Friday 28th October 2016

GHANA CELEBRATION OF 10th ANNIVERSARY OF OPERATION HERNIA

Introduction

On 15th October 2016, Operation Hernia celebrated its 10th Anniversary at the city of its birth, Takoradi in Ghana. It was also a celebration of Ghanaian culture of pomp and pageantry. It was truly, a memorable night. The great and the good in the history of Operation Hernia were present as well as a television crew from the Takoradi Sky TV.

Traditional Dancing

The evening started with traditional drumming and dancing. Drums were played in a coordinated fashion to produce a unique rhythm of authentic Ghanaian music. Energetic traditional dancers performed their complex choreography with grace and passion. They were where clad in very colourful Ghanaian fabric called “kente”. They treated the gathering to an array of mesmerising traditional dances with different themes.

Operation Hernia Exhibition

A photographic exhibition of the Operation Hernia story was opened earlier. It featured the first Operation Hernia team that visited in 2005. On display were photographs of the inauguration by the then British High Commissioner and his deputy, and also the opening of the Hernia Centre at Takoradi Hospital. Photographs of various teams that have visited Takoradi and other centres from 2005 to 2015 were displayed. The series of photographs that stood out depicted the steps in the repair of a large hernia. The use of Operation Hernia Mesh (low cost and affordable) was also highlighted in the exhibition. The picture posters were designed by Mr Bediako, Marketing Manager at Ghana Ports and Harbours Authority (GPHA).

Poster showing details of the first Operation Hernia visit on 2005

Poster showing details of the first Operation Hernia visit on 2005

Main Event

All the attending personalities were acknowledged by Dr Bernard Boateng Duah, local Medical Director of Operation Hernia. We were privileged to have the original group of local doctors and administrators who were instrumental in the nurturing of Operation Hernia. This included the following personalities:-

1. Mr Edwin Philips, a local businessman

2. Mr Philip Nkrumah, the then city manager

3. Dr Kofi Asare, Medical Director of Takoradi Hospital

4. Dr Linda Vanotoo, the then Regional Medical Director

5. Mr Eddie Prah, local businessman and Business Manager of Operation Hernia

The following two personalities were not at the celebration but have been part of the “early brigade” who made substantial contributions to the success of Operation Hernia and deserve our deepest gratitude.

6. Mr Brian Dixon, Ghana Representative for Canadian Natural Resources (CNR) an international oil and gas producer

7. Miss Kate Mensah, our domestic manager. She did not attend but was acknowledged.

The keynote speech was delivered by Chris Oppong, Chairman of Operation Hernia. He emphasised the fact that the success of Operation Hernia is due to the passion and commitment of our selfless volunteers who sacrifice so much for the needy operation hernia patients, and the local doctors, nurses, laboratory technicians, drivers, administrators and the culinary and domestic management skills of Kate and Lilian Mensah and their group of caterers. The pioneering role played by the former CEO Prof Andrew Kingsnorth was recognised both in the keynote speech and in the photographic exhibition. Operation Hernia has treated over 9000 patients and trained several local doctors as well as UK and EU surgical trainees. Emphasis has now shifted to training as exemplified by the recently completed training of ten surgical trainees of the College of Surgeons of East, Central and Southern Africa (COSECSA) in Uganda. Dr Bernard Boateng was given a deserved standing ovation for the tremendous role he has played in sustaining the work of Operation Hernia.

Poster outlining the work of Operation Hernia over the last 10 years

Poster outlining the work of Operation Hernia over the last 10 years

The Opertaion Hernia Team in Takoradi

OPERATION HERNIA MISSION: OCTOBER 2016 TAKORADI, GHANA

TEAM LEADER – MR SHINA FAWOLE (CONSULTANT SURGEON)

TEAM MEMBERS – MR CHRIS MACKLIN (CONSULTANT SURGEON), MS HANNAH WELBOURN (CONSULTANT SURGEON), MELANIE PRECIOUS (ADVANCED ODP), LISA MACKLIN (RGN), VICKY ARMITAGE (ODP), EMMA UPCHURCH (SURGICAL SpR), MICHAEL KELLY (SURGICAL SpR).

The Opertaion Hernia Team in Takoradi

The Opertaion Hernia Team in Takoradi

On the 8th October 2016 we began our mission to Ghana. I joined a team of three consultant surgeons, three theatre nurses, and two surgical registrars.

We arrived in Accra late on Saturday evening where we met the other teams who were also planning to spend the next week operating across Ghana. The Baptist Guest House was our base in Accra. Right from the get-go the Takoradi team was very welcoming and inclusive of an outsider into their clan. I learned that this team (in some variation) has been traveling to Takoradi to perform Operation Hernia missions for the last eight years.

The following morning in torrential rain, we travelled to Takoradi. After a 4-hour drive we reached our destination, a house owned by the municipal government that has been utilized for visiting surgical teams from UK, Netherlands and Germany. At this residence, Lillian and her team of helpers looked after us fantastically. Their attention to details was remarkable. Every morning, hot water (for showering) and breakfast was ready, and every evening we were treated to diverse and wonderful Ghanaian culinary experiences. Their care and attention to us was extraordinary, and I thank them profoundly.

During the five days operating in Takoradi (Monday to Friday), three surgeons operated in three hospitals/medical centres (The Hernia Centre, Ghana Ports and Harbour Authority Hospital (GPHA) and Dixcove Medical Centre). Screening of suitable cases was already performed by Dr Boateng (Medical Director of GPHA Hospital), who was also always available to help and provide local advice. This planned organization facilitated immediate starting of operating on Monday morning. The majority of cases included primary and recurrent inguinal hernias, ventral/umbilical hernias and some paediatric hernias. On average, each centre operated on 8-10 cases per day. The majority of cases were performed under either spinal or local anaesthesia. Over the 5 days, a total of 103 procedures were performed. The working day was intensive with late finishes, but was filled with an atmosphere of both camaraderie and satisfaction. Both local nursing and anaesthetic staff were always adaptable to rapidly processing patients thus maximizing the impact of the mission.

Our last evening at the Hernia Centre with our celebratory Ghanaian shirts given to us by the medical team

Our last evening at the Hernia Centre with our celebratory Ghanaian shirts given to us by the medical team

Finally, I would like to thank Operation Hernia and ASiT for awarding me the Shorland Hosking Fellowship and the immense experience of participating in this mission.

Michael E. Kelly

Surgical SpR Dublin, Ireland

Kosa Beach

Report of the Belgian Team Visit to Takoradi, Ghana March 12–19, 2016

After skipping our 2015 Mission because of the Ebola threat, in March 2016 a Belgian team, consisting of four surgeons (Marc Huyghe, Casper Sommeling, Veronique De Moor and Stijn Heyman) and one resident (Magali Blockhuys) again visited Takoradi in Ghana. Our main financial sponsor still is the Belgian Section of Abdominal Wall Surgery, but also the Lions Club of Waregem supported us financially. We brought meshes (Mr. Oppong meshes aka MROP-meshes from England and BBraun meshes from Belgium), gloves (Medline), disposable drapes (Mölnlycke Belgium and Medline) and suture material (Johnson & Johnson). Local anesthetics were donated by BBraun; this time lidocaine with adrenaline and heavy marcaine were supplied by Operation Hernia.

Kosa Beach

Kosa Beach

Arriving at Kotoka airport with Brussels Airlines on the Saturday, late afternoon, we were pleasantly surprised by the new facilities in the arrival hall, which shortened the check-in procedures. After a 3 hour drive we arrived at the Kosa Beach resort and stayed our first night there.

On the Sunday afternoon we drove to Takoradi, where as in 2014 we stayed in a private house. During the week we again enjoyed the hospitality of Gina Loupiac at her Gilou’s restaurant

Also this year Dr Bernard Boateng-Duah organized the operation programs beforehand in collaboration with the local hospital teams, so we could immediately start our operations early on the Monday morning.

The Belgian Surgical Team at the Hernia Wing of Takoradi Hospital

The Belgian Surgical Team at the Hernia Wing of Takoradi Hospital

During the week we were organised into three teams that rotated in the three different hospitals (Hernia Wing, GPHA and Dixcove). In total 92 patients, of which twelve were children, where operated. Again most of the patients presented with groin hernia.

The first patient operated in the GPHA hospital on Monday morning was the patient in which we performed a Hartmann’s procedure with a temporary colostomy in 2014 due to colonic necrosis. Restoration of the bowel continuity was performed and the postoperative course was uneventfull.

The motivation of the local hospital teams was very good and the level of care of the nurse-anesthetists in the three hospitals was high. The first evening Marc and Magali sustained by the enthusiastic team of Marian at the Hernia Wing worked until 11.00 p.m. to get the selected patients done. The last patient that evening had a giant sliding (sigmoid) hernia, a recurrence after a Lichtenstein procedure some years before.

The equipment in the hospitals is of a reasonable level, but structural changes should be made to the operation theatres. There still is the problem of lack of running water in the Dixcove Hospital.

Our mission was certainly interesting for our resident who could perform several operations in both adults and children.

Visit to the Metropolitan Coordinating Director

Visit to the Metropolitan Coordinating Director

On Saturday morning we first visited the Takoradi harbour currently in a phase of new developments and where big changes are taking place. Then we were received by the Metropolitan Coordinating Director in his private house in the beautiful hills in Sekondi. He thanked us on behalf of the local government for our mission and explained that the local government this year supported us regarding transport and food. Following that we we drove back eastbound to Kotoka airport in Accrea to leave for Europe again.

Conclusion: This was again a very rewarding mission; the future developments will to have be awaited for.

Casper Sommeling, on behalf of the Belgian team

OPERATION HERNIA MISSION: 6TH – 13TH JUNE 2015 – TAKORADI, GHANA

TEAM LEADER – ADESHINA FAWOLE (CONSULTANT SURGEON)

TEAM MEMBERS – RUPA SARKAR (CONSULTANT SURGEON), RAJIV DAVE (REGISTRAR), ZOE SUN (REGISTRAR), MELANIE PRECIOUS (ADVANCED ODP, TEAM LEADER), CLAIRE CASEY (ODP)

Report by Zoe Sun

This was my first time Africa and first time with the mission, led by mission veterans Mr Shina Fawole (Team Leader and Consultant Surgeon) and Melanie Precious (Advanced ODP and Surgery Team Leader), along with my fellow colleagues Miss Rupa Sarkar (Consultant Surgeon), Rajiv Dave (Registrar) and Claire Casey (ODP). The mission was in June, the rainy season, rather than its usual time in November. We carried with us medical supplies for the duration of the mission including medications, local anaesthetic, mesh, syringes, needles, sutures, gloves, gowns and hats. With all these, we met at the airport ready for our mission led by our team leaders.

We arrived in Accra, Ghana on the evening of 6th June and stayed overnight in Accra. The next day, the taxi driver took us on a 4 hour journey to Takoradi. We stayed in a house owned by the local government and used specifically for teams on the mission. Lillian and her team of helpers stayed with us and looked after us during the mission. They did all the hosting, cooking and general maintenance. We visited one of the hospital sites in Dixcove and greeted the local team of nurses and doctors. Next to Dixcove was a tranquil, unspoilt beach where we shared a few drinks and a group photo and Mr Fawole taught us the suture-sparing mesh repair technique for hernias! The same night, Dr Bernard Boateng, Medical Director of GPHA (Ghana Port and Health Authority) Hospital, greeted us at the house. He and his team had assessed the patients locally and planned their operations and their respective hospital sites for their operations. We decided on the order of week and how to split the team along with Dr Boateng.

Monday was the start of the testing week. We based ourselves in two hospitals in Takoradi, Takradi Hernia Centre and GPHA into teams of three. Introduced to the local friendly and very outspoken team of nurses and ODPs, we started on our operations. The caseload consisted of primary and recurrent inguinal hernias, hydroceles, umbilical hernias and children with groin hernias. On average, there would be 8-10 cases per day. Most hernias were operated on under a local anaesthetic; recurrent and larger hernias had spinal anaesthesia, which the local anaesthetic nurses specialised in.

The challenge initially was with the size of the hernias and their chronicity. The rule was not to open the hernia sac if possible, but only Miss Sarkar stuck by this rule, we later found. After the first day, we divided ourselves in teams of two for each of the three sites, with those at Dixcove travelling an extra 2 hours return journey on a daily basis. We were faced with additional challenges, with power cuts and during a longer power cut, we learnt to operate under a torch light. We were also faced with shortage of running water, for which we were provided with water from a tank for scrubbing. At Dixcove, the same theatre was shared between elective and acute cases. Whilst we were carrying out our operation on children, two emergency Caesarean sections came through back to back. The operating tables adjacent to each other, we would be placed in the in stifling conditions when our local colleagues performed the emergency Caesarean sections.

The children were extremely compliant as were the adult patients. The nurses were outgoing and outspoken. Lilian and her helpers were extremely responsive to our needs back at the house. The people in general were very friendly and helpful. One young man, a patient, thanked us profusely as he could now find a wife now that he no longer has a deformity (his hernia). On the last day, we ended the day, altogether at the Hernia Centre with Dr Boateng, and had a group photograph to mark our time there. Many of the staff, were desperate for our return on following missions and explained how much they enjoyed our times together. We were greeted later in the house by politicians who were grateful for our work and wanted to improve the host’s programme for later groups and to include organised sight-seeing. We thanked Lillian and her team for their hospitality before embarking on a return journey to Accra the following day.

I was extremely grateful for this experience, learning not just about operating, but about people and cultures. I learnt that some aspects were not a good mix for my team members…Mel and cockroaches, Mr Fawole and Raj sharing a room, Miss Sarkar and ‘vegetable free’ foods, Claire and any Ghanaian foods. However, the team was fantastic, the experience invaluable. I have learnt a lot about myself, others and the skills I will carry forward in my future training and life thanks to Operation Hernia and my team leaders.

Zoe Sun

Missions

Report of the Belgian – Italian team.

Visit to Takoradi from March 15 – March 23, 2014

In March 2014 a team of four Belgian surgeons (Myriam Bruggeman, Paul Van Acker, Marc Huyghe and Casper Sommeling), one registrar (Stijn Heyman) one nurse (Pina Orlando), accompanied by an Italian surgeon (Cecilia Ceribelli) again visited Takoradi in Ghana. Our main financial sponsor is still the Belgian Section of Abdominal Wall Surgery. We brought meshes (kindly donated by Medri, Covidien Belgium, Bard Italy and Assut Europe), gloves (Medline), disposable drapes (Mölnlycke Belgium and Medline) and suture materials (Johnson & Johnson). Resterilized polypropylene meshes and so called “Indian meshes” were also taken. Local anaesthetics, syringes and needles were donated by Bbraun and BD; this time lidocaine with adrenaline and heavy marcaine were donated by Operation Hernia and bought for us in Ghana.

After arriving at Accra, late Saturday night, for the second time we stayed at the Ghana Baptist Mission. The following day we made the trip to Takoradi, meanwhile visiting Kosa Beach.

This year, thanks to the contacts we have built up in the last years, we stayed in a private house, where we were taken care of by Gina Loupiac. She also owns a very good restaurant in Takoradi and managed to provide us with three meals a day.

During the week we organised three teams

that rotated in the three different hospitals (Hernia Wing, GPHA and Dixcove). In total 81 patients, of which six were children, where operated on. Again most of the patients presented with groin hernias. To our surprise in one patient with bilateral inguinal hernias, a volvulus of the sigmoid was found with necrosis, so a Hartmann’s procedure with a temporary colostomy had to be performed. Reversal of the colostomy is planned in November 2014, when Chris Oppong will visit Takarodi. After our return to Belgium we collected colostomy bags and other materials and sent them to Bernard Boateng to support this patient.

The motivation of the local hospital teams is good and the level of care by the nurse-anesthetists in the three hospitals is high. The equipment in the hospitals is of a reasonable level, but structural changes should be made to the operating theatres. There is still the problem with the lack of running water.

On Friday evening we had our usual dinner with Bernard Boateng Duah and his wife at the the “Gilou” restaurant. Bernard explained to us that also in Takoradi the support of the project is questioned.

On Saturday morning we again visited the Takoradi harbour which is in a phase of new developments. Afterwards we drove to Kosa Beach again and stayed one night at this beach resort. On Sunday afternoon we drove back eastbound to Kotoka airport to leave for Europe again.

Conclusion: again a rewarding mission; the future developments are eagerly awaited.

Casper Sommeling, on behalf of the Belgian – Italian Mission

At Work

Takoradi, Ghana January 2014

Operation Hernia – Polish Team to Takoradi/Dixcove (Ghana)

18-25.January 2014

Team members: Maciej mietañski, Kamil Bury, Magda Bury, Maciej Pawlak, Stefan mietañski, D. Richert

At Work

At Work

Since 2005 Operation Hernia sends doctors of good will to Takoradi in Ghana to help Dr Bernard Boateng Duah to treat people suffering from hernia and related diseases. On the 17th of January 2014 three doctors under leadership of Maciej mietañski fled cold Polish winter and have landed in benevolent and warm embraces of Accra to become a part of fantastic charity mission.

After a day of traveling with few sightseeing stops in Kakum National Park and Elmina Castle we have reached Takoradi. During the week of intense work the two teams, one in Takoradi and the second in Dixcove, we have managed to operate more than 50 cases. For the young doctors Kamil Bury and Maciej Pawlak it was an amazing and memorable experience. We were the second team to work in Dixocve and were met with fantastic welcoming and gratitude and therefore generated a good spirit of cooperation and much satisfaction.

Maciej mietañski as always made an excellent work, operating on the most difficult cases and performing as many as 10 operations per day. In both Takoradi Hospital and GPHA Hospital we were met with good atmosphere that made the hard days of surgery pleasant and memorable.

The last few days of our mission we have spend recharging batteries on the beach near Akwidaa, beautiful place with long sandy beaches, huge waves and cold Star beer.

Unfortunately good times ends to fast and our pack had to leave Ghana and head back to Poland where thermometers were showing -15oC. We will surely return with some more help and a mission to the Northern Region.

We would like to thank Dr Boateng for all of his help and for being there for us in the difficult moments and also to Linda and Benedicte for taking good care of us in the Villa. Special thanks to the staff in the Takoradi Hospital, GPHA Hospital and Dixcove Hospital for their help and worm welcome.

Polish Team Takoradi.

Missions
November 2013
Mission to Takoradi

The team arrived in Accra on the evening of Saturday 2nd November 2013. As a registrar in General Surgery this was my first trip with Operation Hernia, but I was travelling with experienced Operation Hernia member Melanie Precious and fellow first-timer Nicola Perrin, both Operating Department Practitioners, along with a large supply of surgical and anaesthetic equipment. The rest of our group comprised of Chris Macklin (Consultant Surgeon), Jurij Gorjanc (Consultant Surgeon from Austria and President of the Slovenian Hernia Society), Khaled Ismail (Consultant Anaesthetist), Beverley Parker (Registrar in Anaesthesia), Rafay Siddiqui (Registrar in General Surgery), and our team leader Shina Fawole (Consultant Surgeon), on his seventh Operation Hernia mission to Takoradi.

After a late-night dinner and an initiation to the unconventional practices of Ghanaian taxi drivers (including rolling backwards down the hill to start the engine, and opening the passenger side door to get the radio to work!), we spent our first night in the comforts of the Baptist Guest House. After a minor drama with an early-morning altercation between Melanie and a cockroach (“don’t you dare come any closer to me…!!) we set off on the three and a half hour minibus journey to Takoradi. We received a very warm welcome from our host Lillian and her helpers at the villa in Takoradi, and they even arranged a solar eclipse to mark our arrival! After unpacking our medical supplies we spent a relaxing and enjoyable afternoon at the Busua Beach Resort. In the evening we were visited by Dr Bernard Boateng, Chief Medical Officer of the Ghana Ports and Harbour Authority (GPHA) Hospital, and the plan for the week was set out.

On Monday morning the hard work really began. Each day a team of between two and four of us travelled to Dixcove Hospital, GPHA Hospital and the Takoradi Hernia Centre. The patients had been assessed and selected by Dr Boateng beforehand, and after a brief ward round to review all of the patients for the day, and decide on the most appropriate anaesthesia, the list started. We were warmly welcomed at all three hospitals, and worked alongside the local theatre teams and nurse anaesthetists, who were particularly skilled at spinal anaesthesia. Between the teams we operated on 105 hernias and 7 hydroceles in 107 patients, including 19 paediatric patients and 6 patients with recurrent hernias. Fifty-seven patients were operated on under spinal anaesthesia, 24 had a local anaesthetic and 26 had a general anaesthetic.

The days were long and intensive, but it was undoubtedly worth all the hard work to be able to achieve so much in just 5 days of operating. The impact that we were having on the patients was clearly apparent; I particularly remember one elderly gentleman who had travelled for nearly twelve hours to have his hernia repaired. The children were amazingly brave and compliant, not a word of objection or a tear from even the youngest ones. On one of the days at Dixcove Hospital, a local surgeon attended our list, and we were able to show him how we use the hernia meshes to reduce the recurrence rate for inguinal hernias. As a team we were fortunate enough to have both a Consultant Anaesthetist and a very skilled Anaesthetic Registrar with us, and as well as enabling us to operate on more children by means of general anaesthesia, it was also clear that the local nurse anaesthetists benefited from the training and advice they provided. Likewise, our experienced Operating Department Practitioners, Melanie and Nicola, were able to work alongside, and pass on their expertise to, the local theatre staff.

But it was not just the patients and the local theatre staff who benefited from our mission. All of the Operation Hernia team members gained invaluable experiences from the trip, which provided us with insights into our own practices in the UK and an appreciation of our own privileged situations, as well as improving our ability to adapt to challenging situations and make the best possible use of the minimal resources available. We are all especially proud of Melanie, for mastering the art of the scrotal bandage, after what was, it has to be admitted, a rocky start! As a group we are very thankful to Shina for his guidance, support and unwavering encouragement, unperturbed by any obstacle, apart from those baby lizards! Despite problems with an intermittent water supply, Lillian and her team ensured that we were comfortable, well fed and well looked after for the whole week, and we all appreciate her efforts.

From a personal perspective I feel very privileged to have been given the opportunity to be a part of such a fantastic, life-changing organisation. I am grateful to the other members of the team who were all wonderful colleagues and companions, and who provided much friendship, support and laughter. As a trainee surgeon I am particularly grateful to Chris, Shina and Jurij, whose patience and skill in training enabled me to operate on more challenging hernias than I have ever encountered before. I hope that I will continue to be involved in future missions with Operation Hernia.

Hannah Welbourn, ST8 General Surgery

The Team

3-11 March 2012
In March 2012 a team of four Belgian surgeons (Myriam Bruggeman, Paul Van Acker, Marc Huyghe and Casper Sommeling) accompanied by an Italian surgeon(Cecilia Ceribelli) and a Belgian nurse (Pina Orlando) again visited Takoradi in Ghana.

The Team

The Team

We brought meshes (kindly donated by Medri, Covidien Belgium, Bard Italy and Assut Europe), gloves (Cardinal Health/Medline), disposable drapes (Mölnlycke Belgium and Medline) and suture material (Johnson & Johnson). Resterilized polypropylene meshes and so called “Indian meshes” made part of our overweight luggage. Local anesthetics were donated by Bbraun, only the lidocaine with adrenaline had to be bought by us in Belgium.

This year special thanks to the Ghana Ministry of Health presented by Dr. Kwesi Asabir, Deputy Director Human Resource, who welcomed us Sunday morning in Accra.

After arriving at Accra, late Saturday night, for the first time we stayed at a hotel in Accra. The following Sunday we made the trip to Takoradi, meanwhile visiting Elmina Castle and Kosa Beach.

At arrival Sunday night in “the Villa” a nice meal was ready for us. Again “the girls” (Kate, Linda and Benedicte) took good care of us. The food they prepared was fine and far better than the Western food served in the local restaurants.

During the week we organised three teams of two, that rotated in the three different hospitals (Hernia Wing, GPHA and Dixcove). We performed 88 operations on 81 patients, of which eight were children. Most of the adult patients, presented with groin hernias (in six bilateral). In almost all these cases a Lichtensteinrepair was performed. For the first time we did use sterilised mosquitomesh (or Indian meshes, as it sounds less charged) we brought with us, in about half of the Lichtensteinrepairs. The handling is surprisingly good and suturing works fine. Half of the patients were operated under local anaesthesia, but loco-regional anaesthesia was used as a standard in all three locations in the more demanding scrotal hernias, contributing to a better comfort of the patients. There were four patients operated on recurrent hernia, of which one with an acute strangulated hernia on Sunday-morning just before we were to leave for Accra. The children of course were operated under general anesthesia, as well as one patient with a large upper abdominal incisional hernia.

Again this year there were some challenging scrotal hernias, and also the age of the patients we operated on is still increasing. The oldest patient was 94 years of age and in good condition!

The advantage this year was that we could split up in three teams of two, so that we could assist each other and could share the frustrations in operation another challenging hernia. Even if you think to have seen it all, another situation presents itself.

Operating Takoradi

Operating Takoradi

The motivation of the local hospital teams is excellent and the level of care of the nurse-anesthetics in the three hospitals is high. The equipment in the hospitals (also in Dixcove) is of a reasonable level. There was probably a shortage of heavy marcaine in one of the hospitals, and maybe also of gowns. The operation table in Dixcove is waiting a repair, so that it can be lifted to normal height.

Although with three teams we still made long days, but once again it was rewarding.

After a long week hard work we had dinner at the Planters Lodge Friday night together with Bernard Boateng Duah and his wife.

On Saturday we made a trip to Green Turtle Lodge, the nicest place to be at the Atlantic Coast, were we spent a wonderful day. At Sunday morning we said goodbye to the girls; on arriving at the GPHA-hospital to say goodbye to Bernard he had a little surprise for us. While the rest of the team took a trip to discovery the Takoradi-harbour, Bernard and Casper did perform an emergency operation for a recurrent and now strangulated groin hernia. Luckily for the patient and also for us the strangulated intestine was still vital, so we could preform a Lichtensteinrepair.

After that we drove to Accra, and after a last meal in the Airport View Restaurant we arrived at Kotoka Airport to travel back home again.

Conclusion: again a rewarding mission; due to the fact, that we were with five surgeons and one nurse, we could in teams of two operate in the three hospitals. We know the work we do is a drop on a hot plate, but it is very worthwhile on an individual level. As Belgian-Italo team we will engage us to go back next year to Takoradi.

We once again want to thank Bernard Boateng for the organization at the local level: selecting the patients on forehand; helping us out during the week and operating the people afterwards, that were on the list at GPHA but could not be operated by us.

Casper Sommeling, on behalf of the Belgian – Italo Mission

The Dutch Team

14-24th JANUARY 2012

The Dutch Team

The Dutch Team

This Operation Hernia mission was a collaboration between the Diakonessenhuis Utrecht and the Groene Hart ziekenhuis Gouda. A team of 4 surgeons and 2 surgical residents arrived in Accra, Ghana on the 14th of January.

On the 15th we made our way to Takoradi, where we were warmly welcomed by the ladies in the Government Guesthouse. On Monday morning we could finally start with our Operation Hernia!

The upcoming week we would perform our operations in three different hospitals: The Hernia Wing and The Harbor in Takoradi and finally the local hospital in Dixcove, a small village which is a 45minute drive from Takoradi. Each morning breakfast was prepared for us and we were picked up by a driver to bring us to the different hospitals.

In Takoradi we usually performed five to six operations: patients were preselected by a Ghanaian surgeon. On the morning of the operation we saw the patients and judged if we would perform the operation. Most patients had an inguinal hernia and unless the patient was not fit or the hernia was irreducible we would operate them. There were children as well as adults and we also treated some prisoners. Surgery was mostly performed under local or spinal anesthesia.

Some patients had a bilateral hernia, an (para-) umbilical hernia or a hernia cicatricalis (= a scar hernia caused by a previous operation).

In Dixcove there were not as many patients as we had hoped for: usually two or three a day. We usually had time to visit the village with the fortress by the sea or go to the market in Takoradi if we were scheduled for an operation day in Dixcove.

Tarora Hospital

Tarora Hospital

In all hospitals the OR personnel was good and spoke English very well, unfortunately the patients usually did not speak English and communication could be difficult.

A Ghanaian surgeon performed one surgery with our team on a patient with a large irreducible hernia. It was very useful to see how he performed the operation. Since they usually do not use a mesh he asked our team to finish the operation by placing the mesh. The meshes we did not use were left behind for the local surgeons to use. In total we treated approximately 65 patients.

After the last day of operations in Takoradi, we drove to the north during the nighttime. The road was uneven and because it was pitch black around us it was a spectacular ride. We arrived at Turtle Beach and could hardly see where we had arrived. But most important, we heard the wild sea and saw thousands of stars! The next two days were for relaxing, running and visiting the nearby village.

On Monday morning we were picked up by the driver and drove back to Accra. Along the way we stopped at the Cape Coast fortress, built by the English and also used by the Dutch to ship out slaves. After a last Ghanaian meal we were driven to the airport and said goodbye to Ghana: It was a wonderful experience!

German American Team 2011

A German/American mission visited three regional hospitals in the area of Takoradi and Dixcove in southwestern Ghana from 14th to 25th July. The first team from Berlin consisted of Dr. Petra W?lkering (anestetist), Zhanna Bourtseva (OP-assistant and scrub-nurse), Manuale Menke (anestetist-nurse) and Dr. Ralph Lorenz (surgeon), who was leading the whole team.

German American Team 2011

German American Team 2011

The second team consisted of MD Timothy Napier (surgeon) from Mauston/Wisconsin, Dr. Karl Spitzer (surgeon) from Munich/Germany and Mario Frey (OP-assistant and OP-attendant) from Hamburg/Germany.

The suspected problems with the excess baggage (ca. 250 kg) on the check in desk where fortunately absent as well as the expected problems with the customs in Ghana. In Takoradi we were kindly accomodated in the Villa, the guesthouse of the Health-Department, where Kate, Lilly and Barbara expected us and supplied us lovingly with all we needed the whole mission through. A big heartfelt thanks to all!

The first two days were taken for acclimatisation and team-building and lead us to the sightseeing-points of the area. On Saturday already we visited on the way to a dreamlike beach of the Gold-Coast also the hospital in Dixcove, a small city westward of Takoradi. In that moment we were not aware that our humanitarian mission was also scheduled for this hospital. During our survey we were struck by the fact that no doctor was around ? he was attending an advanced training course in Accra for two weeks, we later heard.

During our survey in the hospital one patient touched us especially: a six year old boy was accommodated on the same day after a gas-explosion had caused third-degree burns in his face, both arms and both legs – the nurses did the wound treating meanwhile. This case would accompany us throughout the following week. We felt empathy and hoped passionately together with the nurses and attendants to save his life.

On Monday 18th July, we began with our work with two teams in Ports and Harbour Hospital (Takoradi) and in Takoradi Hospital. We performed surgery from 8 am to 8 pm treating as many patients we could. There were many patients on the waiting list. At this point we would like to say a deep-felt thank you to the regional persons in charge as well as to nurses and attendants in the three hospitals under the supervision of Dr. Bernhard Boateng-Duah for their perfect preparation and coordination!

Scrub Nurses, Dixcove

Scrub Nurses, Dixcove

Dr Ralph Lorenz

Dr Ralph Lorenz

The statistics added up to 77 operations on 67 patients within six days: All together 61 inguinal hernias were operated, including 32 inguinoscrotal hernias. 15 patients had a hernia with a 20 cm hernia sac (Kingsnorth classification H3/4-20 and 4 patients were treated with a large-size Hernia with a 30 cm hernia sac (Kingsnorth Classification H3/4-30). Futhermore 9 ventral hernias (6 primary -epigastric and umbilical and 3 incisional hernias) as well as 7 hydroceles were operated.

All of the three hospitals were attended by our teams within those six days. Nearly all patients apart of the younger patients were supplied with a mesh. Thanks to the generosity of companies donations in all cases original meshes could be used instead of mosquito-nets. All currently possible open operation-techniques like SHOULDICE; LICHTENSTEIN; Plug and Patch and TIPP were applied. The diagnostic findings however cannot be compared to European standards. Nearly all hernias were indirect, mostly with a small defect but with a large hernia sac. In certain cases there was additionally a hydrocele. Anesthetic methods included local as well as general anaesthesia, in certain cases spinal anaesthesia was the preferred method. Besides a postoperative hematoma in one case, all operations were successful without complications. The majority of the patients were outpatients. In addition, we assisted in one emergency-laparotomy and we supervise patients with chronic wounds, accident injuries and a thoracic drain. Mrs. Dr. W?lkerling however managed to give a lot of advices and tricks to the anesthetic nurses in charge. Our wish to instruct other local surgeons could unfortunately not be satisfied, since no Ghanaian surgeon could be present at that time.

The sustainability if our mission resulted mainly in giving away a lot of medicine materials the surgeons are now able to use. Without the generous support of numerous private and company donations as well as from the German Hernia Society this mission would have been unthinkable. We have gained a lot of positive insights through this humanitarian mission. Emotionally most touching was the deep thankfulness of the patients, and last but not least of the nurses and hospital workers.

The great success of that mission was mainly possible because of the distinguished capacity for teamwork of every participant. All team-members expressed their wish to participate on the next humanitarian mission. Furthermore, a lot of colleagues in Germany have a lot of interest for that project, and also uttered to participate themselves the next time. The small boy with the severe burns was at the same time attended by our team, especially through giving him urgently needed wound dressings and medicine. After initial fever, he was at the end of our mission ‘out of the woods’, free of fever and the large wounds were healing.

New hope for a new life! We are deeply thankful!

Ralph Lorenz f?r das Team Germany /U.S.