Surgical trainees with Mr Chris Oppong and other faculty members

A Multinational Operation Hernia Team, led by Mr Chris Oppong, Consultant Surgeon and Chairman of Operation Hernia, have just returned from Rwanda.

Surgical trainees with Mr Chris Oppong and other faculty members

Surgical trainees with Mr Chris Oppong and other faculty members

The course faculty drawn from the UK, Germany and Austria trained 14 first year Surgical Residents in both mesh and tissue repair of groin hernias.

Lectures on almost all aspects of groin hernia surgery were delivered on the first two days of the training course. The most important lecture, on the anatomy of the groin, was delivered by Dr Ralph Lorenz, Consultant Surgeon from Germany. The lectures were followed by hands-on, one-to-one Operating Theatre training at the Central Teaching University Hospital of Kigali (CHUK) and Rwamagana Hospitals. This occupied the next 5 days.

Overall it was a very successful programme which provided essential, high quality training to Rwandan postgraduate surgical trainees. Operation Hernia is most grateful to the other members of course faculty; Mr David Sedgwick (UK), Dr Maik Lechner (Austria), Dr Albrecht Frunder (Germany) and Dr George Ntakiyiruta from Rwanda.

Lecture on the anatomy of the groin

Lecture on the anatomy of the groin

Inguinal hernia repair with affordable (low-cost) polypropylene mesh

Inguinal hernia repair with affordable (low-cost) polypropylene mesh

For this important surgical training course Operation Hernia was in partnership with the Rwanda Legacy of Hope charity. Operation Hernia is also extremely grateful for the enormous support and hospitality received from the Rwandan Ministry of Health and the Government of Rwanda.

Following the visit by the Operation Hernia Team an article outlining the visit and its achievements was publishd in the New Times, Rwanda’s Leading English Daily Newspaper:

http://www.newtimes.co.rw/section/article/2017-03-14/208886/

Chris Oppong

Surgical trainees in the operating theatre. The "Safe Surgery Checklist" can be seen in the background.

Surgical trainees in the operating theatre. The “Safe Surgery Checklist” can be seen in the background.

Friday 28th October 2016

OPERATION HERNIA – NEWSLETTER OCTOBER 2016

Dear Partners,

SUCCESSFUL FIRST COSECSA/ OPERATION HERNIA TRAINING

I am pleased to inform our partners of the success of the first COSECSA/OPERATION HERNIA TRAINING held in Uganda from September 2-9, 2016.

Operation Hernia was recognised by The College of Surgeons of East, Central and Southern Africa (COSECSA) as Trainers in Hernia Surgery in 2015. Nsambya Hospital in Uganda was designated the COSECSA Hernia Centre.

Ten surgical trainees were taken through a comprehensive hands on training by four Consultant Surgeons – Chris Oppong, Roger Watkins, Prof Jacob Akoh all from Plymouth and Tim Brown from Swansea. The 6-day hands-on apprenticeship was preceded by a day of lectures on all relevant aspects of hernia surgery.

Outcome

I am delighted to announce that the training programme has been an overwhelming success. This is evidenced by the very positive formal feedback from the trainees, assessment by Prof Kakande of COSECSA and his team of surgeons and feedback from the trainers.

At the completion of training the competence of trainees was assessed formally using the UK Royal Colleges of Surgeons assessment tools.

1. Five trainees were assessed as “Able to perform Lichtenstein operation independently”.

2. Four were assessed as “Able to perform with minimal supervision / occasional help”.

3. One was assessed as “Able to perform with supervision”

Prof Kakande has suggested that we repeat the training in the Northern COSECSA sector. This has already been scheduled for May 2017.

Recommendations

Various recommendations proposed by the trainers were discussed at a debrief meeting with Prof Kakande and his team. This included a proposal that fortnightly hernia session be organised to help the trainees further develop and maintain their acquired skills. The first of such follow up training sessions was successfully completed on October 8, 2016.

Thanks for recognition of OPERATION HERNIA Trainers

On behalf of the board of Directors of Operation Hernia and on behalf of the four consultant trainers, I would like to thank the Executive Committee of COSECSA for the trust placed in OPERATION HERNIA consultants and for the opportunity to serve COSECSA and the surgeons of the future. The outcome of the training programme has more than justified the trust.

We hope this programme will become a regular part of COSECSA curriculum, in order to benefit other trainees.

Chris Oppong

Consultant Surgeon

Chairman, Operation Hernia.

Missions

REPORT FROM HO MISSION NOVEMBER 14-21, 2015

This was the third Operation Hernia mission to Ho Hospital. The first mission was in 2012.

The team comprised the following members:

Coordinator: Miriam Adedibe Surgical Registrar;

Consultant Surgeons: David deFriend, Prof Guido Schuermann, Prof Odd Mjaland,

Surgical Registrars: Naami MCaddy and Sebastian Galler

Travel to Ho

Following arrival in Accra the team stayed overnight at the Baptist Guest House in Accra on November 14. All team members met with Chris Oppong for a briefing. The team travelled to Ho hospital the following day. They were met by Dr Geoff Nyamuameh, senior surgeon who took the team on tour of the hospital.

Accommodation and food

We enjoyed very good accommodation. We were hosted at Chances Hotel. This was specially arranged by Dr Ben Gbeve, a retired Plymouth Orthopaedic Surgeon whose nephew owns the hotel.

Theatre Sessions

We occupied three theatres for 4.5 days. One consultant and one junior were assigned to each – this allowed for maximum teaching. The 4th theatre was left for Ho Hospital to fulfil their emergency commitments.

It could not have been used as an extra theatre because it was impractical for us to do so due to:

1) A paucity of simple cases

2) Equipment/sterilised packs – Sister Lucy was struggling to equip the three theatres already running

3) Low staffing – again, Sister Lucy and the nursing staff pulled together and worked beyond their usual hours to complete this mission.

Outcomes

The total number of procedures performed was 80 and there were no early complications.

Post-operative patient reviews on the ward were performed by one of the visiting team when time allowed, otherwise the home team managed the patients.

Home Visit

As a first by the Operation Hernia team, 3 patients were visited over Friday afternoon and Saturday morning at their homes. The patients were happy to see the team and it was a wonderful opportunity for Operation Hernia to see the patients in their home environments.

This excellent idea had been suggested by Prof Guido Schuermann.

Debrief

1. Safety issues highlighted by team members included: sharps handling (scalpels should be handed over in a dish), swab count (not rigorously performed for each operation)

2. Worn-out needle holders

3. Diathermy: worn out accessories

This first section of the report was coordinated by Miriam Adedibe. Individual Team Members have provided their own additional comments and these are detailed below:

1. Prof Guido Schuermann

The Ho mission was a great success. The team was just perfect and it was very helpful that Naami and Miriam were with us. The hospital was well equipped and we could run three operating theatres for the whole week. We did more than 80 cases – most of them with huge hernias – without any major complication perioperatively.

The staff were excellent, highly motivated and very well trained. The hotel was the best I have ever seen in Ghana, all making it a very enjoyable and successful mission.

I thank the whole team for taking Sebastian and myself, for the friendly atmosphere and for the collegial and friendly exchange of ideas. It was just a great week!!

2. Miriam Adedibe

I fully echo Guido’s sentiment. The mission was a success in every way.

We completed the list of hernia repairs, totalling 81 cases, and most of these were relatively complex H3 cases. Many thanks for supporting me as the administrator/team leader. It was an unexpected opportunity from which I learned much. The team worked well together and were very helpful with suggestions on how to increase our efficiency in theatre. A special thanks to David (whose seniority and expertise was invaluable in many situations) and Naami (my co-pilot).

3. David deFriend

I can only say what a privilege it was to be part of such a great team and to have the chance to work with wonderful local staff and patients. Thanks to Miriam and Naami for organising us so well and for the report. I can’t think of anything to add except to say that I very much intend to go on another mission and would be honoured to work with all or any of you again. It went by so quickly that it almost feels like I never went away now that I’m back to the day job!

Chris, thanks again for the opportunity and it was great to see you.

4. Odd Mjaland

I am filled with great memories of a fun an interesting mission and happy to have made such nice friendships at my mature!!!! age. I felt young and revitalized when getting back to the frozen lakes and minus 7 in Norway. The cases were challenging but as I see it, the quality of our work could not have been much better. Working close with Naami was inspiring, the trailblazing energy of Miriam gave the group an energy boost that lasted long beyond the flight back home. I shall be back!! Miriam’s report covers our mission well and I would echo the comments about the problems with worn-out needle holders and diathermy equipment, areas for potential improvement.

Missions

November 2015 “Operation Hernia” Mission to Bole, Ghana

Visiting Team

John Budd – Team Leader – Vascular and general surgeon

Anna Budd – Theatre nurse

Graham Howell – Urologist and previously a general surgeon

Rosemarie Howell – Theatre nurse

Travel Itinerary

Direct BA flight London Heathrow to Accra arriving 21.30 on 14th November

Overnight stay in Accra at the Baptist Mission Guest House. Meet, greet and brief with Chris Oppong and teams heading for other destinations.

Nissan 4×4 road transfer to Bole: depart Accra 06.00 and arrival at 16.00

Return to Accra by road on 21st November with wash up at the Guest House and return flight to London departing 22.00

Accommodation

The Cocoa Research Institute Guest House ½ mile from the hospital in Bole provided comfortable and clean accommodation with full board and air conditioning if required. Morning pick up was at 07.30 and return at 19.30.

Surgical Achievements

The team carried out 112 elective procedures in 97 patients as follows:

Adult Inguinal hernias 61 Inguinal Herniotomies (children) 15

Femoral hernia 1 Umbilical hernia 1

Hydroceles 18 Epigastric hernia 2

Lumps and bumps 8 Minor ano-rectal surgey 1

Four Emergency procedures were also performed:

Laparotomy and splenectomy for trauma

Appendicectomy for gangrenous appendix

Laparotomy and repair of perforated distal ileum for blunt injury

Caesarean section and tubule ligation

Training

Basic surgical training and some surgical skills were imparted to Dr Asiz and Dr Gerald, two newly qualified general doctors.

Nurse training included theatre skills for the nurses and concept of swab count for laparotomies.

This was a return trip to Ghana for John and Anna and a first visit for Graham and Rosemarie – deferred by the West African Ebola epidemic the previous year. The plan had been to visit Keta on the coast but there was a greater surgical need in Bole despite another teams endeavours the previous week, and we headed up country in the Bole Hospital Nissan pick-up truck on metalled roads. The 50 miles of potholes and craters on first leaving Accra had fortunately been resurfaced since John and Anna’s previous visit 3 years ago. The 10 hour journey was remarkable by its near misses and our passing 19 overturned lorries en route.

We had very comfortable and clean accommodation in the Cocoa research institute guest house and the food was a very pleasing combination of local and European fare.

We were warmly welcomed by the hospital director and the theatre and ward staff. Our surgical day began on the ward each day soon after 7.30 with a pre-operative examination of the day’s patients with surgical marking and a review ward round for those who stayed overnight on day 2 onwards. We used both operating theatres available. Each is now equipped with effective air condition units which made the operating environment quite comfortable. We were most impressed by the ability and humbled by the enthusiasm of all the theatre team.

There were two very capable and experienced nurse anaesthetists – Vitus and Michael. The strategy was to use spinal anaesthesia for the adult patients with very large, irreducible hernia or large bilateral problems whilst the children were given IV Ketamine. There was a modern anaesthetic machine in the main theatre and pulse oximetry and Valley Lab/Eschman diathermy units in both theatres. The laparotomies were done under GA and the Caesarean section under spinal anaesthetic.

John had brought a substantial supply of disposables including mesh, syringes, needles, local anaesthetic, sutures and diathermy pads/pencils. The BMI Bath Clinic had kindly supplied the bulk. It would have been difficult to have managed without the imported supplies and the hospitals own resources were preserved as a result.

We were assisted for some of the operations by Dr’s Asiz and Gerald who were recently qualified doctors with an interest in surgery and there was some time to help them with surgical skills . Dr Joe, the Hospital’s resident doctor, was very supportive and we were fascinated to hear of his WHO secondments to Liberia as part of the Ebola effort and to Ethiopia with the Polio eradication programme.

Some of the hernia repairs were challenging and very worthy of our visit. The diathermy finger switch devices tended to degrade with recycling and we encountered a diathermy pad burn for reasons which weren’t immediately obvious. We had no returns to theatre but disappointingly our splenectomy patient failed to regain renal function post-operatively and died of multi-organ failure within 36 hours. It was a busy week of operating made light by the enthusiasm and hard work of the Bole staff. There was a very positive ambience in theatre and laughter reminding us of the surgical careers of our youth.

Anna and Rosemarie visited the local market on Friday morning kindly escorted by Agatha, one of the theatre nurses, to help with the robust matter of negotiating prices!

We spent our evenings in the guest house discussing how best to resolve the world’s problems but failing somehow to reach a solution. Our final evening in Bole involved a great send off by the theatre team in a down town hostelry and our introduction to BBQ’d chicken gizzards. We were honoured to receive traditional headman’s robes. We renewed and made friendships and look forward keenly to a return visit.

Graham Howell 29/11/2015

Missions

TEAM REPORT FROM NALERIGU MISSION: NOVEMBER 7-14, 2015

This was a good mission to the Baptist Medical Centre at Nalerigu in Northern Ghana. This mission was significant for the fact that the second Guido-Cordula Fellow, Dr Mohammed Bukari was a member of the team.

Team Leader: Chris Oppong

Members: Nazzia Mirza (Consultant Surgeon), Sandra Stanton (Theatre Nurse), Dr Mohammed Bukari (Surgical Registrar at Komfo Anokye Teaching Hospital).

Travel November 7, 2015

The team stayed overnight at the Baptist Guest House in Accra. The hour’s flight to Tamale, Ghana’s northern city, on the following day was seamless. This was followed by a 2-3 hour journey to Nalerigu in a hospital 4Wheel Drive vehicle. The road was in parts very bumpy!!!

Accommodation and food

We were provided with very good accommodation. Food was provided by a local chef who would do extremely well on the UK “master chef” TV programme. The accommodation is set in a leafy area of the hospital compound which also houses hospital staff. The morning walk from our accommodation to the hospital was an enjoyable experience. Wi-Fi was available in the “business office” but there were some issues with the network

Theatre Sessions

We met with the whole of theatre team. This was to affirm each member of the theatre team and share our ethos for the week: team work to deliver quality treatment to as many patients as we can manage with compassion and efficiency. We were all encouraged to wear name bands to help with integration of the team and to break down barriers. The WHO check list was used in parts. The whole team worked as a family. The nurse anaesthetists were excellent. The theatre lead and all the staff were very cooperative.

Training

The Fellow, Dr Bukari, was trained in mesh repair and performed 15 procedures independently in addition to 5 procedure performed assisted by a Consultant as part of his training.

Outcome

Total number of procedures performed was 49 (Hernias 43, including 11 herniotomies in children (26% of hernia patients); Hydrocoeles 4; Lipoma 1; with one return to theatre. Many more patients would have attended for surgery with improved communication and organization.

Post-operative complications

We had only one early complication. A poorly nourished adult male became septic after repair of a large scrotal hernia. He was returned to theatre for evacuation of scrotal haematoma and made a good recovery.

Debrief

A most important final event was a closing debrief meeting of all theatre staff and medical staff, including the Medical Director. There was an open, honest feedback from both the hernia team and the theatre staff. The highlights of the feedback were the following points:

1. The hard work of all team members was acknowledged and commended.

2. There is a need to improve communication with all hospital staff during the planning stages of future missions. This will facilitate better recruitment of patients.

3. Theatre requirements could be more effectively communicated to hernia team.

4. Decontamination and sterilization of diathermy pencils and cables was reviewed. It was agreed the pencils and cables would be cleaned with antiseptic and sterilised in antiseptic solution until required for surgery.

5. The hernia team thanked all the theatre and medical staff for the support received.

6. A group photograph was taken to remember the mission.

Chris Oppong

Consultant Surgeon and Chairman, Operation Hernia

Tuesday 25th November 2014

UPDATE ON ESSENTIAL (GLOBAL) SURGERY – NOVEMBER 2014

Chris Oppong, Chairman of Operation Hernia, attended the Netherlands Society for International Surgery Symposium on “Surgery in Low Resource Settings” in Amsterdam from November 14th to 16th, 2014.

There were some important highlights that may be of interest to Operation Hernia partners.

1. International Collaboration for Essential Surgery: 15 x 15 Campaign

15 x 15 is a campaign by the International Collaboration for Essential Surgery (ICES) http://www.essentialsurgery.com/ and Operation Hernia is a Supporting Body of ICES. Hernia Surgery is one of the 15 Essential Surgical Procedures. The ICES website explains that the campaign focuses on promoting the 15 essential interventions that can take care of the basic surgical needs of any community. 15 x 15’s overarching goal is to ensure that Essential Surgery is recognized as a priority for primary care policies, practice, and research by 2015. The 15 x 15 campaign aims to increase access to Essential Surgery through:

Piloting — innovative models for task shifting and training non-MDs to perform surgery
Advocating — for essential surgeries to be integrated into existing health systems
Informing — the field through research, publications, and screenings of The Right to Heal

The Right to Heal is a film that sheds light on the neglected issues of surgical care globally, and the need for organizations and individuals to unite in bringing essential surgery to poorly-served areas of the world. Please visit the ICES website (http://www.essentialsurgery.com/the-right-to-heal/) to watch a trailer of The Right to Heal or http://vimeo.com/91687421 to watch the full film.

2. The Role of the World Health Organisation (WHO) in Global Surgery

This was the keynote lecture delivered by Dr Meena Cherian who leads the WHO Global Initiative for Emergency and Essential Surgical Care. She is a Professor of Anaesthesia, having originally graduated from a University in India.

Dr Cherian announced that the WHO will at its meeting in May 2015 formally approve of Essential Surgery as part of its Global Health agenda. This will be preceded by approval by the WHO Executive Board at their meeting in January 2015 and will bring hope to the 2 billion people who lack access to basic surgical care. It will be the culmination of years of campaigning by various bodies and individuals to persuade the WHO to end years of neglect of basic surgery as an essential part of the WHO programme to improve global health.

3. Edna Adan University Hospital, Somaliland www.ednahospital.org

Edna Adan thrilled the meeting with her eloquent presentation of her achievement in establishing a successful healthcare system in Somaliland from the ruins of a war. Born in Hargeisa in1937, she was trained as nurse and midwife in the UK. In 1961 she returned home becoming the first qualified midwife in Somaliland. Her career for the WHO started in 1965. In 1991 she became WHO Representative in the Republic of Djibouti where she served until retirement in 1997. In 2002 she became the first and only woman Minister in the Government of Somaliland when she served as Minister of Social Affairs, and between 2003 and 2006, she was Somaliland’s Foreign Minister. For her impressive work she has received numerous awards and she has been invited to several international conferences, like the Lancet Commission of Safe Surgery. In order to reduce the high maternal mortality rate of the women in her country, her lifetime goal is to train 1,000 midwives to work in remote areas in Somaliland and encourages other countries in Africa to train one million midwives to work in African countries with similar harsh conditions for women like Somaliland.

Dr. Shukri is a remarkable young doctor. She became one of two first female doctors in Somaliland. First she graduated as a midwife at the Edna Adan Hospital. Due to her talent and motivation she received sponsorship to go to medical school. After graduation in 2011 she was one of the first female medical staff members of the Edna Adan hospital. This ambitious lady is still improving her skills. She became the first national trainer on infant resuscitation. Dr Shukri is currently focusing on surgery and recently performed her first obstetric fistula operations.

4. E-Learning with 3D visualisation for training

Theo Wiggers a retired surgeon presented a novel e-learning module with 3D visualisation for training surgeons. This will be piloted in Ghana during an Operation Hernia mission led by Dutch surgeon, Maarten Simons.

5. College of Surgeons of East, Central and Southern Africa

The College of Surgeons of East, Central and Southern Africa (COSECSA) is an independent body that fosters postgraduate education in surgery and provides surgical training throughout the region of East, Central and Southern Africa. COSECSA is a non-profit making body that currently operates in 10 countries in sub-Saharan Africa: Burundi, Ethiopia, Kenya, Malawi, Mozambique, Rwanda, Tanzania, Uganda, Zambia and Zimbabwe.

Prof Jani, Secretary General of COCSECA, presented the innovative model for training of surgeons in the COSECA region to improve the critical shortage of trained surgeons. Operation Hernia is now exploring possible collaboration with COSECSA to be involved in training in hernia surgery.

Chris Oppong,

Chairman, Operation Hernia

November 24, 2014

Operationn Hernia team in Rwanda

OPERATION HERNIA MISSION TO RWANDA – FEBRUARY 2014 REPORT BY CHRIS OPPONG, CHAIRMAN OF OPERATION HERNIA

INTRODUCTION

The OPERATION HERNIA/LEGACY OF HOPE MEDICAL MISSION to Rwanda 2014 was the largest this year. It was led by Chris Oppong, a UK Consultant Surgeon who is the Medical Director of Operation Hernia. A UK medical team of four teamed up with a team of 13 from Germany, led by Ralph Lorenz. We were attracted back to Rwanda by the burden of need but also by the legendary warm welcome which awaits volunteers and visitors.

Operationn Hernia team in Rwanda

Operationn Hernia team in Rwanda

We linked up with LEGACY OF HOPE for the RWANDA Project. Legacy of Hope is a church-based registered UK Charity. They operate from Plymouth which is also the base of Operation Hernia. Operation hernia provided the UK and Germany teams. This year we had a solo Plastic Surgeon who works in the UK. Ralph Lorenz, a Consultant Surgeon, is the Operation Hernia Ambassador in Germany.

The aim of OPERATION HERNIA/LEGACY OF HOPE MEDICAL MISSION is to deliver sustainable, high quality medical care to relieve suffering from burden of disease in Rwanda and to train local doctors, nurses and other healthcare workers.

BURDEN OF HERNIA DISEASE IN RWANDA

Hernias are more common in Rwanda than is commonly thought. In fact the estimated burden (prevalence) of hernias in Rwanda is 5.78%3. This compares with 5.36% in Tanzania1 and 3.15% in Ghana in West Africa.2 Repair of Hernias with polypropylene mesh (Lichtenstein technique) has become the standard in high income countries. In low resourced countries high tension, sutured repair is standard because of cost of branded mesh and lack of skill. Resultant high recurrence rates increase the total cost of treatment of hernias. Mesh repair of hernias averts significant number of disability adjusted life years (DALY)4.

HOSPITALS

Last year, OPERATION HERNIA/LEGACY OF HOPE MEDICAL teams worked in two mission hospitals: Nyamata and Remera-Rukoma hospitals. This year we worked in two additional mission hospitals: Kirindi and Gahini hospitals. The new Hospitals were represented by the Medical Director of the Association of Presbyterian Hospitals, Dr Esperance. Nyamata, Kirindi and Gahini hospitals hosted Hernia surgery. Remera-Rukoma hospital hosted hernia surgery and plastic surgery. The latter is an expansion of the medical programme of LEGACY OF HOPE. Training of local doctor was a high priority and this was provided in Kirindi and Gahini hospitals.

PATIENT RECRUITMENT

This year’s recruitment was a massive success. The publicity for the programme was mounted by the Rwandan Ministry of Health for all the four hospitals involved in the project. This is because of the vital link established between the project and the Rwandan Ministry of Health. This link was negotiated by LEGACY OF HOPE (LOH), led by Pastor Osee Ntavuka. Legacy of Hope is officially recognised by the Rwandan government and OPERATION HERNIA (OH) is a partner of LOH.

The success of recruitment was in part due to the involvement of Dr Esperance, the Medical Director of the Presbyterian Hospitals.

A young boy with an inguinal hernia being assessed prior to surgery

A young boy with an inguinal hernia being assessed prior to surgery

TRAVEL AND CUSTOMS

All equipment brought by the teams were cleared for customs by the Ministry of Health because of the official recognition given to LOH.

MEDICAL REGISTRATION

The OPERATION HERNIA/LEGACY OF HOPE MEDICAL team is in a unique position in Rwanda regarding registration of the medical team by the Rwanda Medical Council (RMC). We are grateful to Pastor Osee through whose efforts, all the doctors on the project have been given a 5-year registration by the RMC. This includes registration as Continuing Professional Development (CPD) providers. This is an invaluable platform on which to expand the work of OPERATION HERNIA/LEGACY OF HOPE MEDICAL team in Rwanda.

ACCOMMODATION

The teams stayed overnight in Kigali, the capital. Accommodation in Kigali was in a hotel. During the week, all volunteers were accommodated by the hospitals who also provided subsistence. Volunteers paid for their hotel accommodation in Kigali.

TRAINING OF DOCTORS

This training programme was registered by the Rwandan Medical Council for CPD points. A total of 13 local doctors received training in two hospitals. All but one of the doctors had skills in hernia surgery. The training programme included formal teaching on anatomy and the essentials of mesh hernia repair. This was delivered by PowerPoint. Trainees then had hands-on training –

Assisting OH surgeons
Assisted to insert mesh in at least two cases.
A few had opportunity to do more cases.

At Gahini hospital, trainees were presented with certificates to recognise their attendance at the training sessions. Five doctors adjudged to be competent at the end of the 5 days were given mesh to use in their hospitals. All the cases they perform will be documented for review when the team visits in 2015.

Chris Oppong presenting a certificate of attendance at a training session to one of the local doctors

Chris Oppong presenting a certificate of attendance at a training session to one of the local doctors

CLINICAL OUTCOME

A grand total of 166 operations were performed in all 4 hospitals.

A total of 132 cases of hernias and hydrocoeles were performed in all centres. 33 plastic surgery operations were performed at Remera Hospital.

Table 1

Table 1

CLINICAL OUTCOME

A grand total of 166 operations were performed in all 4 hospitals.

A total of 132 cases of hernias and hydrocoeles were performed in all centres. 33 plastic surgery operations were performed at Remera Hospital.

Table 2

Table 2

Change of policy.

Because of the complication in the 5 year old, it was decided at Gahini hospital to postpone surgery in all children under 9 until 2015 when hopefully a consultant anaesthetist would be part of the team.

MEDICAL EQUPIMENT DONATED

OH/LOH provided and donated a large amount of medical equipment to the various hospitals.

The total estimated cost of medical equipment was £39,000.

ACKNOWLEDGEMENTS

Ministry of Health

Our prime thanks go to God who is the provider of all goodness.

We would like to register our profound gratitude to the Minister of Health for the tremendous support the team has received. Our thanks also go to François Habiyaremye and all the other officials.

Medical Teams

It is appropriate to acknowledge and congratulate the effort of all the medical team for volunteering significant financial resources, annual leave and other resources to provide the people of Rwanda with such excellent medical care. All team members are motivated by a passion to care by employing their clinical skills to provide relief of suffering and transfer of their skills to the local healthcare stakeholders.

The Medical Team would like to express sincere thanks to the following stakeholders.

Minister of Health
Ministry of Health officials
Rwanda Medical Council
All Medical Directors
Staff of all hospitals
The Head of the Presbyterian Church
Dr Esperance, Medical Director of Association of Presbyterian Hospitals

FUTURE PLANS

The OPERATION HERNIA/LEGACY OF HOPE MEDICAL MISSION will continue to cooperate with the RWANDA MINISTRY OF HEALTH to expand the coverage of our care. This will be clearly detailed in our Plan of Action for 2015.

CHRIS OPPONG, CHAIRMAN OPERATION HERNIA

REFERENCES
1. Beard JH, Oresanya LB, Akoko L, Mwanga A, Dicker RA, Harris HW
An estimation of inguinal hernia epidemiology adjusted for population age structure in Tanzania.
Hernia 2014: 18: 289-95

2. Beard JH, Oresanya LB, Ohene-Yeboah M, Dicker RA, Harris HW
Characterizing the global burden of surgical disease: a method to estimate inguinal hernia epidemiology in Ghana.
World J Surg 2013; 37: 498-503

3. Beard JH, Oppong FC
Epidemiology of Inguinal Hernias in Rwanda.
(To be published)

4. Shillcutt SD, Clarke MG, Kingsnorth AN
Cost-effectiveness of groin hernia surgery in the Western Region of Ghana.
Arch Surg 2010; 145: 954-61

Report of Operation Hernia’s Mission to Ho Volta Regional Hospital
November 2013

The Stats!

Location

Volta Regional Hospital in Ho, located in the Volta Region to the west of Ghana
Approximately 3 hours drive from the capital city, Accra

Personnel

From the UK: 3 consultant surgeons, 2 surgical registrars, one scrub nurse
Charge nurse Sister Josephine, who managed everything!
More than 10 theatre staff who rotated between recovery and theatre
Experienced anaesthetic nurses who could give spinals faster than we could scrub!

Patients

98 patients were recruited, 97 patients operated

Facilities

Initially three theatres, with the fourth emergency theatre being made available to us on the final 2 days.

Fixed operating lights and mobile lights
Sutures, gloves, instruments and mesh were brought by the team
2 diathermy machines present from previous trips, we brought a third
Unfortunately no air conditioning was available due to maintenance

Hospitality

We received 5-star treatment from hospital administration and theatre staff
Food and water between cases
Constant care and attention to our every need!

The Story

We congregate at the Baptist Guest house prior to departing to Ho. We meet Mr Oppong who has already arrived early, full of energy and knows everyone’s name. We all feel instantly special. We meet Bernard our hospital representative, who has already been coordinating things behind the scenes. A quick breakfast is followed by us loading up into our respective vehicles and the journey to Ho begins. It a beautiful 2.5hr trip, but one full of contrasts. The beautiful lush landscapes give way all too frequently to little townships, were the even from our vehicle we can see the poverty that so many live in. Grand buildings are side by side with mud huts, small mansions next to tin shacks. Our driver is enthusiastic, and often has to be reminded that we are not thrill seekers. The road is in relatively good condition with the usual perils of overloaded motorcycles, formula one-esque taxi drivers and the ubiquitous tro-tro (public minibus).

Our prayers are answered and we arrive safely at our accommodation. Our residence can only be described as beautiful. To say more would be to tempt you to join the mission for all the wrong reasons!

After a brief lunch we visited the Volta Regional Hospital. We meet the director of surgery, his administrator, head of finance and a senior surgical resident. We are welcomed into a conference room as if we were visiting dignitaries! After introductions and a heartfelt welcome it is time to see the rest of the hospital and staff. It’s a relatively new building, we are told as we walk around. All the buildings are bungalow style sprawling as far as eye can see. Fortunately the walks between the buildings are shaded. The first thing commented on however by our senior visiting surgeon was the ample parking available. I think this alone made his day!

On to the ward to see the patients preoperatively. They have been selected over a period of months, and are eagerly awaiting our arrival. As we enter the ward they have been patiently waiting for us and applaud spontaneously. After a warm welcome by the ward sister, complete with crushing hugs, we begin to see the patients. All the patients are admitted the night before surgery. We reviewed 21 patients, there was only one DNA. What impressed all of us was how organised the nursing and medical teams had been. From blood results to simple clinical notes, everything was in place, and we were able to review and assess all the patients in just over an hour. An impossible feat in the UK! We returned back to our accommodation in the evening, arms full of food that had also been gifted to us.

The week is made up of grueling 15 hours shift days where we operate, ward round, clinics and data collect tirelessly, whilst supported by the brilliant hospital staff, who do overtime to allow us to finish the cases. Our fatigue is quickly forgotten when we see the gratitude of the patients when their operation is completed. Most have travelled many miles to arrive, and wait patiently for their turn with no complaints.

We were pleased to finish all operations successfully on Friday with no complications. We were rewarded with our first social night out where we went for dinner and drinks, dressed in traditional wear that had been gifted to us by the Hospital staff. We left the following day, all of us promising to return the following year!

Special Thanks

To all the theatre staff at Volta Regional Hospital, Bernard, and Mr Chris Oppong.

Miriam Adedibe

Naami McAddy

Outside the OR

Alyssia McEwan reports
November 2012

Outside the OR

Outside the OR

Medical Student Experience (Alyssia McEwan) – Operation Hernia – Ghana, Nov 2012

Africa. I really had no idea what I was getting myself into when I bought my plane ticket to Accra, Ghana. It had taken a year to solidify the plans to join the Operation Hernia team – a year filled with board exams, medical school rotations, and sleep deprivation. It was hard to believe that the day had finally come to board the flight.

My first impression of Accra – the heat was sweltering! After traveling 10 hours from New York City in the aftermath of Hurricane Sandy, the hot African sun beating down was particularly impressive. I had already begun to feel the camaraderie and team mentality that was brewing amongst the United States members of our Operation Hernia Team. Our portion of the team was composed of: Dr. Pedro Cordero, the surgeon from the US team who I had the privilege of working with during my third year surgery rotation and who was instrumental in my being involved in this mission; Aida St. John, a theatre nurse who I had worked with also during my surgery rotation; Carol Turner, a traveling theatre nurse who I met for the first time on this mission; Peter Dixon, a surgical resident from New Jersey; and myself, a fourth year medical student from NYC. From the very beginning of our journey – dealing with missing documents, our bus breaking down on the way to the airport and a variety of other minor meltdowns – it was clear that we were bonding, whether we liked it or not!

The first time that we were all together with the entire team was outside the house where we were staying in Accra. Meeting the Chair of the Board of Trustees of Operation Hernia and lead consultant of the UK team, Dr. Chris Oppong was wonderful – he greeted me with a huge hug and said “call me Chris!” which broke any barriers of formality that could have theoretically been in place. We met the two registrar surgeons from the UK that morning (after a brief hello the night before)– Dr. Surajit Sinha and Dr. Frank McDermott. Immediately it was clear that we would all get along and that this was going to be an extraordinary trip.

The trip from the capitol city of Accra to the much smaller town of Ho was eye opening. Little tiny villages speckled amongst lush green countryside. Small children running around in near-nothing, women dressed exquisitely in form fitting clothing of the most captivating colors, people carrying a variety of items in baskets on their heads, goats, and a lot of selling, trading and working. Structurally-sound thatch roofed houses and above all a sense of community which was obvious in each of these villages, even while driving past at 55 km/hr. The smiles on the faces of the people were unlike smiles that I have ever seen in the United States – these were smiles portraying honest happiness. I kept asking myself “what do these people look forward to?” “what do these people worry about?” – the answer, I imagine comes down to the basic needs of human beings – food, shelter, water, family – the things that actually matter in this world. How different than what so much of the world thinks of.

I found our welcome to Ho Hospital unexpected. An impressive number of regional officials and hospital administrators joined in to welcome our team. There was a lot of this during our stay, lots of introductions to important people and making connections. Though, in my mind, none of these people were as important as the people who we met later that day, our patients.

We entered the doors of the ward that evening to see the patients who we would be operating on the following day. I had seen a handful of hernias over the past year but I had never imagined hernias like this. Basketball-sized masses extending into the scrotums of these men – one after the next. Its difficult to imagine how they managed for the many years that most of these men were carrying these burdens. How they could work and provide for their families is a mystery to me. These men were unlike any pre-op patients that I had ever come across. There was no air of nervousness or being frightened or any requests or questions. They were stoic and ready – ready for surgery and ready for their new lives.

The following day was day 1 in the operating theatres. We met the theatre staff who we would grow to love by the end of the week. Pedro had the brilliant idea of labeling everyone with makeshift tape nametags so that we could get to know the people who we would spend the week working with. In my mind, this was probably one of the most influential decisions of the entire mission. Being able to call each other by name is something that I believe contributed to the bond that we all formed. Nothing is sweeter to our ears than the sound of our own name, and being in an environment of strangers where we can begin to know each other by calling each other by name was very powerful. We learned that the person in charge of the theatres (and quite possibly in charge of the world) was Sister. Though she seemed very “all-business” in the beginning, by the end of the week the soft humanistic side of her was clearly shining through.

The kindness, generosity and politeness of Ghanaians is really beautiful. I felt so welcomed into the community and the hospital. The saying that is repeated over and over by Ghanaians is “you are welcome” – when you walk into a room, when you meet someone. The thing about this, is that it is honest – they were really welcoming us. It wasn’t just something to say to be polite, they really meant it. As much as the members of our team gained from going on this mission, I can say that the people who we worked with gained also. On the last day, one of the scrub techs who we worked with, Senyo, said to me in the most heartfelt and honest way “It has been so wonderful having you all here. It has really brought a lot to us and we will really miss you. I don’t even know how to say how I feel about the way that you have interacted with us and made us all feel. We really wish that you will come back.” It sent goose bumps up my arms when he said this because it became clear at that moment that every single person involved in this mission benefited – the international team, the local nurses and staff, the local surgeons, the hospital administrators and officials, and of course the patients and their families.

Bonded

Bonded

As a medical student, I was able to first assist during the cases. I spent time assisting Pedro, Chris and Sinha. Assisting with approximately 30 inguinal hernia repairs over the course of 5 days offered a unique opportunity for me. For the first time, it gave me the chance to really truly understand what was happening in the operating theatre. During the third year of medical school, we are briefly exposed to a variety of specialties. The rotations in each of these specialties last 1-2 months and by the end of the year we are expected to have made a decision about which specialty we would like do commit to for the rest of our lives. During my surgery rotation, I realized that I loved surgery but the problem that I had was that I could not understand how I could ever be a great surgeon. During my medicine, pediatrics, emergency medicine, and psychiatry rotations it was simple to understand that after 3-4 years of specialized training one could obtain the skills necessary to do those jobs. As a student, I was doing more or less the same things that I would do as a physician – interviewing patients, suturing, making decisions about antibiotics, counseling patients about smoking cessation, etc. But in surgery, I was never really holding the scalpel, understanding why decisions were being made, seeing the big picture, knowing what to do next or even truly understanding what I was looking at. I was retracting tissue and trying to ensure that the surgeon had good visualization, I wasn’t acting as a surgeon by any means. By assisting with the SAME procedure 30 times in a row in 5 days on this mission, I began to understand what was happening and what to do next. For the first time, I believed that I could become a surgeon – I could recognize the difference between a nerve, an artery and the vas deferens. I understood the anatomy of the inguinal canal and what went into the actual repair of a hernia, and why. I could actually for the first time visualize myself being on the other side of the table and knowing what to do next. This was a HUGE realization for me.

In order to feel this way, it wouldn’t have been enough to have simply observed and assisted in the operations. I was fortunate to be in the company of surgeons who love to teach, Pedro and Chris. During one case, I asked Chris a question about the anatomy (a question which he had probably already answered 5 times) and he realized that I was still confused. He removed all of the retractors from the deep tissue and skin and held the skin closed. Then he started at the beginning and slowly retracted each layer explaining and quizzing me on what we were looking at and what had been done. It was important to him that I understood, and somehow this man has been gifted with a seemingly endless amount of patience. At the end of that day, I expressed to Pedro that I felt much more comfortable with the anatomy but wished that I had packed my anatomy books so that I could review before tomorrows cases and understand even more. Pedro has been a surgeon for probably close to 30 years and thus naturally has an extensive and impressive knowledge of anatomy. He instinctively grabbed a piece of paper and drew out in exquisite detail the anatomy of the entire inguinal region – explaining every structure to me and confirming that I understood. By the next day, I was even more comfortable and was able to soak in even more from the cases.

Whatever the rationale that these two gifted and seasoned surgeons had for taking the time and putting the effort into teaching me I cannot say for certain. But what I know is that their efforts resulted in me leaving Africa with the confidence and belief that I could become a surgeon. I have always been interested in international medicine and global health and knew that no matter what specialty I chose, I would incorporate international work into my career. I see, however, through the Operation Hernia that simple surgeries such as hernia repairs can have an enormous impact on communities worldwide. Surgeries to correct hernias, cataracts, and cleft palates are simple yet absolutely life (and community) changing. Without this experience, I would not have believed that I could become a surgeon or have been able to see the results of correcting surgical disease in the developing world. I hope to be involved with future Operation Hernia missions in the future. I am very impressed with the mission of this organization – they are interested in sustainable and innovative improvements. Using mosquito net in place of brand mesh is just one example of the forward-thinking ideas that are born through leaders of this organization. This trip has changed the course of my life and I am forever grateful for the opportunity to have been a member of the 2012 Operation Hernia team.

Alyssia McEwan, BA, MS

4th year medical student

Touro College of Osteopathic Medicine – New York, NY, USA

AWARDS: Dr Chris Oppong, Malcolm Carmichael, Plympton Rotary Club President, and Prof Andrew Kingsnorth

Thursday 12th April 2012

An award has been made to two non-Rotarians, the first time in the club’s history of Plympton Rotary Club, writes Nicola Tapp.

Rotary clubs in Great Britain and Ireland use the Paul Harris Fellowship, named after Rotary’s founder, as a mark of outstanding contribution above and beyond the norm.

The two fellowships have been awarded to Professor Andrew Kingsnorth and Dr Chris Oppong for their work with Operation Hernia.

Launched in 2005 by the two Plymouth-based consultant surgeons, Operation Hernia aims to provide sustainable surgical treatment of hernias to patients, along with training to local medical personnel, in developing countries in Africa, particularly Ghana.

Mr Oppong said: “A hernia is a surgical condition which can be very debilitating for patients in the Third World who don’t have access to the medical care we have in the UK. The painful swelling makes it difficult, and in some cases impossible, for the local farmers and fishermen to work and provide income for their families. Surgical operation to treat a hernia is therefore life changing; improving the quality of life for patients and allowing them to become earners again.”

Since its inception, more than 6,000 hernia patients have benefited from this humanitarian project in Ghana.

Professor Kingsnorth, said: “This recognition is very important to both of us as it has come from within our own community.

“We have received many awards but this will take pride of place.”