Another unaided kidney transplant cements BMH status

05Jul 2020
The Guardian
Another unaided kidney transplant cements BMH status

MEDICAL circles and the wider public had something to smile about on Wednesday as surgeons at the Benjamin Mkapa Hospital in Dodoma, also a teaching facility, registered its second successful kidney transplant without the supervision of foreign specialists.

Ecstatic mood among the staff and academic medical profession as a whole was perfectly understandable, and moreover this confirmation came at the right time. It cemented the datum that strictly speaking Tanzania is a lower middle income state, not ‘poor.’

Being able to conduct delicate operations like kidney or heart, liver or lung transplant is the mark of reaching the apex of the medical profession, and when this skill is domesticated, it means we aren’t required to learn but maintain that ability.  We can say at the level of definition that a poor country must always send its patients abroad for delicate surgeries in particular, whereas a lower middle income country can do it with an effort. It is the history of the country being written from a medical point of view.

BMH administrators said that this demonstrated ability, with a first case of unaided kidney transplant in March and a second one after a few months, shows that Tanzania now has no need of sending such patients abroad. All the same it depends on how many patients there will be in due course and their provenance, as medical attention is also a tradable service like any other, so one can choose sending a patient abroad for one or other reason. When one goes to a far country for such services it is known as ‘medical tourism’ - in many cases pursued for secondary needs, like a facial uplift.

For a while the hospital has performed the delicate surgical procedure with close support and supervision of specialists from the Tokushukay Medical Corporation of Japan. The BMH administrator did not say if cooperation arrangements were supposed to end earlier or local experts mastered the procedures rather fast. When they are sufficiently qualified, they learn fast.

Given the fact that the cooperation arrangement dates back to not much earlier than 2018, it is entirely possible that local experts would have done a good job in taking note of every little step in the surgery and its ancillary aspects. The latter is strictly speaking an aspect of the nursing profession but when it comes to the most delicate of medical procedures, the way it is organized at the clinical level is a medical profession of its own. Any error in setting up the patient and what is clinically administered leads to fatality.

Without crossing any boundaries of being reasonable or hypothetical, it is also evident that the governance ethos of the fifth phase has an input in this achievement. First there is the vastly increased expenditure on medical facilities, such that lockdowns elsewhere haven’t led to a visible medical emergency in terms of the need to send people abroad. Tied with creating new facilities is a boost in training and reinforced cooperation, and also a measure of either luck or blessing, where BMH conducted its first case of unaided kidney transplant back in March, as lockdowns were spreading.

Even within this limited scatter of data, this could not have been achieved if BMH staff were thinking of foreign trips, getting acquaintances favored in sending people for treatment abroad. Good governance was the key.

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