A trip to another country to work on open hearts starts with packing and checklists. It starts in a storeroom under a shed where they keep boxes and boxes of needles and tubes, blades that open chests and drapes to cover the skin. We check off spreadsheets and try to imagine exactly how many small plastic tubes we could want to place in veins and arteries and how many times we will need a second go.
Three months ago we wrote on lists and checked expiry dates and taped the boxes in two different directions. We stacked them on pallets and trusted that things we’d left before would still be found, somewhere in a storeroom.
The Real Start
A trip to open hearts starts earlier, now that I think about it. This trip started at least a year ago. Around the time of the last trip, where the seeds were sown to move the whole thing from Mwanza, curling around the shore of Lake Victoria, to Dar es Salaam where the water belongs to the Indian Ocean.
The local team had a plan that did not include machines that could not be convinced to work and time offered in theatres that would never materialise into actual time and space. So they moved and let anyone who was helping them know that they had turned the light on somewhere else.
The planning started a year back now and only looked like having a name change into an aborted mission twice along the way. Once even after the boxes were packed and on their way. Then Tuesday came and we were here and we found holes in hearts that could be patched and sewn so the blood pumping around the heart would follow better directions.
The Real Finish
Not every aid trip is the same. The Open Heart International trips are mostly not about serving lots of people right now. We volunteer to come and do a particular job which is to put ourselves out of work.
The aim isn’t to turn up and do lots and lots of cases. There’s probably a part of that which is about logistics and funding. It takes a bit of effort to get here from Australia and bring all the gear.
The bigger reason is that it doesn’t matter how often we drop by for a week of operating, we can’t meet the needs of Tanzania. You can set up trips where you aim to do 6 or 7 operations a day and leave 60 fixed kids but it takes a pretty big team and some resources to boot. The sort of resources you have when the guy in charge up Saudi Arabia way sends a team in his private jet with as many widgets and people as you need to do exactly that. That happens next week. That’s not a joke.
Ultimately even those efforts can’t serve Tanzania. A team that was here every day of the year that could look after patients every day, not just when a couple of weeks line up, is the real answer.
That’s why our week is more about helping the local team working at Jakaya Kikwete Cardiac Institute. We’re not here to take their work. We need to be spending time supporting in areas they want to build their skills the most. This means less operations, but making those operations count for every member of the team here in Dar es Salaam.
For this trip they’ve chosen the type of operations they want to focus on and they’re really working on the intensive care side. This isn’t to say they aren’t doing the other work. They do most of everything. So while we packed a surgeon (only recently, not in the boxes) the local surgeon, Dr Godwin Sharau, leads most of the cases with our guy, David Andrews, providing assistance and clever insights (and no, I won’t comment on whether complimenting a surgeon is a contractual arrangement).
Our nursing staff in theatres do their job in conjunction with the local nurses. Our perfusionist, the Red Leopard*, takes up most of the work of driving the wheels of steel (not interesting ones that would drop sick beats, just the ones that replace the work of the heart while the surgeons operate on it) but is also pretty much continuously chatting as he provides teaching for his local colleagues.
The anaesthetists? We just step in for bits when the local guys want us to keep things ticking over. Probably. We’re called upon mostly because the local anaesthetist who does most of this work is spending extra time in the ICU. It’s the ICU they want to focus on.
The goal? About two operations a day. We particularly want those operations to be the sort that mean the kids will end up getting on with school and a full life because all they needed was that pesky heart plumbing re-plumbed.
The bigger goal? Five years. That’s how long we want it to be before we’re out of a volunteer job. Our five year plan is to aspire to being tourists only.
PS I feel like the name Red Leopard could do with an explainer. Our perfusionist, Brad, is a tall member of a tribe defined by their ginger colouring. Upon receiving a compliment from one of the local staff that she thought “his colour was good” he took it, as any proud redhead would, as a sign of admiration of his particular variant of freckled glory. The compliment was directed at his shirt. His very blue shirt.
It did draw the rest of us to comment on the extreme usefulness of having an arrangement of red freckles perfect for breaking up his outline if he wanted to hide in the wild in these parts. A bit like a leopard with their spots. A bit like a red leopard if you will. We were just trying to be helpful, but he seems to have taken to it.
That said, I think it’s probably better if he relies on his skill with the heart-lung machine than hiding in the long grass to earn his supper.
For a broader take on this trip you could check out the Open Heart International website at www.ohi.org.au. They have a daily blog running and Brittany is starting to get stories from some of the kids and families.