Physically challenged individuals

I Am Dr Edward Wayi MD, a Plastic, Leprosy and Reconstructive Surgeon and Director for Health services at Kibaha Education Centre as well as being, Medical Officer In-charge for Tumbi Regional Referral Hospital, in Tanzania.

From 2001 to 2017, worked at CCBRT Disability Hospital, Dar es Salaam, Tanzania as Plastic, Leprosy and Reconstructive Surgeon where i was taking care of patients with physical disabilities. To effect this job, I was able to work as Othopaedic, Neurosurgeon(treating patients with spina bifida and hydrocephalus) and General Surgeon the qualification I acquired in the year 2000 at the University of Dar es Salaam.

 2006-2009, I worked for AMREF Kenya where I was able to work in Eastern African countries through the clinical outreach and Flying Doctor services programs treating patients and teaching General Surgeons and Practitioners about basic Reconstructive Surgery Attended training on reconstructive Surgery both locally and abroad, formally and informally.

As part of the physically challenged community, individuals with cleft deformities have poor access to healthcare, mainly due to lack of skilled cleft-care personnel. 

To improve their access to healthcare, I wish to commission a project which aims at training at least one General Surgeon to each of the 28  Regional Referral Hospitals in Tanzania. When implemented, this will provide a rational distribution of cleft Surgeons in the country thus making access easy. The trained Surgeons will in the future train other practitioners leading to a multiply effect. The outcome therefore will be increased availability of skilled cleft care practitioners, easing access to healthcare and therefore timely treatment. When treated timely and closer to their homes, the problems which are associated with the deformity (Stigmatisation, community outcast, hidden away from society, suffering from limitation of speech, impaired hearing, malnutrition and death due to complications of the deformities) will be avoided.

Individuals born with cleft lip and palate deformities generally have poor access to healthcare in Tanzania. This is due lack to skilled healthcare personnel despite the fact that, the government has improved tremendously the availability of healthcare facilities across the country. Currently, majority are treated in Dar es Salaam, the Tanzania business capital.

Globally, an average of 1 child is born with a cleft in every 1,000 live births. According to the Tanzania crude birth rate ie 36.7, and population at 59,734,218, about 2,192 babies are born with a cleft deformity every year. The available information shows only half are treated and the remaining 50% live in different social difficulties such as being stigmatised, bullied when sent to school, hidden from social gatherings, and some die due to complications of the deformity.

To ease the access to healthcare of individuals born with a cleft deformity, I wish to train at least one General Surgeon to each of the 28 Regional Referral Hospital who in return will subsequently transfer the knowledge and skills acquired to their hospital team members, a projected multiply outcome, further making the availability of healthcare to this community easy.

A training project is planned which aims at imparting knowledge and skills to at least one General Surgeon in each of the 28 Regional referral hospitals. 

Implementation of this project is planned to take two years whereby, the 28 regions in Mainland Tanzania will be divided into seven geographical zones each with several regions. In every quarter of the year, a hands on training coupled with theoretical sessions will be conducted to the Surgeons who will convene at one of the Regional hospital in the respective zone for two weeks. About 30 -50  cleft patients will be prepared for this important exercise. As the Surgeons will have had the Surgical skills training, the trainer will therefore concentrate on cleft surgical skills training by demonstrating the different treatment options to the Surgeon. 

This project therefore wishes to transfer knowledge and skills to cleft care providers down to the region and by so doing expanding coverage and rationalising the distribution of the cleft care skilled workforce in the country thus easing access to the affected individuals

Apart from the social and medical effects of the cleft deformities to the affected individual, there are other associated effects to the families and community at large.

Families have ended up with marital disharmony, the mother being blamed to be the reason for the cleft to her newborn baby. There are many assertions made including curse, adultery during pregnancy, bad omen, Gods creation and many negative connections.

Further to the community, families are seen as cursed, bewitched, thus deserve being outcast. 

Therefore affected individuals and families remain socially distressed, as a result of having a child with a cleft deformity.

This training project wishes to bring knowledge directly to the healthcare workforce by training the Surgeon who through working with team, further transfer of knowledge with take place. As part of the training, the Surgeons will taught about the role of creating community awareness and education which are crucial for the affected individuals to be brought to hospital. Treating a cleft patient therefore amounts to treating the whole family and community at large as most of the asserted connections will be  alleviated and thus bridging the social gaps that may have accrued,together with medically and physically improving the affected individual.

People with Physical disabilities are normally left behind, mostly ignored by society, live in isolation, segregated and live in poverty this being a result of negative attitudes, wrong beliefs, lack of support from the society that would be geared towards their challenges and lack of knowledge regarding physical disabilities.

 As a result therefore opportunities that all human kind would deserve are mostly not part of this community.

I therefore wish to improve healthcare delivery to the group of individuals with a cleft deformity a physically challenged community that I wish to focus on.

After being involved in the healthcare provision to people with physical disabilities for years, I had the opportunity to work with different partners, hospitals, and institutions whereby I was got the idea that training will bring more impact.

To be specific, inadequate healthcare workforce as one of the main challenges will be solved through training.

To substantiate this claim,

• I was involved in a two years training at CCBRT Disability hospital and following those I trained, I already see them operate on many patients.
• I was able to travel across the Eastern Africa region so as to bring the specialty to areas where it wasn't available.
• The magnitude of the problem was huge, like in Tanzania, approximately 2000 new cases are born every year with cleft deformities.

Therefore it was through personal experience and discussion with different people who deal with similar projects particularly CCBRT Medical Director Mr Tom Vaneste and SmileTrain Eastern Africa regional coordinator Mr Joseph Kariuki.

The training project I have been trying to establish is particularly important to people with physical disabilities whom I have been treating for several years. Even after having become administrator at one of the public hospitals in Tanzania, I have seen it that, they can hardly be treated because most of the Surgeons are inclined to other Surgical disciplines.

While on the other hand, the country has invested tremendously on the healthcare infrastructure, with a well established regional referral Hospital in each Province, having at least a General Surgeon who provides essential surgical care, specialized Surgical service is still unavailable. The country  for example still do not have a single formally trained plastic and

reconstructive surgeon. A supplementary effort is therefore needed in order to have the patients in need treated.

Because of these reasons, I felt indebted to my patients across the country and beyond thus a need to assist in training General Surgeons  on basic cleft Surgical care so that they are able to operate on them more so close to where they reside.

Skills, background and experience:

• I have a vast experience in treating patients with such deformities having operated over three thousand cleft patients ( SmileTrain Data base), plus several hundreds not registered on the data base. I even had the opportunity to operate on the ONE MILLIONTH SmileTrain cleft patient.
• I participated in training as member of the Faculty at different workshops which were organized while working for AMREF Kenya during my three years at this Organization. A one to two weeks long workshop was conducted twice in a year with which General Surgeons from Eastern Africa were trained
• Working with 2nd Chance for Reconstructive Surgery, a Swiss based NGO, for many years organizes workshops twice annually, participating as a member of the Faculty since 2007 and this still continue the next to to take place in October 2020.
• I participated in the Consensus Conference  in Nairobi that set pace for the cleft care in Africa during which strategies for scaling  up cleft care were established as well, the Pan Africa Association for Cleft lip and Palate (PACLIP) was established. I am a founder member of this association.
• I already established and conducted a similar two years training project at CCBRT Disability hospital, twelve General Surgeons were trained some of whom continue to provide the service in different countries in Eastern Africa. I attended Surgical missions extensively since 2005 during which I was able to treat patients, provide, lectures, and hands on training to resident staff across the Eastern African Region.

The most challenging moment for was when i was given the duty to establish the department at CCBRT disability hospital. Indeed, I had just graduated and I hard sketch knowledge on this regard.

I had never heard about team building, stocking and stock control, I didnt even know much about treatment options to individuals with physical disabilities.

All that i did was to open up and welcome ideas, suggestions and I was ready to learn from anybody who was willing to share his/her knowledge ( Peers, younger or older). Again, this was the time I had to engage on reading extensively so as to boost my understanding on the assignments.

It is at this moment when, I learned the most on how to overcome a difficult scenario, in similar situations, the same has helped me for example when i joined a public institution after working in NGOs for many years. It was really hard to cope. A leader in the hospital, I hard again to learn from everyone, read guideline, manuals, government standing orders and attend training sessions relevant to this level of leadership. Am comfortably set as of now to face any challenging situation. 

My leadership potential rolled up in the year 2001 when I was charged with a responsibilities to commission services in a newly built CCBRT Disability hospital by;

• Team building (recruitment): Nurses, Doctors, Physiotherapists and supporting staff; 30 and 50 staff were enrolled.
• stocking the unit with required working gadgets.

I generously performed the duty in close cooperation and support from the hospital administration. I must acknowledge Mr Richard Hersi who was the hospital Director for his constant guide, support and training. We were able to establish functional and long lasting department.

This reputation allowed me to further employment opportunities such AMREF Kenya where I worked as a project officer between October 2006 - December 2009 and Tumbi Regional Referral hospital with 405 staff where I have been for the last three years.

At Tumbi, I work as the Medical officer In-charge having had managed to

•  Establish a cleft care program ( new service), trained one General Surgeon who is already competent enough to keep it going even in my absence.
•  Increase the number of operating rooms (from 3-5) each being well equipped
• Boost the overall working spirit of the hospital workforce.
• Established a Neonatal ICU to reduce the Infant Mortality.