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TELEMENTORING


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. To do that, he told me, we needed the video link. No pressure then!


Pamoja Tunaweza The Swahili phrase ‘Pamoja Tunaweza’ is a very common one in Tanzania. It means ‘Together we can’. I have to admit that when we first reached the hospital, my first feeling was the somewhat less upbeat ‘Together we probably can’t’. On the way, I had called in to an Internet café in Moshi to check out what sort of service was available. The emphasis was clearly more on the ‘café’ part of its name, as the owner confirmed what I suspected: the Internet service was virtually non-existent, and there was no Skype. I was relieved that I had put a Plan B in place before we left the UK – Brenda Longstaff had spoken to the Tanzanian Telecommunication Company Limited (TTCL) who had, as promised, installed two ASDL lines for my purposes, which would – or should – enable a broadband connection to be set up over the telephone lines. When I finally located the ASDL lines,


hidden away in a disused office at the back of the hospital under a tangled jumble of cables, and eventually succeeded in connecting them through to my ‘office’ (an old theatre trolley), I thought maybe, just maybe, this unique, one-of-a-kind link could work. We would need a router of course, which we had. Unfortunately, the instructions on how to put it together were only available online, and we couldn’t get online without the router – ‘Catch 22’. Our only option was to fly the supplier of the router out immediately to set it up for us. So, indeed, ‘Together We Can’, but it perhaps wouldn’t go quite as smoothly as planned.


‘You’re doing a great job’ To condense several days of work and problem-solving and a false start into a few words, we did eventually get the connection working, even though it necessitated virtually all the bandwidth


96


A dusty road outside KCMC.


available across Moshi being directed to KCMC for the duration of the surgery. The operation was to be carried out by Dr Chilonga Kondo, a truly world-class surgeon who was absolutely committed to developing his laparoscopic skills. The first patient was anaesthetised and ready for the procedure, a young woman named Angela Joho who was in urgent need of a cholecystectomy (the removal of the gallbladder). I switched the telementoring link on to start broadcasting, held my breath, and waited… “I can see the liver being lifted up, with retraction of the gall bladder. The pictures are fine, I can see everything clearly – you’re doing a great job.” Spoken over the regular beeping of the patient monitoring equipment in the background, these were the first words exchanged between Keith Seymour, FRCS, and Dr Chilonga Kondo. Nothing remarkable perhaps in two doctors sharing experience and expertise during surgery, except that Mr Seymour was in Hexham, Northumbria, and Dr Kondo


nearly 5,000 miles away in Moshi, Tanzania. The link worked.


The return visit It turned out that this was just the beginning. We flew home jubilantly, returning the following year to improve the link. We wanted to add an audio-visual element that would enable the surgeons to see, as well as hear each other. We had two key challenges to overcome: the video link had to be both reliable enough to survive the spikes and troughs of the Internet fluctuations and high enough quality, and sufficiently long-lasting, to enable the Hexham surgeons to mentor effectively. This time the first patient was a middle-aged man called Joshua, who needed an appendicectomy. It all went like clockwork. Even now, I sometimes sit back and


marvel over the route these Internet signals were taking – this was years ago, when the Internet lacked the strength and global cover it has now. They were carried by overland cable across the East African Great Rift Valley and plains to Dar es Salaam, where they were then bounced off a satellite in geostationary orbit some 22,000 miles high down to Israel, picking up a fibre cable running the length of the Mediterranean, up the Atlantic coast of Spain and Portugal, into the English Channel and North Sea, and finally along the Thames Estuary to London for the final leg up to Northumbria.


Outside the KCMC.


Ten years down the line Ten years on from that first visit, and Dr Kondo and his two trained colleagues are now able to carry out laparoscopic surgery without the link, and have treated more than a thousand patients. They have expanded the service to run operations two days a week, and they also provide courses themselves for trainee surgeons. The link is being reinstated next year to introduce more advanced surgical training, and the plan is also to connect up to the local university for post-graduate medical education. KCMC is a growing


IFHE DIGEST 2020


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