Morning Report

This past week I have been attending General Surgery Morning Report. Morning report takes between thirty to ninety minutes. It is an opportunity for the young sleep deprived intern to present all the patients admitted over the past 24 hours. Certain cases or management decisions are dissected with varying degrees of civility by both attendings and more senior residents. It is remarkably like morning trauma rounds at the MGH.

The majority of the cases are emergencies admitted through the ER (or casualty as its called over here). Trauma, especially head trauma dominates. This is unfortunately in line with my observation that there are more cars and motorbikes on the roads of Moshi now. As the number of motor vehicles increase and the road safety mechanisms stay the same, the unfortunate outcome is more road trauma. Also, as KCMC is a referral hospital, a lot of these cases are referred in from other hospitals, so that they are already hours to even days out from their accident. The good news is that if they survive to KCMC, they stand a good chance of surviving in the long run.

Another large component of cases are obstructions. Usually small bowel from a hernia or internal band. Sometime a large bowel obstruction from a volvulus (twisting of the large bowel). Also appendicitis and most recently a perforated gastric ulcer from a porter up on Kilimanjaro.

The work up is usually plain x-rays. The hospital does have a CT machine, but an abdominal scan is out of reach for a lot of Tanzanians. Usually the definitive diagnosis comes from an exploratory laparotomy (open surgery) with the ethos “better safe than sorry”.

After the patients are presented and everyone has their say. The cases for the day are discussed and the department breaks for the next 24 hours.