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First mission completed in Tanzania 2024

March 6, 2024

I begin to write these lines while I am on the plane that takes us from Dar Es Salaam to Addis Ababa and then from there to Italy after 20 days spent in Tanzania, most of which at Ikonda Hospital. I begin to write because, as has been the case for 31 years now, when I began my volunteering activity in developing countries, the moment of departure and detachment from these realities so in need of help and in which we live immersed for the days of our “Mission” is always a difficult moment, a slightly sad moment… even if you return home, to your family, to your usual loved ones at work. So writing, remembering and reliving these intense days that enter you helps to soothe the sadness of separation a little.

Ikonda Hospital is a beautiful reality, a good quality hospital, founded in the 60s by the Consolata Missionaries in southern Tanzania, it stands almost like a cathedral in the desert in a miserable village lost in nowhere. Probably many of you reading this incipit will have thought that such a work has little reason to exist. This is a bit what we, the first ENT volunteers, thought when we arrived in Ikonda in 2017, after a tiring 2-day journey. However, very little time was enough, a few hours, to make us change our minds, to make us grasp the essence and importance of that apparently disproportionate hospital for that region and to convince us of the goodness of the work and the “ENT for Ikonda” project, which was the reason for for which we were there and for which we would return with enthusiasm in the following years.

Yes, because a first tour of the departments, the clinics and the operating room was enough to make us immediately understand two essential things:

  1. A hospital with a “high” level of technology compared to what most Tanzanian hospitals offer, this made it possible to perform good quality diagnostics and surgery
  2.  Hospital with 300 beds always overbooked, never less than 400 inpatients and with clinics and waiting rooms constantly overflowing with patients.
    All this meant that in that structure it was possible to provide patients with care at a level that was finally comparable to that which occurred in other parts of the world and that the number of patients who could benefit from it was very high thanks to the fact that over the years Ikonda Hospital has acquired good fame and captured the trust of a large population from all parts of Tanzania, even from Dar es Salaam,  about 800 km away.

Our mission began almost by chance, when a pharmacologist from Turin, linked to the Consolata Missionaries and that hospital, contacted me telling me about the extreme need and shortage of ENT specialists and proposed that I take charge of a project to bring this specialty to Ikonda. We therefore started in September 2017 with a team made up of myself, a dear colleague from Rome and 2 young ENT specialists, with an anesthetist and an instrumentalist. For the first time after 25 years of experience, they allowed us to treat patients with the aim of healing them and not just alleviating their suffering with palliative practices.

Since 2017, overcoming various problems and above all the dark tunnel of Covid, we have arrived today with surprising numbers and results.

  • After the first 3 years with only one mission per year, since 2020 we have managed to switch to 2 ENT teams who go to the hospital regularly;
  • in 2023, the teams have become 3, approximately every 4 months.

The ambitious, but not unattainable, goal is to soon reach 4 teams a year so that patients can receive treatments, interventions and checks quickly and not just once a year, as was the case at the beginning. . A few numbers to give you an idea of what we can do in a couple of weeks of work during our expeditions:

  • 300-400 patients pass through the clinic every time for visits and tests such as audiometry, fibroscopy, impedance measurement, airway and a certain number of them are subjected to surgical interventions, often very complex and long.
  • On average, we carry out 40 and 50 operations as a team during our stay at the hospital.
  • TRAINING both in the clinic and in the operating room, trying to teach and develop local permanent staff, both doctors and paramedics.

Let us never forget, in fact, that this is one of the main purposes of the Anemon missions and that in Ikonda, but in Africa in general, even the paramedics are eager and eager to learn and often have tasks that here are carried out only by medical specialists. Just to cite a couple of examples, in the Ikonda hospital the anesthetists are all nurses with an ad hoc specialization in this difficult art and the visits to the ENT clinic, in our absence, are carried out by the “Patron” or the head of the room who works in close contact with each of us every time we go on mission.

Experiencing Ikonda to its fullest as we do in the 20 days (too few!) of our mission means first of all “sharing” a lot. Sharing with the hospital staff, sharing with the sick, suffering people who are looking for solutions to their illnesses, often very serious, who arrive from many kilometers away, on foot or with makeshift means, hoping to find healing there. They arrive with their names which are unpronounceable for us, we understand each other only thanks to the translation from Swaili into English by a head nurse or a nurse, they have an immense trust in us in their eyes even if some of them have already been to the witch doctor or by the village witch and we often manage to repay their trust. Other times, however, we have to disappoint them, shake our heads saying that we can’t do anything and communicate that the severity of the disease gives no hope. These are the moments that a doctor would never want to face, even more so in a condition like that where we know that only the delay in diagnosis and the long time that has passed since the onset of the disease have led to the impossibility of treating and healing it. The thing that always amazes is how these people, tried by poverty, by the lack of all the things that in rich countries are considered essential, strongly prostrated by the disease, face the inevitability of death, accept the sad and merciless final verdict, with a dignity and serenity that are totally forgotten and unthinkable here. They arrive with a confident look  but which does not vary and retains its sweetness even when you tell them that… there is nothing left to do. It’s something we’re not used to, we who in the so-called “civilized” world have to have the police defending the emergency room or we witness unmotivated violence, because a benefit that isn’t due is denied or because an elderly person dies at the end of his or her life. life. Here we now take it for granted that death can and must always be defeated by the doctor, by the hospital, by science. An African mission should be a training experience included in the curriculum of all doctors, especially young ones, it is an experience that gives a lot: it costs a little effort, time, loss of work but… it always gives us much more than how much we bring there! There is also great sharing and the bond that is created between the members of the team. Our groups are always made up of a couple of senior surgeons, 2-3 junior surgeons, sometimes an instrumentalist. We live together for 20 days from morning to evening, we share a long and tiring journey, we share heavy and tiring working hours, with the difficulty of not understanding the language but above all we share the beauty of this experience, the joy of feeling truly and fully useful, the awareness when solving a case that you have been truly decisive. Sometimes even resorting to slightly strange and anomalous solutions, sometimes we take risks, we risk, we all work together to find solutions because we know that there is no alternative. Of course it’s not all roses…every year there is some episode that leaves a bad taste in our mouth. Every year we left Ikonda with a name, a face, a sad memory. He could have been called Darusci, the 12-year-old who the first year kept us in suspense for over 10 hours because after the removal of a tumor in his neck he didn’t want to wake up from the anesthesia. And in the following years there were other “Darusci”, even if few, but every year we experienced moments of anxiety and tension which, however, bind and cement our relationships even more and remind us once again that the man, the surgeon, the science can do a lot… but not everything.

Ikonda is all this and much more, it is not easy to enclose this experience in a story but I hope at least to have made you experience its atmosphere, the emotions it gives us, sharing them with us. I’m here on this flight, surrounded by many people together with my dear friends, special people who wanted, for the first time or for the umpteenth time, to share this experience and this makes me happy, it makes me feel a little less detached. , the feeling of having escaped without having finished my, our work. I think of these things but I think above all of the parting words that, as always, I said in the farewell meeting on the last day at the hospital…” Bye Ikonda, we are leaving today but we are always looking forward when we will come back” “Bye Ikonda we are leaving today but we are already thinking about when we will return here” and I guarantee you that it is not rhetoric. Because Ikonda is like this, it grabs you, it fascinates you, it gets inside you and you can’t do without it anymore.

I close with thanks to Anemon and to all those who actively help and support us in this initiative of ours; this year I brought a new nose-fiberscope to the hospital, purchased thanks to the budget made available by Anemon, a budget which will also allow the purchase of a microscope for ear surgery. But the needs of the Ikonda patients are still many so, from now on, I thank all those who want to contribute with donations to the Ikonda-Hospital project, Tanzania.

See you soon and thanks Maurizio Catalani Otolaryngologist in the world