Professor Kokila Lakhoo, along with colleagues from the Oxford University Global Surgery Group, is developing paediatric surgery through a link in Tanzania. In this blog post, Professor Lakhoo reports on their latest trip, which was part of a continuous ongoing strengthening of ties between the Oxford team and Muhimbili National Hospital in Tanzania.
This is year 18 of my association with Tanzania, 10 years with Kilimanjaro Christian Medical Centre (KCMC) and eight years with Muhimbili National Hospital (MNH). They now have five active paediatric surgeons in the institution, two dedicated children’s theatres and a fully fledged department with two trainees and two house officers, all through this collaboration.
I arrived and settled into the university accommodation next to the hospital for easy access. I met with the host team and agreed on the programme. There was a briefing meeting for the Oxford team regarding the programme, activities and code of conduct.
In the morning I met with the hospital director regarding paediatric surgery services and received full support for the team. Lack of anaesthetist raised last year was addressed. A regional meeting with district general surgeons on children’s surgery was discussed and is planned for later in the year, to be run by the local team.
I met with the Head of Muhimbili University (MUHAS) to approve the MSc programme for paediatric surgery, which is to start in October 2020. The programme was discussed and trainers from local and regional countries were selected. Two students were selected and an application made to the College of Surgeons of East, Central and Southern Africa (COSECSA) to run the Master of Medicine (MMed) and COSECSA training fellowship concurrently. The plan is to increase numbers by two on a yearly basis.
Later on, I met with the Head of Research Dr Faraja Chiwanga and Hugh Greenwood/Oxford funded Researcher Dr Godfrey Sama to discuss three research protocols and confirm ethics status which was achieved in November 2019. Data protection was discussed and data ownership to remain with Tanzania was confirmed. Dr Chiwanga is a very active and supportive head for clinical and collaborative research.
Due to the positive history with Oxford Paediatric Surgery team there were no concerns raised regarding research conduct.
In the afternoon, there was a visit to a district general hospital (Amana Hospital) to develop children's ambulatory care with outreach support from Muhimbili paediatric surgery.
In the morning there was a research training workshop by the Oxford team and local faculty to surgical trainees on clinical research and research on the job. It was an excellent workshop with positive feedback. A suggestion was for extension to one day and my thoughts are to keep it as half day for ease for working surgeons to attend. View the programme.
Later on in the day, a Tumour Meeting was held and 12 cases were discussed, in which three were prioritised for surgery the next day.
Clinical cases review for surgery and advice on management. 15 patients were reviewed and a management plan put in place. Eight major cases were planned for two theatres the next day.
The whole day was spent in theatre supervising colleagues. A parallel training session took place for nurses and recovery staff plus anaesthetic clinical officers, run by the medical officer and surgical trainees.
A stackholders meeting with ministry, university, hospital management, clinical staff, district general hospital teams and nursing leadership was held on the future of paediatric surgery for Tanzania and to address the huge gaps. Full support was received by all the stakeholders with starting point in developing ambulatory paediatric surgery in district general hospitals and develop paediatric surgery services at the tertiary hospital in Mwanza (Western Tanzania) once Dr Aicia who is in training in Uganda has qualified as a paediatric surgeon in October through the COSECSA system. View the programme.
I spent the morning supervising colleagues with operations. In the afternoon I met with the global medical student body (INCISION) and the trainees, and discussed research work with funded researcher Dr Godfrey Sama.
Dr Roba Khundkar spent the week with plastic surgeons in training, teaching and supervising projects.
Dr Fungai Dengu ran the research workshop, supervised research projects on MMed and spent two days with the adult hepatobiliary team to work on shared care for older children. Medical student and speciality registrar training. Read Fungai's report
Josephine Powell spent the week on the neonatal unit running small group teaching sessions on high flow ventilation, neonatal resuscitation, neonatal transport and care for the premature babies. She also supervised care for surgical babies and developed generic protocols. Read Josephine's report
Dr Riana Patel and Dr Evie Thangaraj assisted Dr Sama with the research protocols and shadowed their counterparts for the week. Read Evie's report. Read Riana's report.
Harry Jackson-Smith joined the medical students and discussed different training methods from multiple medical schools and par took in a global, teaching session, journal club, case discussions, consultant teaching and examinations methodology using a well known electronic platform used by the local INCISION group. Read Harry's report
Muhimbili Paediatric Surgery has made great progress in service delivery. They now have a MSc approved for training in paediatric surgery in Muhimbili and have made an application for recognition for COSECSA training. The research profile is also on track with three approved studies by the ethical committee and they have several quality improvement projects done locally by junior staff.