September 2023: Slingeland Mission in a New Style

With Erik and Jiska's permanent residence in Tanzania, the content of the Slingeland broadcasts has changed. Instead of operating as much as possible alongside Erik in two weeks, we now aim to provide as much continuity as possible during Erik and Jiska's absences. This includes not only healthcare but also education and support for the construction of the new operating complex. Since Erik performs surgeries throughout the year, the pressure in terms of patient demand is slightly less, allowing more space for other tasks. In September, Paco Heijmans, an anesthesiologist, and myself, Susan Lemson, a surgeon, spent two weeks on site. It was a bit challenging without our familiar interpreters, but we received assistance from tropical doctors Malouk, appointed through the Slingeland Hospital, and Koen, supported by the Friends of Sengerema Hospital foundation. They have become well-acquainted with the hospital and the language. With the help of downloaded Google Translate on our phones, we managed quite well.

Malouk had gathered a series of patients who wanted to get rid of their stomas or thyroid glands. There was also a patient with a severe skin condition, unable to open his mouth properly due to the overgrowth of a type of warts. Surgery on this case posed a risk, so it was postponed until Paco arrived and devised a plan to keep the airway clear while Malouk and I removed the tumors. Stoma patients were treated in the first week so that if complications arose, we could address them ourselves. Fortunately, that wasn't necessary; all patients recovered well and were very happy with their regained freedom. There were two children this time, a 1.5-year-old girl who went home in a beautiful dress after the surgery, and Brighton. We had narrowly saved him from a severe abdominal inflammation due to typhoid fever last year. I hardly recognized him; he radiated joy after the surgery, always running around when we came for visits. Playing outside. Wonderful.

Regarding the new construction, there were some technical questions that required a visit to the construction site. Paco and I were proudly guided through the operating complex, of which the second floor was already taking shape. I presented the construction questions to Manjit, and we took photos of the technical specifications of the generators. This information would allow further planning in the Netherlands.

In the second week, Tanzanian colleagues gradually joined in more frequently during procedures. The delay in their involvement from day 1 was partly due to their other responsibilities in patient care, and they preferred to observe initially. Therefore, we agreed with Malouk that a schedule would be created for the next time so that we could provide as much training as possible during our presence.

Paco provided education on ultrasound-guided pain block for surgeries. Tanzanian and Dutch colleagues were very interested and practiced on each other in visualizing nerves with ultrasound. Subsequently, Paco assisted Steven in placing a block for an arm operation on a patient. Such a block is not only preferable due to fewer risks than anesthesia, but it also provides excellent pain relief for the first hours after surgery. Our last evening was disrupted by a severe bleeding incident with a postpartum woman who had been brought in by taxi in a critical condition. We were called to assist, but everything that could be done had already been done. A breathing tube had been inserted, the gynecologist had stemmed the bleeding with a fist in the uterus, and the resident doctors were setting up infusions. Sister Marie José was shuttling back and forth to the blood bank. Once the operating room was available, the patient was efficiently transported down the hall, and the bleeding uterus was removed in an unbelievably short time.

Paco, reflecting on the evening, expressed warmth for the effective collaboration during the crisis. Despite the sobering outcome, we left with ample reflections, future plans, and a shopping list for necessities after two impactful weeks.