2022年9月26日，中国第32期援桑给巴尔医疗队抵达桑给巴尔，开展为期一年的援外医疗任务，我在温古贾岛的纳兹莫加医院工作。桑给巴尔虽说实行全民免费医疗，但由于医疗资源的极度匮乏，且经济收入低下，患者只能排队“拖、等、忍”，以至于小病拖成了大病，原本简单的手术变成了困难手术。我是妇产科医生，我医疗工作的主要任务负责实施该院妇产科的微创手术、复杂手术和疑难危急重症的治疗及临床带教工作。
      记得第一次急会诊进产科手术室，时间凌晨2点。询问病情，患者约10小时前阴道分娩一足月女婴，产时出血不多，有会阴裂伤，拟予缝合，发现裂伤直达直肠黏膜，缝合困难，请求支援。咨询当班医生，怎么这么迟才开始缝合，说是太忙了，医生短缺，都是这个时候才把今天分娩的会阴裂伤依次缝合。我是一脸茫然，心情忐忑，虽然这台手术过程很顺利，术后患者会阴切口愈合良好，但是我一直心有余悸，惦记着超过六小时才缝合的会阴IV度裂伤。   
      记得2022年10月11日，我做的一台多发子宫肌瘤剔除术。常规开腹手术，一个叫尼氟的年轻医生做我助手。这个病人有三次剖宫产史，术中粘连很重，没有手术进入的空间，膀胱腹膜致密粘连。器械台上只有两把剪刀，四把血管钳，一个拉钩……反正少得可怜。我好不容易分开粘连组织，暴露子宫，没有垂体后叶素等止血药物，只好直接切开瘤体浆膜，血液直喷我脸上，幸好我有眼镜、口罩保护，才没有溅到我眼睛里。赶紧另想对策，纱布压迫创面、用尿管捆绑住子宫下段控制出血，这才耐心顺利做完手术。
      记得2023年3月26日，我诊治一患者哈吉。患者38岁，其5个月前感觉腹胀，在当地医院查出腹部有一个20CM的肿瘤，但是当时并未处理。直到感觉呼吸困难，才找到我中国医生诊治。从外表看，哈吉的肚子已经大得像孕足月了，又合并严重贫血，CT检查之后发现，肿瘤压迫肠管、顶着膈肌，导致呼吸困难，我们首先给她进行输血、吸氧等对症处理，缓解呼吸困难的症状。术前，我们联合影像科、普外科、泌尿科医生对手术进行了充分讨论和评估。经过一个小时的手术，一个重达30公斤的卵巢肿瘤，被我们完整摘除。
      记得2023年6月14日，我急会诊患者哈里玛。她剖宫产术后九天，发热、腹痛六天急诊入纳兹.莫加医院。急诊查超声和CT提示：腹膜严重血肿伴感染，腹壁蜂窝组织炎。患者情况紧急，进一步发展有感染性休克、危及生命可能。顾不得吃午饭，立即为其开始了手术。术中沿原切口进入腹腔，大量脓液涌出体外，肠管粘连包裹成团，分离粘连，见多个脓腔，吸出脓液约2000ml。近三个小时，手术成功结束。术后三天，我发现患者的腹腔引流仍然较多，24小时约500ml脓性液体，切口渗液较多。反复考虑，调整综合治疗策略，更换抗生素美罗培南抗感染治疗，并加强对症、维持水电解质酸碱平衡治疗。术后六天感染终于控制，患者肠道功能恢复，体温正常，腹腔引流和切口渗液明显减少。经过积极的手术及抗感染治疗，术后14天顺利康复出院。
      援非一年，这样的事例很多，每一次都是对我的心理极限挑战。医疗援助非洲是个艰苦的工作，非常考验中国医生的能力，因地制宜，开动脑筋才能更好更多地开展工作。

We saved the uterus of a 28-year-old woman

On 26 September 2022, China's 32nd medical team arrived in Zanzibar to carry out a one-year foreign aid medical mission, working at Mnazi Mmoja Hospital on Unguja Island. Although Zanzibar has free medical care for all, due to the extreme lack of medical resources and low income, patients can only queue up to "delay, wait and endure", so that minor illnesses become major illnesses, and simple surgeries become difficult surgeries. I am an obstetrician and gynaecologist, the main task of my medical work is responsible for the implementation of the hospital's obstetrics and gynaecology of minimally invasive surgery, complex surgery and difficult treatment of critical illnesses and clinical teaching work.
I remember the first emergency consultation into the obstetrics operating theatre at 2am. I asked the doctor on duty about the patient , she told me that the patient had vaginally delivered a full-term baby girl about 10 hours ago, there was not much bleeding during delivery, she had a perineal laceration and was going to be sutured, but she found that the laceration reached to the mucosa of the rectum, it was difficult to be sutured and she asked for support. The doctor on duty was asked why suturing was started so late, and said that he was too busy and there was a shortage of doctors, and it was only at this time that the perineal lacerations from today's delivery were sutured sequentially. I was bewildered and apprehensive. Although this surgical procedure went well and the patient's perineal incision healed well after the operation, I was constantly preoccupied with the thought of the IV degree perineal laceration that took more than six hours to close.
I remember on 11 October 2022, I performed a multiple fibroid removal. Routine open surgery with a young doctor named Nifu as my assistant. This patient had a history of three cesarean sections, heavy intraoperative adhesions, no room for surgical entry, and dense adhesions in the peritoneum of the bladder. There were only two scissors on the instrument table, four vascular forceps, and one pulling hook …… which was pitifully small anyway. I had a hard time separating the adhesive tissues and exposing the uterus, there is no post-pituitary hormone and other haemostatic drugs, so I had to cut directly into the tumour plasma membrane, the blood sprayed directly in my face, but fortunately, I have glasses, mask protection, so I did not splash in my eyes. I was able to think of another way to control the bleeding by compressing the wound with gauze and tying the lower part of the uterus with a urinary catheter, which made me patient and successful in the surgery.
  I remember on 26 March 2023, I treated a patient Haji. The patient was 38 years old and he had felt bloated 5 months ago and was found to have a 20cm tumour in his abdomen at the local hospital, but it was not treated at that time. However, he was not treated at that time. It was not until he felt difficulty in breathing that he came to our Chinese doctor for treatment. From the appearance, Haji's stomach was so big that it looked like a full-term pregnancy, and she was also suffering from severe anaemia. After CT examination, we found that the tumour was compressing the intestinal canal and pushing against the diaphragm, which led to respiratory difficulties, so we firstly gave her symptomatic treatments, such as blood transfusion and oxygen inhalation, to alleviate her respiratory symptoms. Before the surgery, we combined with the imaging department, general surgery department and urologist to fully discuss and evaluate the surgery. After one hour of surgery, a 30kg ovarian tumour was removed completely by us.
 I remember on 14 June 2023, I had an emergency consultation with patient Harima. She was admitted urgently to Mnazi Mmoja Hospital. nine days after caesarean section with fever and abdominal pain for six days. Emergency investigations of ultrasound and CT suggested severe haematoma of the peritoneum with infection and cellulitis of the abdominal wall. The patient's condition was urgent, and further development of the disease could lead to life-threatening infectious shock. Without thinking about lunch, we started the surgery immediately. During the operation, the patient entered the abdominal cavity along the original incision, a large amount of pus gushed out of the body, and the intestinal adhesions were wrapped into a mass, separating the adhesions and seeing multiple pus cavities, and suctioning out pus of about 2,000 ml. Nearly three hours later, the operation was successfully completed. Three days after the operation, I found that the patient's abdominal drainage was still high, about 500ml of purulent fluid in 24 hours, and the incision oozed more. Repeated considerations, adjust the comprehensive treatment strategy, change antibiotic meropenem anti-infection treatment, and strengthen the symptomatic, maintain water electrolyte acid-base balance treatment. The infection was finally controlled six days after the operation, the patient's intestinal function was restored, body temperature was normal, and abdominal drainage and incisional exudate were significantly reduced. After active surgery and anti-infection treatment, the patient was discharged from the hospital 14 days after surgery.
   Aiding Africa for one year, there are many such instances, and each of them is a challenge to my psychological limit. Medical aid to Africa is a tough job, which tests the ability of Chinese doctors, and they can only work better and more efficiently by adapting to the local conditions and using their brains.