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AusHeal Blog

Wednesday in Goma

Dear friends,
Wednesday morning here in Goma – all ready for a full day ahead.We are all well and the new team members are establishing themselves in Emergency and Intensive Care.

ANAESTHETICS department:
The senior Anaesthetist and the most experienced Anaesthetic nurse have both left HEAL Africa, leaving a very inexperienced team of anaesthetic nurses. Dr Anthony has to re-establish some basic teaching content necessary with them for the ongoing surgical work conducted at HEAL Africa Hospital. It is  foundational they learn how to think through processes and understand WHY they need to do what he is teaching them to do. This is one of the biggest challenges in education in Africa – process thinking rather than rote.
Today Neil is scheduled to operate on 2 or 3 very big goitres – one would be the second biggest he has ever done (the biggest being Nyota back in 2007 for those who may remember back then!) Dr Luc can now do the standard goitre surgeries, so these 2 or 3 will be quite taxing for Neil and Luc.
Thursday Neil is doing the first of the very difficult oesophageal surgeries (Fanny was the first and then he did another one last year). This is on a 21-year old male who thought he was drinking water but in fact it was acid (the bottle was not labelled). The surgery involves moving the bowel from the stomach to the neck through the chest. It is risky, being done in this environment. The first 2 of these surgeries went well, so we are praying for skill, stamina, wisdom and alertness for the surgical/anaesthetic team. These operations take about 5-6 hours.
Friday and Monday Neil will do the same oesophageal surgery on 2 children – one is 2 ½ and the other about 4. He is not experienced in paediatric surgery, so we are praying that God would equip him to cope with the surgery itself and the emotional strain of operating on children (his father/grandfather heart kicks in here and he finds this challenging!!!)
There are probably about 5 more with the same oesophageal condition – so Dr Luc and Neil need wisdom to know who to prioritise.
Emergency & Intensive Care staff – with our 3 new team members getting alongside the Congolese doctor and nurses. We hope for good relationships and trust to be established, and again that the hospital staff will understand the need to think through WHY they do things, and then actually do them!! Sometimes they do know what to do, they just don’t do it – other times they just don’t know that they don’t know the right thing to do.
Cheryl is heading up the Nursing members of the team. She is doing a good job of co-ordinating the other 2 nurses on team. We are hoping for a good relationship with the senior nursing staff at the hospital – that they will be able to learn from her and in turn further develop and advance nursing skills and procedures.
Radiology team members, Murray & Sue, always just ‘pick up where they left off last time’. They are very regular team members with already established relationships with the radiology staff here. They are a vital part of the whole multi-disciplinary approach and good diagnostic skills are so important.
Team co-ordination is progressing reasonably okay – I (Gwen) am endeavouring to ensure that the needs of the team are met. Bits & pieces of background admin stuff to do.
Dr Miriam Lee (Obs/Gyn from Gold Coast) will be travelling to Congo Friday/Saturday. She will be here for 1 week. Hopefully the border crossing will be smooth for her, unlike the difficulties we experienced last Saturday.

We greatly value your support.  Greetings from all the team,

Friday & Saturday Update

We wanted to let you know about the long surgery yesterday on the 3 year old girl who had the oesophageal operation.

In actual fact the surgery itself progressed well and Neil was happy with the technical aspects of it, having not performed this type of surgery on an infant before. Unfortunately about 2 1/2 hours into the operation the child had a major cardiac arrest but was able to be resuscitated. She had 4 further arrests as the surgery continued & was quickly able to be resuscitated but each episode delayed the procedure further. The surgery was completed in about 5 1/2 hours but while Neil was writing up the notes and before the anaesthetic had been completed, the child arrested again. This time, despite working on her for at least 45 mins and involving other members of the team for advice and an independent perspective, she was unable to be resuscitated. This was pretty devastating for all concerned, particularly Neil and Anthony. One of the hospital chaplains who was then going to be involved in informing the family, came and prayed for Neil and Anthony. We heard today that the family, although naturally upset, are accepting of what has happened because at least someone had tried to help their daughter. That is the bad news.

The good news is that today we had a very successful training session with the doctors and nurses on Early Management of Severe Trauma. There was good participation by the hospital doctors in a new form of teaching we have not used before, running scenarios where they had to be involved in resuscitating patients. It was a great encouragement that this went so well, particularly after yesterday’s disappointment.

Thursday 15th August

The op on the 21 year old man mentioned in the previous blog went really quite well but was difficult – the most difficult one of the 3 I have done here now. It took 7.5 hours in hot, humid conditions with the air-conditioning turned off most of the time and 1 power failure. He had a perforated oesophagus from someone at another hospital trying to dilate (stretch up) his oesophagus in March so his body tissues were not great and everything was gummed up inside. He also had an anatomical abnormality increasing the degree of difficulty.  The operation took a long time but the end result was good. We as a team prayed for him tonight but it really is up to God to do the healing from now on.

While operating today there was a severe trauma case admitted – a young university student hit by a UN truck. Some of our team were involved in his care but he subsequently died. His injuries were so severe that even with the best care in Australia he would probably not have survived. There is a degree of UN distrust by the local population with a city-wide strike on Tuesday protesting against the UN. The death of this young man resulted in further University protests about midday. Things seemed to have settled down by this afternoon’s drive home – even the University site we pass on our way home was quiet.

We have had the use of a HEAL Africa vehicle which Neil has been driving but it is not marked with the HEAL AFRICA logo. As a result of the anti-UN feeling, it was decided we should change vehicles, so for the next 2 days we are driving in a HEAL Africa Ambulance. Neil and Anthony Fisher feel this is “cool” and turned the siren and flashing lights on when we got “home” tonight.

But on a serious note we would appreciate prayer for safety and peace to reign in Goma!

Neil

First day back in Goma, 2013

The day started early as the 3 nurses in the AusHEAL team attended the weekly HEAL Africa nurses meeting, while our team doctors went to the weekend handover of patients by HEAL Africa doctors. Neil drove the team from the home to the hospital in his first drive in Congo in the 4 wheel drive left hand manual landcruiser… his first time to brave the Goma traffic. All went well

After such warm welcomes from the hospital staff, a tour of the hospital and projects building followed for the new members of team and then each went to their respective areas to work. These areas are [1] Intensive Care, [2] the Emergency Department [3] the Operating Theatre and [4] Recovery ward.

Imagine an Emergency Department with no Oxygen and no suction. That is what the team found. Logistics to be addressed. The local staff are however keen to learn. Dr David Symmons and Kirsty Freeman (RN) have spent the day just assessing what needs to be done. Similarly an Intensive Care Unit with very few if any functioning monitors and a ventilator that no-one know how to use. Damon Bruce (RN) will also have plenty of work to do teaching about how an ICU should run.

Dr Anthony Fisher (anaesthetist) found that 2 key anaesthetic nurses present in previous team visits have since left the hospital. He has almost had to start over again teaching lessons he has taught in previous years. Anthony spent the day observing current HEAL anaesthetic practices and soon realised topics to be addressed. Meanwhile Murray Thorn and Sue Reid slipped back into the Radiology Department with plenty of work. Neil Wetzig performed some endoscopies and assessed patients for surgery later in the week. Gwen spent the day organising the remainder of the team visit.

The day concluded with a teaching session for the doctors on “Shock” and then we returned to our accommodation at Maji Matulivu for a shower, debrief and dinner

Short and sweet ………. or maybe not so sweet

MONDAY 30th JULY 2012

This is our final newsletter before we leave Goma. We are nearing the end of the day and the end of our stay here.

Security:

Many of you will know of the security issues surrounding Goma at this time. Some of you will know of an attempted evacuation of us on Saturday night, which was unsuccessful because we were not allowed across the Rwandan border. This all took place about 9pm Saturday night. We had exited Congo but were not allowed into Rwanda so we were ‘stuck’ in a small strip of ‘no man’s land’ !

It was all to do with the date on our Rwandan visa approval being 31st July and we were trying to cross on the 28th July. So we were not allowed into Rwanda. We returned to Congo with the assistance of Dr Jo Lusi who convinced the Congolese to cancel our exit visas. We had packed in such a hurry after being advised by the senior staff of the hospital that we should move out of Goma following reports the town would not be safe on Saturday night and Sunday. We returned to our accommodation at Maji and went to bed, trusting that God was still in control of everything and that if there was nothing else we could humanly do, we just ‘wait it out’.

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U.N. peacekeepers in an APC patrol a key road linking Goma and Rutshuru in eastern Congo

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Sunday was quiet as usual but we still did not venture out in the morning.  We spent time in the afternoon with our Congolese ‘daughter’ who has become very special to us and whom we are sponsoring through her Accountancy studies.  Then in the evening we took Neil’s colleague, Dr Luc and his wife Stephanie, out for dinner.  Again another special time – so we are really glad that we did come back into Goma.

Monday has been ‘life as usual’ and this morning’s reports indicated that there had been no developments in the security situation.  Soldiers and the UN are visible on the streets but not much activity in the skies.    Apparently there were talks/negotiations over the weekend which halted the conflict – but things may ‘hot up’ again at any time. So we spend tonight at our accommodation at Maji, say farewell tomorrow morning in the Chapel service and then make our way to the Rwandan border again…. on the correct date!
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Photo : Neil, Dr Luc (Director fo Surgery), Gwen & Dr Muller (Emergency Medicine) outside the operating block
Surgeries:
Most of Neil’s surgical patients are doing well and he has been able to achieve much in the two weeks here.

ABC:

The ABC’s Africa Correspondent, Ginny Stein, has been here today filming and interviewing us about our work here at HEAL Africa and our commitment to the work, even during a time of conflict.  She went to the doctors meeting and then accompanied Neil on a ward round.
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Farewells:Saturday night, leaving in a hurry, and not having the opportunity to say goodbye was difficult. More difficult, however, was the thought that our Congolese friends wanted us to flee to safety and here we were heading towards the border knowing that we were leaving our dear friends behind in a situation that was so unknown.  Their response – “we live with it – every day’.  It has been good to be here these past 2 days to complete those things we came to do.

So as we farewell our friends here, we also look forward to returning home to our families.  Thanks again everyone for your interest and support.
Neil and Gwen 
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