On March 11, 2022, at 1.00 p.m. East African time, the low voice of Dr. Yang Xiaoqing of the Obstetrics and Gynecology Department was heard in an operating room of Mnazimmoja Hospital in Zanzibar saying, “Please give me 3-0 absorbable stitches, gauze….. pay attention to the blood vessels next to the adhesive intestinal tube, ready to remove the tumor, please pays attention to the patient’s blood pressure and cardiac function under anesthesia”. 

That was unusually difficult and complex huge pelvic tumor surgery that has been going on for 3 hours. Under the shadow of lamp, Dr. Yang, wearing a surgical gown labelled China Medical Team, was conducting an operation in close collaborationwith local doctors, Dr. Sabra Salum and Dr. Zeyana Abdulaziz Ibrahim.

At the very moment, the entire operating room was quite quiet except for the clinging of forceps and beeping of the monitors. The patient was about to get rid of the nightmare that had tormented her for nearly two years.

The 42-year-old patient, Hadeja Garfa (pseudonym), from Zanzibar, who had given birth to 3 children, had found a belly bulge since the beginning of 2020 which developed to the size of a full-term pregnancy by the second half of 2020. Then she went to the community hospital, where she was considered to have pelvic tumors, and was given oral medications.

But the oral medication had not taken effect by early 2021, at which time the abdominal bulge was like a full-term twin pregnancy. The patient was then referred to Mnazimmoja Hospital, where chemotherapy was recommended due to her huge tumor. After 8 times of chemotherapy the condition was still uncontrollable. By the beginning of 2022, due to her abdominal bulge and difficulties in urination, body movement, and breathing, the patient revisited Mnazimmoja Hospital for treatment.

In view of the patient’s complicated condition, Dr. Sabra and Dr. Zeyana of the Obstetrics and Gynecology Department consultedDr. Yang Xiaoqing, a member of the 31st China Medical Team for Zanzibar.

After inquiring the medical history in detail and a physical examination of the patient, Dr. Yang found that the patient’s blood system and liver function were damaged after 8 times of chemotherapy; the white blood cells were only half of normal people; the red blood cells and platelets only 60% of the normal people, with severe anemia, and previous examinations could not indicate the source of the tumor due to its huge size.

Dr. Yang Xiaoqing recommended that the patient’s entire physical condition be immediately adjusted, and the blood system and liver function be improved; meanwhile, CT and other tests be completed to initially confirm the diagnosis, and an operation be prepared.

Dr. Yang and other doctors from the Obstetrics and Gynecology Department knew that the operation would be highly challenging considering the huge size of the tumor, the patient’s physique after chemotherapy, and her history of 3 caesarean sections.

Dr. Yang contacted Dr. Lin Zenghua, a hematologist back in China, for professional opinions on how to quickly improve the function of the blood system.

Dr. Yang discussed this case with Dr. Qu Lishuai, leader of China Medical Team, other members on the team, and other gynecologists from Mnazimmoja Hospital.

On March 9, the patient’s preoperative examination was completed, and the patient’s blood system could basically tolerate this operation after careful conditioning. Dr. Yang discussed again with her team leader and members, including the gastrologist Dr. Qu Lishuai, the radiologist Dr. Liu Tingting, and the anesthesiologist Dr. Chen Hongsheng. She also consulted gynecologists Dr. Zhang Yuquan and Dr. Zhong Jianxin, the radiologist Dr. Gu Hongmei from the Affiliated Hospital of Nantong University in China, and other gynecologists at Mnazimmoja.

They discussed issues related to the safety of such surgeries, consulted the patient’s CT results, considered a huge cystic tumor of right ovarian origin, compressing the bladder, ureter, intestinal tube, etc., having adhesions to the surrounding organs, and how the patient could tolerate the heart function after the removal of the huge tumor.

In the evening, China Medical Team hosted an MDT, and all the team members, including the acupuncturist Dr. Liu Donghua, ophthalmologist Dr. Zhou Tianqiu, and the general surgeon Dr. Zhu Shajun participated in the discussion and jointly formulated the surgical plan.

On March 10, the day before the operation, Dr. Yang and the gynecology team at Mnazimmoja Hospital came to the ward early in the morning to instruct the participating surgeons to take precautions before surgery, reassure patients, prepare the medical equipment, needles and sutures for the operation. With the help of Dr. Zhou Tianqiu, Dr. Yang even made two sandbags out of sands from a nearby beach, which could be used on patients to slow down the pressure of her heart reflux after removing the tumor.

On March 11, the operation day, Dr. Yang Xiaoqing, Dr. Chen Hongsheng and other doctors at thehospital went to the ward early in the morning to check the patient’s night situation, reassured the patient. At 10:00am, the operation started.

For such a huge tumor, the difficulty of anesthesia was obvious, but with the anesthesiologist Dr. Chen Hongsheng’s real-time monitoring, close cooperation from all colleagues at thehospital, the full preoperative preparation, and Song Jianqing, Zhou Tianqiu, and other CMT members’ presence, Dr. Yang and the gynecology team were confident on the success of this surgery.

When the huge bulging abdomen was cut open, the entire subcutaneous tissue was seen to have edema.

When the abdominal cavity was opened, what came into view was a huge tumor as big as a basketball.

After the tumor sac fluid was repeatedly sucked, it was found that, behind the first tumor, there was another cystic solid tumor of about 30 cm, the upper boundary of which was almost impossible to touch.

From this tumor it was impossible to suck out the liquid, and the surrounding intestinal tubes, large omentum, stomach and so on were densely adhered.

After removing meticulously the first huge tumor sac wall, Dr. Yang Xiaoqing began to separate the tumor and peripheral adhesions with great care. For a lack of electrocoagulation equipment, she had to use suture to stop bleeding by hand. The operating room was quiet except for the ticking sound of patient monitors.

“Well, prepare to remove the second tumor, get the sandbag ready. Anesthesiologist, please pay attention to blood pressure and heart function,” Dr Yang said.

“The patient is unstable in blood pressure. Dopamine. Prepare for blood transfusions. Go to get plasma…”The anesthesiologist Dr. Chen Hongsheng and his colleagues were always there monitoring the patient’s vital signs.

“Blood pressure is OK now. It is safe to take the tumor out.” Dr. Chen made the judgment. Two huge tumors that had tormented the patient for 2 years finally left the patient’s body.

Since the patient had given birth to 3 children, the ovarian uterus was atrophied; and for unavailability of intraoperative pathology and thus the possibility of tumor malignancy could not be excluded, the patient was given a total uterus+contralateral appendage resection + large omental resection at the same time,

With the efforts of the team, the patient’s operation went smoothly and the patient was returned to the ward in good condition. The postoperative measurement of tumor volume was 35 * 30 cm, 30 * 20 cm, weighing nearly 30 kg include cyst fluid within the tumor. According to doctors at Mnazi Mmoja, the tumors are the largest they have ever seen so far.

On March 12, at 6 a.m., Dr. Yang received a text message from the doctor in the ward, saying the patient was in stable condition at night and was already sitting on the edge of the bed. Dr. Yang came to the ward early in the morning, carefully examined the incisions and health conditions of the patient, and changed the medicine for the patient.

This is a habit she developed since she was in China. In the ward, the patient was extremely excited and grateful at seeing Dr. Yang and took Yang’s hand, and repeatedly saying “thank you doctor!”

Before the operation, the patient had spent all her family savings for the treatment of the disease, Dr. Yang took out part of her personal living expenses and gave the patient Sh60,000 as support. 

According to Dr. Sabra and Dr. Zeyana, this is a very complex case.

“It is incredible that our team, under the guidance of Dr. Yang, had completely removed such huge pelvic tumors without almost no intraoperative bleeding. Without Dr. Yang, this operation would not have been possible. Dr. Yang is so outstanding.  We hope she could work here for good,” Dr. Zeyana said.

Relieving the pain of patients, sewing sandbags for patients, sewing abdominal belts, donating money and goods to poor patients. All of these are rooted in the kindness and benevolence of a doctor.

As the Hippocratic Oath says, health depends on life. A doctor is determined to do his best to eliminate the pain of human diseases, help the perfection of health, maintain the holiness and honor of medical skills, save lives and help the injured, spare no effort, persistently pursue, and strive for the development of medical and health undertakings and the physical and mental health of mankind for the rest of his life.

This is the best embodiment of the spirit of China Medical Team, “fearless of hardships, boundless love, willing to dedicate, saving lives and helping the injured”.

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