Introduction

The main event was a Hernia Course organised for the Surgical Registrars at the teaching Hospitals at Kigali, Rwanda. This was at the invitation of the Head of Surgery at CHUK Teaching Hospital. In collaboration with Rwanda Legacy of Hope (RLOH) – a Rwandan Charity – an ENT team accompanied the Operation Hernia team.

 CONSOLIDATED PATIENT NUMBERS

 TRAINING OF SURGICAL RESIDENTS

The patients were operated on the two centres as shown below: 

Training Centre Patients Operated On
CHUK 39
Rwamagana 46
TOTAL 85

  SERVICE DELIVERY

  Hernia Surgery 

Hospital Patients Operated On Adults Children
Gahini 45 25 20
Kigeme 21 20 1
Kirinda 6 5 1
TOTAL 72 50 22
       
HERNIA TOTAL 144 100 44

  

 ENT Surgery 

Hospital Patients Operated On Adults Children
CHUK 12 0 0
       
   

  SUCCESSES

  1. Intense training of 14 Surgical Residents in hernia surgery. Most of the trainees were trained to the level of “Able to perform procedure with minimal help”. In the process, 85 patients were offered surgery for their hernias.
  2. Very good feedback from trainees regarding hernia lectures and training in the operating theatre.
  3. Effective collaboration between RLOH ENT surgeon and CHUK ENT surgeons. Plans for the 2018 mission to include training of registrars agreed were agreed.
  4. Equipping Rwandan Hospitals to the tune of over 100,000 Euros.
  5. Successful recruitment of 32 Volunteer Consultant Surgeons and Anaesthetists and Nurses from UK, Germany and Austria. They all funded their own travel and other related costs.

  ACKNOWLEDGEMENTS AND GRATITUDE

1The Government of Rwanda arranged Medical and Nursing Registration for the RLOH Medical Team.

2. The Government of Rwanda waived all Custom and Clearance costs for medical equipment imported by RLOH

3. The Government of Rwanda provided high quality accommodation for RLOH team during their stay in Kigali. The Hospitals provided the accommodation for teams that worked in the district hospitals.

4. The Government of Rwanda funded a Certificates Ceremony.

 

CHRIS OPPONG FRCS, CONSULTANT SURGEON

MEDICAL DIRECTOR RWANDA LEGACY OF HOPE AND CHAIRMAN OPERATION HERNIA

 

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.

Nyamata Hospital

Rwanda was a very pleasant surprise. The country has recovered from the genocide that ravaged the country 20 years ago. The people are very welcoming. I felt I could easily make Kigali my second home in Africa, after Ghana.

Nyamata Hospital

Nyamata Hospital

The capital Kigali has been rebuilt. It is a very clean city. Commerce is booming. French used to be the lingua franca until after the genocide. English is now taught in schools. We were so embraced by the city I have already started planning a return in 2013!!

A visit to the Genocide Memorial was both emotionally challenging and hugely instructive.

The surgical team comprised one Consultant Surgeon and a nurse. This was meant to be an exploratory visit. For that reason we planned to perform only 25 cases.

Travel

We travelled on Kenya Airlines and stopped over in Nairobi before connecting to Kigali, capital of Rwanda. We were met at the airport and transported to our accommodation.

Hospitality

We were very warmly welcome by the Medical Director Dr Alfred Rutagengwa ( Dr Alfred) and by the General Manager. They offered us the best hospitality they could offer from the resources they had. Our accommodation was in the hospital guest house. It was basic but included en-suite facilities. The team was grateful for the care and attention we received in the guest house. We were adequately fed, probably overfed!

Dr Alfred is very enthusiastic about establishing NYAMATA HOSPITAL as a Hernia Centre. Operation Hernia is keen to make this happen.

Chris & Helena

Chris & Helena

Chris & Dr Alfreda

Chris & Dr Alfreda

Theatre Staff

There were 2 trained nurses, one student nurse and 2 auxiliaries. We had 2 anaesthetist each day. They offered a superb service. One doctor was assigned to help us. The staff nurses were competent. The Anaesthetist were skilled in Spinal anaesthesia and committed to best patient care. Staff were helpful. The intensity of work we required was not the norm but they coped reasonably well. No cases were cancelled due to lack of theatre tome or staff. All our full days ended after 7pm.

Patient Screening

Not all had had their pre-operative investigations. Some of them had not been fully registered. This delayed the start of surgery on 2 days. That will be improved for the 2013 visit.

Facilities

2 Theatres, one Recovery room, one Minor surgery room, 2 Changing rooms, Doctors office equipped with a computer connected to the internet, Theatre Sister’s office; Stock / Nurses room with a PC; Sterilisation Room with 2 autoclaves.

Theatre facilities

Each theatre had the following facilities:-
Theatre table: This was old but functional
Anaesthetic machine which was modern
Monitor which was also modern
Ceiling theatre Lamp. Functional in only one theatre.
Standing lamps which had poor focus.
Air conditioner worked in one theatre.
Diathermy machine: We provided and donated a refurbished Eschmann’s diathermy machine complete with accessories- patient plates, diathermy pencils, foot pads. This was a donation from TORBAY HOSPITAL.

Surgical Instruments and supplies

They had enough instruments to perform 7 procedures a day. Most of these should be replaced. We can do with Travers / West/Weislander retractors, decent needle holders, scissors. These instruments would have been provided had our order arrived on time!! They coped with the rapid turnover. Theatre gowns and drapes were provided for all. Autoclaving of kit kept pace with the relative rapid turnover of patients. Some theatre gowns showed their age but did not affect sterility.

Outcome

25 patients were originally booked for surgery. We operated on 29 patients and performed 33 procedures. This is a credit to the theatre staff for being willing to work hard on our full days to ensure that no patients were cancelled because of theatre time. All hernias were graded using Kingsnorth Grading. All operations were entered into Operation Hernia Database.

Apart from 2 patient excluded on clinical grounds, all hernia repairs were performed with Mesh. This was a complete novelty at Nyamata Hospital and was well received.

A major breakthrough was introduction of Hernia Repair under Local Anaesthetic infiltration. There was initial resistance from patients, anaesthetists and nursing staff. This has never been practiced. All hernias had hitherto been performed under spinal anaesthetic. Success of this “new ” technique was welcomed enthusiastically by all staff. The advantages over spinal anaesthetic were swiftly recognised by the Chief anaesthetist:- safety, day case surgery, no family visits, less cost.

From a genocide orphan

From a genocide orphan

Training

One of the local doctors assisted me and was trained to insert mesh in 3 patients. The need was expressed to train more local doctors in both mesh repair and local anaesthetic surgery.

Commendation

1. Enthusiastic and hardworking staff

2. Skilled Anaesthetists

3. Keenness to learn new techniques.

Achievements

1. 33 procedures performed in 4.5 working days

2. Introduction of Mesh Repair of Hernias – a more effective treatment.

3. Introduction of Hernia Repair performed with Safe Local Anaesthetic Infiltration

4. Training one surgeon in Mesh Repair.

Recommendation for future Visits

1. CME on theatre management

2. Workshop to train doctors – Mesh repair and LA infiltration

3. Require new surgical instruments

4. New Air conditioner

5. Possible New Theatre Table

6. Possible New Theatre Lamps