Surgical ward

The surgical ward at Mnazi Mmoja hospital is not dissimilar to the medical ward in layout and function however as with most surgical wards the morning rounds are generally briefer, as the surgeons need to get to theatre. The layout of the ward is basic; surgical wards are separated into male and female (I've been on the male ward/team). The male ward is divided into one large room containing about 30 beds, and a smaller room containing about 10 beds. The larger of the rooms takes all surgical cases for the hospital except for urological cases which are all in the smaller room.

Surgery days for the male general surgical ward are Tuesdays and Thursdays, except for emergency cases which will be operated on as required. On these days there seems to be either a very brief round, or no round at all, before the surgeons go to theatre. Mondays consist of a standard round which usually takes up to 2 hours and Wednesdays are a teaching round including local students which usually takes slightly longer. Fridays involve another ward round and an outpatient clinic, which is beneficial as this provides probably the greatest opportunity to practice examination and history (with the aid of the doctor translating) skills and to formulate diagnoses. As with the medical ward, the greatest barrier is the language difference with most patients only speaking Swahili and translation required by the doctors (who all speak and write notes in English).

The ward itself is fairly ill-equipped and as with the medical ward patients are required to obtain medications and other necessary supplies from the local pharmacy as the ward does not stock them. This being said equipment such as dressings, needles and syringes, cannulas, antiseptic, gloves and saline/IV lines are stocked by the ward. At times been difficult to differentiate who are doctors and who isn't, as it seems that everyone except the nurses are addressed as 'doctor', including both local and international students.

In comparison to the ward, the OT was surprisingly well organised and relatively comparable to home regarding equipment and procedures to retain sterility. Students are encouraged to attend and observe operations but it's advisable to bring your own scrubs (which we all wear on the wards anyway as it's too hot to wear a white coat over pants and a shirt) and mask/cap as it seems that these are in relatively short supply and aren't as readily available as in western hospitals. All staff are required to remove their outside shoes before entering the theatre wing and to put on theatre shoes as there are no shoe covers. Fortunately there is an abundance of spare crocs and sandals around, but it's still worthwhile checking with someone so as not to inadvertently take someone's personal footwear. There are at least two operating theatres which are used by the general surgical team and another used by the obstetric/gynaecological team. Procedures performed are common procedures which you'd see in most western general surgical theatres; appendicectomies, laparotomies for perforated bowel, herniotomes, cholecystectomies etc. Along with other procedures not done so often in western theatres including TVPs (trans-vesical prostatectomies) and open nephrolithotomies. There is no laparoscopic equipment so all surgery is done via laparotomy, but all surgeons appear fairly highly skilled and all procedures are performed in sterile conditions with full scrub attire and drapes (albeit that there isn't much disposable equipment, most is sterilised and re-used).

Students in the surgical team aren't expected to stay at the hospital all day, however are invited to make an effort to get involved as much as possible in assisting procedures in theatre and on the wards. There isn't much to do on the wards after rounds, and on theatre days students aren't expected to observe all day, however interest is appreciated and surgeons are obviously more likely to invite keener students to assist where possible.