I have been travelling to Zimbabwe annually since 2012 to undertake training, teaching, mentoring, operating and lecturing in Plastic Surgery. When I first started Zimbabwe had no “home-grown” Plastic Surgeons but we have now helped to train 2 local surgeons: Dr Faith Muchemwa and Dr Kevin Nduka. Faith spent a year training with us at St Georges hospital. A third surgeon took take his exit Plastic Surgery examinations at COSECSA (College of Surgeons of East, Central and Southern Africa – http://www.cosecsa.org) in Kigali, Rwanda in December 2018. I was also the external examiner in Plastic Surgery for COSECSA until December 2019.

I previously undertook these missions on my own with like-minded colleagues paying our own way but I decided, in 2017, to link these efforts with BFirst (http://www.bfirst.org.uk), the charity arm of BAPRAS (British Association of Plastic, Reconstructive and Aesthetic Surgeons) to ensure continuity and a more reliable funding stream. Our first mission with myself leading 3 young surgeons (and 2 hand therapists) happened in January 2018: http://www.bfirst.org.uk/wp-content/uploads/2018/04/Harare-Zimbabwe-2018.pdf.

Location of Mission and challenges
Pariranyetwa hospital is a general purpose, large government teaching hospital in central Harare, the capital. In it’s heyday the hospital was wonderfully equipped and supplied. Many years of economic hardship mean that even basics like simple drugs, instruments, suture materials, masks and caps etc. are in short supply or non-existent. I take my own latex-free gloves. I have also previously taken surplus instruments out to Zimbabwe (most private hospitals here in the UK use small, disposable minor surgery sets in their minor ops theatres and I ask the lovely nursing staff to keep all those instruments that are not used!). Donations would, however, be welcome!
Patients between the ages of 6-65 have to pay for their own treatment in the Government hospital. Patients also need to bring their own food and often bedding in to hospital and most have to pay the administration towards the cost of treatment – dressings, antibiotics etc. This is another cost we hope to cover in future missions.

My contact was/is Prof Godfrey Muguti who is Chair of the Dept of Surgery at the medical school; he is a fantastic, talented old style general surgeon who has always had an interest in Plastic Surgery and was an early mentor in my career. All local surgical trainees are generic but “with an interest” and we are tasked to talk to both the broader group of surgical trainees (usually about 30) or just to the Plastic surgery interest group – about 3-4. They are all very keen and enthusiastic and experienced with trauma and sepsis!
The mission generally spends the first day undertaking formal teaching duties: we do a long clinic in the morning seeing potential patients for operating on in theatre for the rest of the week. On Monday afternoon we have done various forms of teaching including didactic lectures, tendon and nerve workshops and cadaver flap teaching for the Plastics interest trainees.

The rest of the week is spent operating on a mixture of cases with the emphasis being on training local surgeons to do the surgery with us assisting and teaching. We did the first microvascular surgery performed in Zimbabwe on our mission in January 2018. We undertake only surgical cases that we feel the local surgeons can learn from and indeed look after when we have left.

Specific Pathology
There’s plenty of post-burn reconstruction, congenital hand surgery, complex adult hand surgery, some breast recon/breast reduction and complex scars and wounds. Our follow-on resources have been very weak (therapy/dressings etc) in the past but that year we took 2 fantastic St Georges Hand Therapists who trained over 80 hugely enthusiastic therapists during the week.

This charity depends on you the donor. I continue to pay my own way but I would urge anyone who feels they can contribute to do so via this link:
Please let me know that you have contributed so that I can acknowledge your support.

Zimbabwe, Drew in Zim video_480

Drew Fleming
May 2020