds and food etc. The benefits extended far beyond hospital budgets. In Tanzania, being able to return home earlier meant that a sick person would be better able to afford to give up the time needed to be treated; due to the long stay in hospital required after open surgery, treatment was often avoided or put off until the last minute, frequently making the case more acute. For the men of the family, the main concern was often who would look after the smallholding of crops, the animals, or earn money, and for the mothers, who would look after the house, feed the family, and care for the children. For standard open procedures, which often meant up to a three-week stay in hospital, family members would also have to be nearby to provide food and to do
the laundry because these services were in acutely short supply.
Pain management
Another aspect was pain management. Medicines were expensive – that is if they were available at all – and open surgery needed more pain management and for a longer period of time. The cosmetic benefit of being left with only three small scars was of little concern to the majority of Tanzanians – a ‘nice-to-have’, but being scarred was part of life, and vanity was a luxury ill-afforded. However, the smaller the incision, the easier it is to avoid secondary infection – with open surgery, this life-threatening risk occurs in 50% of cases.
Liam Horgan was convinced of the benefits of laparoscopic surgery for the Tanzanian people. If we could make laparoscopic surgery part of the Tanzanian healthcare service for good, carried out by local surgeons rather than visiting volunteers, we could improve surgery and outcomes for the 15 million people served by KCMC, and perhaps even more if the initiative took hold.
Clinicians viewing the video connection.
Laparoscopic surgery under way. January 2019 Health Estate Journal 55
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