2014 – 2nd week in Goma DRC

A very busy week for the AusHEAL team started when the remainder of the team arrived safely last Monday afternoon and had an uneventful border crossing.

MONDAY for ‘Dr Neil’ (Wetzig) and ‘Dr Paul’ (Millican) as we are known at HEAL Africa, involved seeing more patients to triage for theatre. Then a high level meeting with Senior Staff and David Kelly to commence a Clinical Services Plan for the hospital. Now that Goma seems to be entering a time of peace it is important to try and plan for the future. Meanwhile Gwen Wetzig and Heather Kelly visited an IDP (refugee) camp to interview and film for future advocacy. Sadly they had to leave in a hurry after some violence broke out which just shows that we always have to be on our guard here as the security situation can change quickly. The Monday morning doctors meeting also outlined how sexual violence is still a major issue in this area of DRC. A 15 year old girl had presented with sepsis. She had been raped and become pregnant. She had then sought a ‘backyard abortion’. She had been given 16 unknown tablets and some form of instrumentation to her uterus and presented with sepsis and bleeding. She was one of four similar cases admitted over the weekend!

TUESDAY the main team had a rest day to recover from the long trip from Australia. Neil, Peter Tralaggan (Anaesthetist) and Paul commenced operating.

WEDNESDAY  Neil performed a major oesophageal bypass using colon on a 12 year old girl who had inadvertently swallowed caustic soda on Christmas day 2013. Bottles are not labelled here and she thought it was water! The surgery went well but took 8 and a half hours, complicated only by what we subsequently discovered was a faulty anaesthetic machine detected half way through the procedure by Peter T and aided by the new monitor AusHEAL had purchased for theatre – so this has already paid for itself by a potential life saved. This young girl Stephanie is so far doing very well 4 days post op.

Wednesday afternoon  Darryl Burstow (Cardiologist) presented a great teaching session on Cardiac arrhythmias. This is the first time the AusHEAL team has included a Physician so Darryl has been warmly welcomed and he is a great encouragement to Dr Albin, the HA Physician, who usually has no colleagues to discuss cases with.

THURSDAY more surgeries by Neil and Paul – Goitres, Cleft palates, Cleft lips, a Hernia and even a varicose vein case. All good teaching for the HA Staff. Graham Zerk has found the staff in the Emergency Department so keen to learn. Damon Bruce (ICU Nurse) was thrilled to find that the staff he worked with last year in ICU have continued many of the processes of patient management that he taught them last year. Anna Murray (Theatre Nurse) taught the staff in the OT to perform a ‘count’ of instruments and swabs before and after the surgical cases. They have never done this before and yet it is such standard practice in our culture so that nothing is retained within the patient.

FRIDAY was spent with further surgeries including 2 emergencies, one of which was a bowel perforation due to a worm. This case had been misdiagnosed and mismanaged at a previous hospital and delayed by the ‘traditional medicine’ people, but it highlighted the improved care of HAH due to the work we have been doing over the past 10 years. The day concluded with a Morbidity and Mortality meeting when the doctors discussed a difficult case where a patient had recently died in the hospital. This meeting is again something which is the norm in our culture but not conducted in many African hospitals so we were thrilled the way that the staff engaged in this activity. In this particular case there was some mis-management but it mostly occurred before the patient was transferred to HAH but it was still a good teaching experience.

SATURDAY is a slower day at HAH but another difficult case was admitted overnight. The morning doctors meeting gave us the ‘heads up’. The woman had a large goitre but her main issues were medical so Darryl B was able to contribute. Later in the day we found that the woman had not been given the medications Darryl had ordered because her family could not afford them, so the AusHEAL component of the ‘Mercy Fund’ was called into action and paid for her medications – so today the patient looks so much better. There is so much to teach, so many poor people who cannot afford medical care and the HA staff sometimes do not have good medical practices purely because they have not been taught these. It is not their fault. One could become overwhelmed but when you see the smiles on the faces of the patients receiving care and the sustainable improvements that are occurring and continue to be made, it encourages us to keep going.

SUNDAY Two more weeks here and the final members of our team arrive this afternoon.