Albert Wittkampf has paid a visit again, to two district hospitals in Tanzania, together with Petra Meerwijk , who acted as scrub nurse. They spent nine days at Buganda Medical Center from October 1st to the 9th. A large number of instruments, necessary for the treatment of the pathology as seen in this hospital, was sent beforehand. These instruments could be bought, thanks to a generous donation of the Pharus foundation. Unfortunately, these instruments arrived half way the week they were there, but they could be used the last two days to show Dr Motaga, the chief of the department, how they should be used. The hospital and dr Motega were very thankful for the donated instruments, that allow them to adequately treat the major pathology that comes their way.
The hospital had, at that time, not begun with the construction of the new outpatient clinic yet, but apparently they have started recently. The new clinic will have eight chairs instead of three, which was certainly necessary to be able to cope with the large number of patients that visit the clinic. The other good news is, that two young doctors will be trained at Muhimbili in Dar es Salaam. One will begin this year and the second one in 2024. Once they have finished their training, the department will be fairly well equipped.
The team flew to Arusha on October 10th to visit the department at KCMC. They were able to operate on a large tumor the same afternoon with dr Kaninkira and dr Alphonse. A total of 17 operations were carried out during this short visit. The new clinic is functioning well. The good news here is, that dr Alphonse will become available by next year, after he has finished his training at Muhimbili. That will be of great help for dr Kaninkira, who currently is the only OMF surgeon to cope with the enormous patient load.
The miniplates, that were ordered last year by our foundation, have finally arrived and all three centers will be stocked with these plates, which will facilitate the treatment of the many facial fractures that are seen.
The next visit in 2023 has already been planned, at which time all three centers will be visited including Muhimbili in Dar es Salaam.
Despite the Corona pandemic, considerable progress has been made in 2021. Dr Albert Wittkampf and Petra Meerkamp, a specialized operation assistant, have visited KCMC in Arusha. They were pleasantly surprised to see that the hospital had extended the facilities of the OMFS department. There are presently five chairs available in the outpatient clinic instead of the two in 2020. Dr Kaninkira and his staff had made good progress and together with him the Dutch team was able to successfully operate on some problem cases.
The Dutch team also brought some instruments that were missing in KCMC and enough Carnoy solution for both Muhimbili hospital as well as KCMC, and also for the new unit at Bugando.
An excursion was made to Bugando Medical Center (BMC), the third regional hospital in Tanzania, that is beginning a department of OMF surgery. It covers a large area in the north east of the country, close to Lake Victoria, that is densely populated. It concerns a large hospital with more than 1000 beds and with a modern OR facility. The outpatient clinic, however, would need considerable improvement and also appropriate instruments. Dr Motega, who was trained in Muhimbili Hospital, will be setting up this department and will need support from the foundation. The most urgent matter is the training of a colleague who will be working with Dr Motega. A plea has been made to the staff at Muhimbili to take on an extra resident for training. A meeting was arranged with the director of the hospital to discuss the future plans (see photograph). It is planned to visit BMC again in 2023 and to support this 3rd OMFS unit in Tanzania.
Last but not least, the donation of osteosynthesis miniplates, that were delivered in 2019, have been widely used both in Muhimbili and KCMC. Measures have been taken to provide a second batch of these plates for all three hospitals.
The Covid pandemic has had a major influence on the activities of the Foundation. It made it impossible for us to travel to Tanzania, which was the intention of dr Albert Wittkampf. He had planned a visit to KCMC in 2020 together with a nurse assistant to support the newly appointed staff member dr Kankinkira and to bring some necessary instruments. It was also planned that he would visit Bugando hospital in Mwanza (see below) with Dr Elison Simon.
However, some important developments can be reported:
- A large number of miniplates and screws with the necessary screw drivers, had been send to Muhimbili hospital in Dar es Salaam and KCMC in Moshi. This would make the treatment of facial fractures a lot easier and better. It is planned to continue to provide these plates and screws in the future.
- The most important aim of the foundation, to make oral and maxillofacial surgical care available for all Tanzanians, received an important boost. A third center was opened at Bugando Medical Center in Mwanza, south of lake Victoria, a densely populated area. A resident trained at Muhimbili was appointed at this University hospital.
- Dr Alphonse had been admitted as trainee at Muhimbili hospital largely because of a strong recommendation of Albert Wittkampf, who had worked with him at KCMC during his last visit in 2019. He will most likely be joining dr Kankinkira at KCMC once he has successfully finished his training.
The ultimate goal of the foundation to help the Tanzanian colleagues to make oral and maxillofacial surgery accessible to a large part of the population, has come a little bit closer. In the densely populated north east, with the cities of Arusha and Moshi, a regional center has officially been established in the Kilimanjaro Christian Medical Center (KCMC). Dr Kanankira, who had been trained at Muhimbili National hospital and The Muhimbili University of Health and Allied Sciences (MUHAS) in Dar es Salaam, has been appointed in this hospital. The foundation has found a sponsor to pay for the training of a second colleague who will likewise be trained and join the department in the future. The next step would be to try to open a third center in the north western part of Tanzania, which is also densely populated.
The department at the Muhimbili Hospital in Dar es Salaam had a new Chairman and several new members of staff. The new Chairman is Dr. Karpal Singh Sohal. Other members are Dr. Jeremiah Moshy, Dr. Sira S. Owibingire, Dr. Shaaban Daud, Dr. William Sianga, Dr. Arnold Mtenga, Dr. Gemma Berege, Dr. Omar Hamza, Dr. Baraka Kileo, Dr. Dora Kiwale and Dr. Samuel Mwalutambi. The colleagues Kalyanyama, Shubi and Simon are retired staff members but still active in the department. Muhimbili hospital is the only training center in East Africa apart from the one in Nairobi, Kenya, hence they also train surgeons from neighboring countries. Two colleagues from Zambia have graduated, one in 2015 and another in 2018. There are currently four graduate students, one from Rwanda and one from Kenya and two from Tanzania. The department also contributes to the graduate programs of Otorhinolaryngology, emergency medicine and plastic surgery. Their residents rotate for four weeks in each of the following departments; General surgery, Anaesthesiology, Otorhinolaryngology weeks.
The main bulk of the activities of the department are dento alveolar surgery, infections, trauma and the treatment of a large number of patients with all sorts of tumors that are often very large. Since they have received a donation from the KLS Martin group in Tutlingen, Germany, existing of special reconstruction plates, they have been able to continue with the very successful way of reconstructing the mandibles of these patients. Several follow-up studies have been published that emphasized the efficacy of the method used. (See publications)
A recent epidemiologic study carried out at Muhimbili hospital points to the vast number of especially odontogenic tumors that require treatment.
The department collaborates with other institutions in the east African region, including participating in examinations and inviting colleagues of other departments to serve as external examiners
At KCMC, Albert Wittkampf has paid a visit in October 2019 and has helped Dr. Kanankira with some of the difficult cases. He also brought several instruments that would make life somewhat easier in the operating theater. A second visit is planned in October 2020.
The foundation has been able to acquire miniplates for both departments that will greatly facilitate the management of the trauma patients. Some 250 plates and screws for each department will probably suffice for the coming two years.
In the period 2017-2018 the second department of Oral & Maxillofacial Surgery has been established in the Kilimanjaro Christian Medical Centre (KCMC) in Moishy, approximately 300 km north of Dar es Salaam. This hospital has created space to accommodate a clinic and provided for time in the operation room. A container full of instruments collected in 2016-2017 had finally arrived, including an orthopantomograph.
At the Muhimbili hospital (MUHAS) a young dentist (dr Kanankira Anandumi) has been in training to become the first OMF consultant at KCMC. He will probably be ready to begin in KCMC halfway 2020. Meanwhile, a dentist who had been working in KCMC for a long time (dr Rwakatama), is running a clinic and taking care of mainly trauma patients. One of us, dr Albert Wittkampf, has spent twice four weeks, once in october2017 and once in September 2018, to help and train dr Rwakatama. He has noted that several instruments necessary to treat the various pathology, are still lacking. It will be necessary to acquire these instruments before he goes again in 2019.
With the establishment of the second department of OMF Surgery in Moshy, the ultimate goal of the foundation, i.e. four departments spread over the country, has partially been fulfilled.
The department of OMF surgery in the MUHAS, Dar es Salaam, has received a considerable donation from KLS-Martin. A large amount of reconstruction plates and screws, sufficient for at least two years to reconstruct the mandibles of patients who had to undergo segmental resections because of large Ameloblastomas.
In 2015-2016 we have focussed our efforts and funds on the collection and transport of the equipement for the new surgery in the Kilimanjaro Christian Medical Centre (KCMC) in Moshi. We have received several contributions from Rijnstate hospital in Arnhem, Laurentius hospital in Roermond, Slingenland hospital in Doetinchem and the UMC’s in Nijmegen and Maastricht. The majority of the equipement was surgical instruments but it also included surgical chairs and furnature for exmination rooms. Amongt others a drilling machine and a surgical lamp had to be purchased. This used a significant amount from the foundations resources but it made the equipement complete.
End of 2015 Ricoh SCM bv in Bergen Op Zoom offered to coordinate and organize the transport of all the equipment from the Netherlands to Dar Es Salaam. In February 2016 the goods were transported free of charge by Maas Transport & Expeditie bv from the temporary storage in Oosterbeek to Bergen Op Zoom. Ricoh & DHL carefully wrapped all goods and arranged the transport to Dar es Salaam. The whole transport, including the arrangements with customs in the Netherlands has been paid and arranged by Ricoh SCM bv.
When the goods where delivered in Moshy, the staff of KCMC immediately started to use the instruments and other items. The equipment was received with great enthusiasm. The shipment also contained items for the department in Dar es Salaam which they collected in Moshy. Both departments have received a good amount of surgical plates and screws to treat jaw fractures.
Another important development in 2016 is the appointment of two new members of the foundations’ board members. Rob Mooren and Albert Witkampf joined the foundation while Jan Laverman has retired from it.
Scientific progress was also made. A follow-up study of patients with tumors in the symphyse area of the mandibula, reconstructed with previously mentioned techniques, had been completed. This article has been offered to the International Journal of Oral and Maxillofacial Surgery.
Both Thijs Merkx and Paul Stoelinga paid a visit to Dar es Salaam from 8 to 14 December 2014. The primary goal was, together with Dr. Elison Simon, to visit Kilimanjaro Christian Medical Center (KCMC) in Moshi and to discuss the possible establishment af a satellite department of Oral an Maxillofacial Surgery in that hospital, linked to the center in Dar es Salaam. It was also intended to visit the new facilities in Muhimbili hospital, made possible by a donation of the Nina Harris Pebley Foundation through rhe IOMS Foundation, that where finally completed. Last but not least it was also planned to see some of the recent patients that were reconstructed after ablative surgery for Ameloblastomas.
It was a pleasant surprise to see that the new operating theatres were both functioning well, including the new examining room and conference room. All the equipment that was donated through the IAOMS Foundation was in place along with the instruments needed for treatment of a large number of patients. It was also very satisfying to learn that the number of patients that had benefitted from the novel recontruction method had grown to fifty. It has turned out that the donation by KLS-Martin Company of Smart plates and screws has become a huge succes particularly in combination with the technique of reconstruction as introduced by the department in Nijmegen. A follow-up study is underway to assess the tongue function in case a resection also included the symphysis of the mandible.
The journey to Moshi was also very rewarding in that an intention was expressed to come to a satellite department in KCMC with the help of the Dutch Foundation. The current medical staff and the director were very much in favor to establish such a department. It was agreed that a list of items necessary to furnish the department is to be put together along with a list of instruments needed. Government agreement, however, will still be necessary to come to a final decision. Discussions on this started early 2015.
It looks as if the goal of the foundation to establish satellite departments in the three large regional hospitals has become somewhat less hypothetical. It is hoped that in 2015 major progress will be made to establish the new department in Moshi.
The situation at the department of Oral & Maxillofacial surgery in Dar es Salaam has changed in that Elison Simon has stepped back as chairman since he has been appointed Dean of the Dental School. Jeremiah Moshy has followed him as Chairman. The department has continued to train two residents a year which so far has resulted in an increase of OMF surgeons from 4 in 2008 to 12 in 2013. Some of the trainees come from neighboring countries and return to their home land after completion of their training.
The main project, supported by our Foundation, remains the reconstruction of patients with aggressive odontogenic tumors. Thanks to a generous donation of KLS-Martin company there are sufficient numbers of plates and screws available for another 30 patients. Till present more than 40 patients have benefitted from this procedure. The foundation has supported the travel expenses of dr Simon to Johannesburg and Barcelona. In South Africa he was invited to report on the ongoing study on the before mentioned reconstruction method, while in Spain he was invited to report on the efficacy of the IAOMS sponsored educational program that ran from 2005-2008.
The original aim of the Foundation, to support the establishment of a second department of Oral & Maxillofacial surgery in the densely populated area around Arusha has been hold up by the board of directors of KCMC hospital. There happens to be a change in the management of that hospital that will become effective in the course of 2014. We plan to save the planned amount of money available to help establishing such department until the negotiations between the Tanzanian OMF surgeons and KCMC will be reopened.