Table 7.

Care limitations due to inexperience and infrastructural deficiencies

1	Here, our main issue is anaesthesia care. Sometimes I have to leave the operating theatre to control anaesthesia, patient is not asleep during operation, have to do two things at once, it's very difficult. Sometimes we are pushed to operate because the patient is going to die without the operation.	AC
2	We have no specialists, they won't come to a district hospital, poor instruments, didn't plan this area as a theatre, buildings are poor, scrub area is poor.	AC
3	No anaesthetist, need more trained staff, need better equipment, suction machine not working, power goes off and we have no generator, do most laps without suction, hard to control bleeding when you have no lights, can't see. I'm a surgeon, paediatrician, and health secretary.	AC
4	Poor equipment and infrastructure, have to operate with the window open, no anaesthetist, just got a machine last week but no one can operate it, sterility is a problem in the theatre and ward and leads to wound infections.	MO
5	I usually just have to do it. I watch YouTube, call for assistance, we go in pairs. When you come here, you are an MD, everybody is looking at you and people expect you to do surgery when you haven't been taught. We learn at the expense of the patient. My early patients were not so lucky though now I'm more comfortable and my patients are luckier.	MO
6	You are forced to do things to help the patients, because you can't refer them to MNH [Muhimbili National Hospital in Dar es Salaam]. We are very far; patient could die on the way and sometimes relatives refuse to transfer the patient … I have to have courage, I can't leave or transfer the patient, because it won't help them.	AC
7	Difficult to refer cases because [my hospital] is geographically isolated and patients have low SES, need to operate to prevent complications.	MO

AC, associate clinician; MO, medical officer; SES, socioeconomic status.