BPC surgeon Paul Anderson describes his work in Zambia: treating urethral strictures and building a future service

Pual Anderson Urologist Zambia

For a surgeon accustomed to recently built West Midlands hospitals, it was inevitably going to be a dramatically different place for the morning ward round.

“I remember seeing patients on mattresses crammed into every available space,” Paul Anderson recalls of his first day in Lusaka, Zambia, southern Africa.

“My main memory from that first morning was the rainbow riot of colour: to divide the patients in such a packed space, they hung immaculately clean sheets covered in brightly coloured African designs.”

Urologist Paul Anderson had travelled to Zambia to carry out and train local medics in the treatment of urethral strictures. The urethra is a tube which carries urine from the bladder out of the body and a stricture is a narrowing or blockage of this tube.

In the UK, men with urethral strictures typically see a doctor because they are having trouble going to the toilet. In Zambia, those affected usually don’t reach a doctor until they are in retention (unable to pass urine at all), so need to wear a catheter and often have kidney problems.

“It is life limiting and life threatening for the man and in Zambia, as the main wage earner, the whole family become desperately poor because the man cannot work.”

With the right expertise, urethral strictures can be very effectively treated, enabling the man to return to a full and normal life. But in Zambia, with a population of 14 million people, there are just three urologists and none are trained in stricture repair, called a urethroplasty. So the British Association of Urological Surgeons (BAUS) Urolink section, established to share skills and training in the developing world, has launched a three-year programme in Zambia.

Mr Anderson, who carries out the highest number of urethroplasties in the UK, was invited to participate, together with fellow British urologists Susie Venn and David Dickerson.

Arriving in Lusaka at the start of April, the team’s first task was the very difficult decision of who to operate on.

“There were about 30 men in the hospital, many of whom had walked for three days to get there in the hope of being treated,” says Mr Anderson.

“We had to choose 15 men for surgery. It was a very difficult choice but we were clear about what we were doing: we wanted a wide range of patients and types of conditions so we could maximise the training we were providing for the Lusaka based team,” explains Mr Anderson, known for his regular television appearances on Channel Four’s Embarrassing Bodies and Live from the Clinic.

“We didn’t want to land in Zambia for a week, bring all our own equipment, do the operations, then pack up and leave nothing behind. We didn’t bring our own anaesthetist and brought a minimal amount of our own equipment.”

Mr Anderson and the team will return in one year’s time and for a third time a year after that, each time supporting the local urologists to do more of the operations themselves and to learn all the required skills.

“I watched one of the Lusaka surgeons after an operation, picking up the surgical instruments which he had paid for himself and watched him meticulously cleaning them. I have so much admiration for the local team we worked with. In the UK, much of what we use is single-use, so is thrown away afterwards and once I have finished an operation, I am finished and the theatre team will clear up.”

In the UK, Mr Anderson works at Dudley Group of Hospitals NHS Foundation Trust and the Birmingham Prostate Clinic. Additionally, he is an honorary consultant for injured servicemen treated at the Queen Elizabeth Hospital in Birmingham. His team were given a prestigious Military and Civilian Partnership award in 2014 for their work.

“The challenge for us at the QE is we are seeing young men with appalling injuries not seen in most areas of civilian medicine,” says Mr Anderson. “Fortunately, we are treating them in Birmingham with the very best available medical technology in an ideal hospital environment.

“This was a different challenge. I carry out more than 100 urethroplasties each year, but this was the first time I’ve worked in an African hospital. There was a risk that we could lose electricity during an operation, although fortunately that wasn’t the case. The supply of water is also a problem, so they have a giant water barrel and saline solution ready for that eventuality. They have anaesthetic gas, but it took time to get antibiotics for patients, which is never a problem in the UK.”

As well as returning to Zambia in the forthcoming years, Mr Anderson is now planning to embark on a similar project in Ethiopia.

“It is beneficial for everyone involved,” said Mr Anderson. “When I did my first operation back in Dudley, I completed it in an hour less than I would normally take. My own skills developed and I had a new perspective on all the support and equipment we have in the UK.”

Of the patients in Zambia, Mr Anderson recalls one in particular. “He was 17 and had been hit by a car three years earlier. Part of his injuries included a urethral stricture and he had a catheter ever since, with all the risks of repeated infections that brings. Now he is free from the catheter and able to work, provide for himself and his family and play a full role in the life ahead of him.”

Paul Anderson with Nenad Spasojevic, consultant urological

Paul Anderson with Nenad Spasojevic, consultant urological surgeon at the University Teaching Hospital, Lusaka who contacted UroLink asking for support