Operation Hernia Mission to Keta & Takoradi, Ghana, January 6 – 14, 2018

The 9th Dutch Operation Hernia mission was undertaken in January 2018.

This year, the Dutch team, consisting of eight surgeons and six surgical residents, travelled to Accra on January 6th.  All medical supplies needed for a week of hernia surgery in Ghana were packed, and 28 suitcases made their way to Ghana.  After an uneventful flight, Ghanaian Customs let the team pass co-operatively and the first night was spent in Accra to avoid nocturnal driving to our final destinations.

On January 7th, the team was split in two: seven members made their way to Takoradi, the other half went to Keta.  Both are typical Ghanaian coastal towns, where the hospitals and their staff were awaiting our arrival.

 

Keta mission (Maarten Simons, Frank Garssen, Anne Ottenhof, Renée Barendse, Olivier Wijers, Sebastiaan Festen, Martje vd Wilt)

The Keta-team had a bit of a rough start, with a delayed bus and a driver who didn’t quite seem to know the way to Keta. Nevertheless, it was a fine way to submerge into the African way of life.   An interesting ride through the desert-like surroundings, we stopped on the way to buy a few kilos of pineapples, made the ‘Ghana-playlist’ for some music during the operations and finally made it to our lodge in Keta.  We were welcomed by our lovely host Irene, shown to our rooms and of course went for a swim in the salty Atlantic Ocean.  In the evening, we had a short briefing on the coming week while enjoying our first Ghanaian beers; the discussion as to whether Star or Club is better, has still not ended!

On Monday we made our first trip to the hospital, in the back of the pick-up truck belonging to the hospital administrator, Serene Akpanya.  Keta Municipal Hospital is a moderately-sized public hospital with an operating theatre complex including three operating rooms, where mostly emergency operations are performed.

The hospital was well-prepared for our arrival.  The Operating Rooms (OR) were reserved for the hernia operations, there were ample numbers of scrub-nurses and OR-staff and, most importantly, for the first time the local population had been informed through “What’s-app” and as a result, patients were waiting in line to be operated upon.  Of course, they first needed to be screened.  We started every day in the outpatient clinic to see whether the patients indeed had a hernia and if they were fit to be operated on.

The hernias were classified using the Kingsnorth Hernia Grading system: H1 Groin hernia, spontaneously reducible; H2 Groin hernia, reducible with gentle manual pressure; H3 Inguino-scrotal hernia, reducible; H4 Inguino-scrotal hernia, irreducible.  After the head nurse had made the daily schedule we were ready to start.  During the week the Keta-team operated on a total of 71 inguinal hernias and 14 hydroceles.  In all adult patients a Lichtenstein procedure was performed using a mesh, which was brought from Holland.   Paediatric patients were treated with a hernia sac resection alone.  Almost all patients were operated on using local anesthetic.  Spinal anesthesia was used in patients with bilateral hernias, large H3 or H4 hernias. Children were treated under general anesthesia with Ketamine.

Three local medical officers scrubbed in and learned the basic steps of the surgical procedures.

The evenings were filled with lots of good music, stories, drinks and rice with chicken or fish. Laughing was combined with an occasional cry (eg: John Denver – Leaving on a Jet Plane).  On Thursday, our last night in Keta, we had a nice dinner with all the working staff of the OR including the hospital administrator and director.

On Friday, after a few last operations and a last warm farewell including nice Ghanaian gifts we left Keta in the afternoon by bus to Accra.  Here we met up again with the Takoradi team.

 

Takoradi mission (Nanette van Geloven, Eddy Hendriks, Frank Ypma, Marjolein Leeuwenburgh, Erik Tanis, Anneke Jilesen, Oddeke van Ruler)

Our group left early in the morning heading towards Takoradi. Halfway on the long bus ride we visited Fort Elmina. Originally this fort was used for trading gold.  Later in history Fort Elmina was used for slave trading by the English, French, Danes, Swedish and by the Dutch. It was a challenging and confronting but worthwhile visit.

In the late afternoon we arrived at our hotel in Takoradi.  Our host Lillian welcomed us, and she and her staff prepared a lovely meal.  After a welcome cold drink and making the preparations for visiting the three hospitals, we turned in early for a fresh start the next day. On Monday morning we split up to three groups and we went to the different hospitals in and around Takoradi: the Hernia Wing and GPHA in Takoradi and a hospital in Dixcove (about 45 minutes from Takoradi). The hospitals were all well prepared for our visit and patients were already waiting for us. After a quick patient examination, we could start our first operation of the day. We brought our own material such as meshes, stitches and gloves, thereby not having to compromise the local medical supplies. We operated on 85 hernias, including 2 epigastric hernias, 6 hydroceles and 7 umbilical hernias.  At the end of each day we returned to our hotel in Takoradi where we enjoyed a nice evening meal and shared our experiences of that day.

Next to the sublime interactions with the local staff and patients we also learned to deal with the other African ‘experience’, namely multiple daily power failures.   At those moments there was no light, no cautery (electric knife) and even more challenging, no air conditioning.  Nonetheless, we could continue surgery with the illumination by cellphone lights of the staff, until the power was restored or the backup generator came online (if it was fueled). These challenging circumstances were especially valuable for the surgical residents joining the operation.

On Thursday we organized a dinner for all the staff of the three hospitals where Lillian and her staff served a variety of local cuisine. It was a very  valuable occasion where we exchanged the stories of the last week and some of us learned how to backpack a baby.

On Friday morning we thanked the local OR personnel with a typical Dutch delicacy, “stroopwafels”.  And we visited the children and maternity ward to handout toys and coloring books.

We went back to Accra where we rejoined with the Keta group.  In our final weekend we stayed on the beach where we shared our experiences with each other while enjoying a cold beer and a nice meal.  Needless to say, it was a special trip for all of us.  Next to the hard work, it felt great to help and give something back to the people of Ghana. We very much look forward to next year!

 

The Dutch Operation Hernia teams would like to express huge gratitude to the staff of the hospitals in Keta and Takoradi and the many locals that helped with transportation, hotel accommodation and catering. Thank you, Chris Oppong!

The following sponsors made the mission possible:

MRC Foundation

Hilversum Rotary

Unie van Vrijwilligers Hoorn

OLVG (pharmacy and Anesthesiology), Tergooi, Amstelland, Albert Schweizer Hospital, Ijsseland, VUMC and UMCG, who kindly provided materials and medications

Bard, Medtronic and Duomed for mesh

Medtronic for diathermia materials

Chris Oppong for low cost mesh