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Through the Kilimanjaro Keyhole

An Irish surgeon's medical adventures in Africa involving Coca Cola gas, home-made fuses and a hotline to the Electricity Supply company. Emer Horgan gets to see at first-hand the impact of the teamwork involved in surgical development in Tanzania. (2015)

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Documentary Maker : Emer Horgan

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Documentary-maker: Ronan Kelly

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Through the Kilimanjaro Keyhole

For years, Irish doctor, Liam Horgan, has regaled his family with stories of his trips to East Africa – tales of great adventure and medical challenges.   In February this year, his sister, Emer Horgan, decided to travel to Tanzania with Liam to record the work he does there in partnership with local surgical staff. 

In 2004, Dublin-born Liam Horgan performed the first ever 'keyhole' removal of a gall bladder in East Africa.

For Europeans, used to advanced health care, that may not seem overly-significant but for surgeons and patients in Tanzania it was a dramatic day and one which began a long-standing medical adventure.

Liam remembers the excitement of the surgery that day, “we had all sorts of problems to sort out, stuff you’d never see at home.  For instance, where were we going to find a supply of carbon dioxide gas that’s needed to inflate the abdomen while you’re operating?  We were scratching our heads in the hospital canteen, drinking Cokes, looking at the bubbles and suddenly thought, that’s CO2 and we’re drinking it, so it must be fairly safe, let’s see if we can get a hold of that!”

Soon afterwards, some very large Coke CO2 canisters appeared in the operating theatre.

Then there was the worry of electricity outages common in that part of the world: “The electricity supply is always dodgy in Tanzania and having a black out when you’re in the middle of a delicate, high-tech operation is not what you want. 

So I rang the national grid and got a very nice woman who was very interested and said, yes, of course you can have a constant supply until 12 o’clock. Luckily we had just finished and tick tock, the clock ticked round and off it went at 12 o’clock on the button.”

“Keyhole”, or laparoscopic surgery, makes a big difference in African health care. For most operations – gall bladders, hernias, and appendix – the small keyhole incisions mean that wound infection is massively reduced. In Africa, hospitals are desperately overcrowded and cross-infection can be deadly.

With keyhole surgery patients are in hospital for about 36 hours and get home to their families and work much quicker.   It’s much less expensive for them too which makes it more accessible for more ordinary people.

For Irish surgeon, Liam Horgan, the key thing is the Tanzanian surgeons, “If they hadn't been keen, nothing would have happened. We’d have gone over, demonstrated and then, nothing. But because Dr Kondo and his team have made the development their own, they are now running laparoscopic courses and doing over 90 operations a year which in a country as poor as Tanzania is just amazing”. 

Liam's stories are reminiscent of the 1980s TV series, “MacGyver”.  They make great listening but what’s also really fascinating is to hear the way friendships and professional relationships have made this development project the success it is.  For example, in 2014, they won a prestigious British Medical Journal award.

Liam always comes with a packed suitcase to Kilimanjaro: laparoscopic instruments, new scissors, tubing, all sorts of medical goodies. This year he’s brought mosquito netting which has been sourced in China, cut to size, sterilised and packaged - all ready for Dr Kondo and his team to use in hernia repair.

Medical grade mesh costs $70 per patient; this mosquito netting costs 1cent.

But this work with the mesh won't just benefit patients in Tanzania.  “Why are we paying so much here?” says Liam, “I’m very interested to see if we might be able to introduce it to the UK and Europe”.

In this documentary, Emer gets to see the at first-hand the impact of the teamwork involved in surgical development in Tanzania.    She shadows her brother as he operates, teaches and socialises with Dr Kondo and the other medical staff. 

Emer also follows one of the local patients, Bathilde, a Tanzanian woman suffering from gallstones and appendicitis, through her operation and return home.  Bathilde has no fear of her operation.  She prays to God to guide the surgeon's hand.  After all, she explains, God was the first surgeon, when he removed Adam's rib and created Eve.

Surgeon Liam Horgan's success in Tanzania is bittersweet.  The more the local medics take over his work, the less need there is for him to travel there, something he relishes.  “They don't have the amount of paperwork we have.  They focus on their patients.  That's something we've lost in our European medical system and, in the end, that's what the job is all about:  the patient.”

Narrated by Emer Horgan.

Produced by Emer Horgan with Ronan Kelly.

This documentary was produced in association with Irish Aid/Department of Foreign Affairs

Music featured on this documentary includes: 

"Saida Karoli  Mapenzi Kizunguzungu”,  bartamaha

"Roho Inaniuma”,  Vipaji Vingi ft. Lameck Ditto

"Nawashukuru Wazazi Wangu”,  Frank Gunderson & Mlimani Park Orchestra (Sikinde)

"Saida Karoli  Wakati Ndio Huu”,  Emmanuel John

First broadcast on RTÉ Radio 1, 2pm Monday 1st June 2015

An Irish radio documentary from RTÉ Radio 1, Ireland - Documentary on One - the home of Irish radio documentaries

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