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SUCCESSFUL COMBINED SURGERY AT ABDALLA MZEE PEMBA HOSPITALI

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BY HAJI NASSOR, PEMBA:::::::


OCTOBER 25, 2021 was a memorable day for Dr. Wang Juan, an obstetrician and gynecologist at the First Affiliated Hospital of Soochow University and a member of the Chinese Medical Team in Zanzibar.

She had barely worked at Abdulla Mzee Hospital on the Pemba Island for one month when she encountered acomplicated case.

Although she had an experience on the case before her arrival on the islands, she was still shocked by the complexity of the illness of her patient, a 21-year-old mother from Matele Chake Chake.

The patient had been leaking urine for nearly seven months with a foul smell which made her so embarrassed that she always remained in her house.

According to the Assistant Director of Abdulla Mzee Hospital and Head of Obstetrics and Gynecology, Dr. Aboud, the patient had delivered a healthy child by cesarean section five years ago. Seven months ago she expected her second child with a great joy but the baby died during childbirth due to shoulder dystocia.

The patient suffered from sequelae of a large vesicovaginal fistula with an area of 4 cm2 due to bladder rupture during childbirth, which caused great psychological and physical trauma to the patient, making her even more sad.

With all her clinical experience, Dr. Aboud felt it a great challenge for her due to the complexity of the case and the patient’s history of a failed repair surgery. He consulted the Chinese Medical Team for help.

After receiving the case report, the Chinese Medical Team held consultation and discussion and formulated a detailed surgical plan. The team reported the case to the Chinese Consulate General in Zanzibar and the Foreign Cooperation and Exchange Office of Jiangsu Health Commission.

After getting unanimous consent and support, Dr. Li Hualei and Dr. Liu Donghua, the two consultants at the Affiliated Hospital of Nantong University, were dispatched from Unguja to the Pemba Island to attend the case.

         

Joint surgery

To effectively treat the patient, the medical team set up a multi-disciplinary group of diagnosis and treatment consisting of Dr. Li Hualei, the urologist, Dr. Wang Juan, the obstetrician and gynecologist, Dr. Yin Jun, the general surgeon, Dr. Shan Xisheng, the anesthetist, Dr. Liu Donghua, the acupuncturist, Dr. Wang Haipeng, the cardiologist, and Dr. Ye Aihua, the radiologist.

Dr. Wang Haipeng and Dr. Ye Aihua were mainly responsible for the preoperative assessment, Dr. Shan Xisheng monitored the patient during the operation, Dr. Li Hualei, Dr. Wang Juan and Dr. Yin Jun performed the the operation while Dr. Liu Donghua developed the patient's postoperative rehabilitation treatment plan.


Dr. Li Hualei, the urological surgeon, has years of rich clinical experience and unique insights in the diagnosis and treatment of urinary fistula. Before the operation, he joined the case discussions within the team and virtually discussed the treatment plan with a number of urology experts back in China.

Due to inadequate medical resources in Pemba, he made a simple cystoscope with Dr. Chen Hongsheng, consultant of Anesthesiology, through repeated experiments, using visual light sticks brought from China.

On October 17, 2021, Dr. Li Hualei and Dr. Liu Donghua performed the joint surgery in cooperation with doctors from departments of urology, obstetrics and gynecology, and anesthesiology in the presence of the local doctors who were there to observe the procedure of a rare and complex case.

Complex operation

The operation was difficult as the patient’s obesity made it difficult to provide enough vision for surgery; it was hard to separate the scar adhesion, and the fistula opening was too large and too close to the bilateral ureters for the safe suture of the bladder fistula. Dr. Li Hualei, Dr. Wang Juan and Dr. Yin Jun overcame all the difficulties through close operation and finished the repair within 5 hours.

The bladder then was observed with a self-made cystoscope and the bilateral ureteral openings were confirmed to be normal. Methylene blue staining test showed no vaginal blue stain. The operation was a great success.

 

Postoperative care

Fistula repair alone is not enough. Good post operative care is as important as a perfect repair for a quick recovery. The next morning, Dr. Wang Juan, Dr. Li Hualei and Dr. Liu Donghua visited their patient in the ward.

The examination showed a most desired condition: the patient's urine was clear, abdominal incision dry, and no urine leakage in vagina. Follow-up treatment suggestions were made to the ward staff.

Dr. Liu Donghua formulated a plan for preventing postoperative abdominal distension and rapid functional recovery from the perspective of Traditional Chinese Medicine.

The combination of Traditional Chinese and western medicine was expected to secure a quick recovery. Seeing the smile on the patient’s face, Hospital’s Assistant Director Dr.Aboud commended and congratulated the Chinese Medical doctors for the successful operation.

What the doctors say

According to Dr. Li Hualei, urinary fistula is the formation of abnormal channels between the reproductive tract and the urinary tract in which urine is discharged from the vagina but hard to be controlled.

Obstetric injury is the main cause of urinary fistula, which often occurs in areas with backward medical conditions and seriously affects women's quality of life.

A fistula of the size of a patient who had undergone operation at Abdalla Mzee Hospital was very rare in clinic. The success of the operation resulted not only from the adequate preoperative preparation and the close cooperation of multidisciplinary experts, but also from the sincere cooperation within the China Medical Team.

The patient talks

The patient told the Zanzibar Mail that was her third pregnancy as the last two deliveries were also done by operation.

She said she expected operation in her third delivery but when she reported at the hospital a local doctor convincingly told her that she would deliver without undergoing operation.

                   END

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