The Cheshire team, Leighton Hospital, Crewe, UK – Visit to Takoradi, Ghana. 29 NOVEMBER – 10 DECEMBER 2008

Team Members: Magdi Hanafy (Consultant Surgeon), Selvachandran (Consultant Surgeon), Neil Brooks ( Consultant Anaesthetist), Virginia Long ( Theatre Manager), Janet Burrows (Theatre Sister), Emma Reay ( Theatre Nurse and ODA), John Kerslake ( Local GP), Rachel Kerslake ( Writer).

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The first step was to create a team of professionals, willing to give their own time and money for this purpose without pressures from work or families. They should know each other, work as a team, good communicators and aim to achieve common goals. These goals are, to treat as many patients as possible (and teach local doctors and nurses), and return safely back home. (May be visit schools and distribute stationary to children). A welcome addition to our team was our Local General Practitioner John Kerslake and his daughter Rachel Kerslake who works in the Local news agency. We managed to get articles published in local newspapers, and radios. Donations poured from patients, relatives, consultants colleagues, local GPs, practices, Rotary clubs, personal friends..Etc. Further collections achieved by members of the team (mainly Janet Burrows) through raffles, bag packing at supermarkets, duck races, ..Etc. The above team worked hard over six months before the trip. All in all we managed to collect £4,300.00 . We have spent £6,700.00.

The hospital managed to donate almost everything we needed for the operations from redundant equipment, sutures, dressings..etc. (nothing out of date). The hospital paid for all the anaesthetics, antibiotics, analgesics. We had to buy syringes, needles, venflons, and disposable scrubs. (Not a good idea in hot countries). In June 2008 we had a visit from The Presidents and council of the Royal College of Surgeons of England. Mr. B. Ribeiro (who is Ghanaian himself) praised our efforts and suggested to add footballs and sports equipment for the children as well. The hospital paid for our vaccinations, anti-malarial, and anti-retroviral prophylactic medications. They have paid for shipment of 39 boxes to a container in Plymouth heading to Takoradi. All these boxes were there when we arrived. British Airways waived fees for extra 12 luggages. The British High Commission in Accra offered support if needed. Bard supplied us with a box full of meshes (worth £9,000), other companies supplied us with boxes of gloves, gowns, drapes.. Etc.

Communications with Professor Kingsnorth, Chris Oppong, and Brian Dixon, answered all the questions. We planned to travel to Heathrow by a mini bus, and a van, kindly lent by Go Green cars, and driven by one of the team s husband and son (Janet Burrows). We arrived safely and had a nice luggage check in. 29 bags checked in. BA was as usual very efficient. We noticed their strict rules regarding bags number and weight and time. Plane was late taking off (55 minutes). Runway was too busy. Smooth flight, seven hours but plenty of entertainment. Arrived in Ghana, 10:00 pm. Warm weather. I started sweating once we got out of the plane. We cleared the immigration and customs very easily with all the boxes and bags. Pushing two full trolleys, one in each hand, down slope was not easy.

Once outside the airport, we had to deal with ten men appearing from nowhere trying to help. We could not differentiate between them and the two drivers sent to us with their minivan and truck. All cleared and on the way to Takoradi. 11:00 pm. Three hours drive arrived to the villa 02:00. Transferred 29 luggage safely inside, all counted for, luggage and personnel. We were met by Brian Dixon (our man in Ghana).

Brian and the girls (Kate, Lillian & Grace) gave us a warm welcome and explanations about how things are going. We resided in a local government villa with seven rooms, each one with en-suite and a large bed and air-conditioning. Everybody phoned home to reassure their relatives. Each one went to a room, and fell asleep. I could not believe the day passed without any problems. The next day Brian took us to visit a local village. Almost 80% of the children were staring at us with their tummies exposed showing an umbilical hernia. They are really nice full of smiles, surprise and interest. We went to the Turtle beach had a relaxing day and swam in the ocean, dangerous waters with strong currents.

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First day at work.
Woke up early, 5:00 am. Had breakfast and we started to empty boxes and redistribute drugs, stitches, drapes and gowns between two teams as we were going to work in two different hospitals. We saw children going to school passing by our villa, we went out and distributed some stationary. Dr Boateng came at 7:30 and took us to the Hospital. We went up to theatre, were introduced to all theatre staff, then shown around the department. We than began to open our 57 boxes which have arrived (with us and the container), and collected medicine and equipment needed immediately for the cases. We examined the patients, decided the procedures they required, and marked the sites. We were introduced to the Nurse anaesthetist, and we started working. Hernias, recurrent hernias, Hydrocoeles primary and recurrent, varicocoeles. Adult and children, Males and females. Electricity went off four times during one of the procedures, I had to have a torch light directed into the wound, and my reading glasses put on for me, my protective mask removed, to be able to safely continue the operation. A hand torch and headlamps would be handy. After our first day of operating, we all relaxed meeting up at Africa Beach bar for a beer! This is to be our after work meeting place for the rest of the week.

Further days at work
Woke up all together around 7:00 am and had Breakfast, the driver came and took us to the hospitals. Ginny collected some more stuff from the boxes, and off she went with Selva to the other hospital. No more electric failure. All the cases for today were presented to us, previously clerked in and screened for diseases like HpB and HIV, and consented. We only had to mark them and decide which type of anaesthesia we needed. We made sure they had prophylactic oral antibiotics. We continued until 2:00 pm when Selva and Ginny had their share of mega hernias (shown below) but finished early and came over to join us. Selva did our fifth case while I had lunch, met with the hospital Director, and marked my last patient. Each team did one patient until we finished.

We went with Brian to the Africa club for a beer and a swim, then back to the villa for dinner. We had to make arrangements for visiting schools, the next days. The responsibilities lied with Emma and Neil and the Kerslakes, for distribution, taking photos and video shots. We opened the bags, distributed contents in the four cases, hoping to visit four schools at least, one every day. The first school was for deaf children. It became apparent that distributing stuff individually to huge number of children was not a good idea. Also giving a football to a group of young children to play with meant that older kids will take it from them. We preferred to give the donations (Footballs, clothes, school stationary, chalks and board erasers) to the school principal, who will make sure donations will go to those who need them, and create some discipline and order. We went to other schools later on in the week, and followed the above advice.

We met some high ranking Ghanaian officials as well. Brian Dixon, Operations Director for Operation Hernia, has invited us and them to a dinner in a Chinese restaurant. We met Dr Bernard Boateng-Duah and The Honourable Edwin Phillips the Presiding Member of the Municipal Assembly for Takoradi and Sekondi the equivalent to the Leader of a local authority and extremely well respected in the area. They warmly thanked us and Brian and Operation Hernia . We responded by praising their hospitality and kindness.

Over five days of work we managed to perform 74 procedures, a respectable number, we are proud of, but it left us and the Takoradi team completely exhausted. Things that we take for granted like electricity and running water were not routine commodities there, we had to scrub by asking somebody to pour water from a bucket onto our hands. Without the air conditioning in theatre we could not have achieved half the above numbers. The diathermy kept disconnecting because the plate has been used on many patients beforehand and was not sticking and connecting properly. The diathermy stick was disinfected in fluid and would not work unless dry.

Further advice published on the site and written by Brian Dixon are first hand, important and worth considering. Unfortunately Brian Dixon is due to retire by the end of 2008. We were the last team he took care of and he did this job perfectly well. I am sure the local teams will do an impeccable job, but replacing Brian s position will be a hard act to follow. I hope the girls (Kate, Lillian & Grace) will continue serving the coming teams as well as they did with us.

Conclusion
Back safely we think we have achieved these goals:
1. Getting Leighton Hospital involved within the community of the European Hernia Society for its charitable Operation Hernia exercise.
2. Creating a successful team willing to give their time and money for this cause.
3. Collecting funds securely and professionally.
4. Getting as much advertisement as possible to help collecting the funds and to improve our hospital profile in the community.
5. Collecting and transporting as much as we can from donations, etc. that is not needed anymore by our hospitals, but is essential for our purpose.
6. Providing all possible protection to our team from vaccination and prophylactic medication.
7. Creating a charitable, happy atmosphere within the team and colleagues in the hospital.
8. Reducing expenditure to as little as possible. (Ex. Airline tickets, transports. etc..)
9. Achieving contacts to ease passing through customs in Ghana.
10. Safe arrival of all medical and school equipment (61 boxes and bags) to their intended destination. (Takoradi Hospital)
11. Achieving a respectable number of procedures (74) by two surgical teams and an anaesthetic team in five days, without immediate complications.
12. Leaving a good impression within the local and international Operation Hernia team .
13. Arriving back home safely, without accidents, incidents, or illnesses. Only extremely tired.

Thank you
On behalf of the Ghana Team
Magdi Hanafy

First mission to Carpenter, Bole District, N. Ghana 14-31 OCTOBER 2008

On the plane travelling to Ghana in November 2007 we met a Medical Team of Canadians lead by Dr Jennifer Wilson. The Team was bound for Carpenter to work with the Northern Empowerment Association-Ghana Rural Integrated Development (NEA-GRID) organisation.

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The NEA is the brain-child of Dr David Mensah and his wife Brenda who have given their lives to helping the rural poor around the desperately underprivileged area of Carpenter, where David was born. The NEA has improved life for the local community by provision of infrastructure, fresh water from wells, training of farmers, school buildings, fish farming, poultry husbandry and disbursement of micro-credit to women s groups.

After a preliminary site visit by in February 2008 and the consent of Dr Mensah, Operation Hernia began to plan a very ambitious mission to perform Hernia Surgery at Carpenter, where Hernias are epidemic in the people of the surrounding villages. No clinic or hospital previously existed. One of the buildings of the NEA compound was to be prepared as a rudimentary hospital with pre-assessment rooms, recovery rooms, examination rooms and two operating theatres . The nearest hospital or anything resembling a rudimentary healthcare facility is a distance of 30 kilometres.

A container to equip the two operating theatres together with the necessary supplies was sent out in advance loaded with redundant equipment supplied by Derriford hospital (Plymouth, UK) and the consumables required for the surgery. The surgical team comprised 8 members with an anaesthetist. In addition UK members joined the Canadian Medical team (two doctors, one dentist and two general Volunteers).

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It was a true pioneering adventure, with a few scares on the way – one in a patient with a giant “below-the-knees hernia! We operated on 76 patients and performed 93 procedures. The Canadian medical team set up mobile clinics in the surrounding villages (some a distance of 3 hours drive away by 4-wheel drive station wagon through the Volta swamps) and treated patients with a variety of tropical diseases. The number of hernias in the Northern Region is staggering – the local Medical Assistants surveyed 50 local villages (population estimate about 50,000 living in primitive conditions with no roads, electricity, or running water ) and stopped counting at 700! This equals a prevalence of at least ten times the expected level.

Along the way the Team enjoyed warm, enthusiastic and joyful hospitality from the local Chiefs, Elders and villagers. Cuisine was prepared from local produce and the tropical, torpid mosquito-ridden nights were brightened by the stunning sights of a billion African stars. There are plans to repeat this mission in 2009.

Our Sponsors for this mission were as follows:
1. Atrium Medical – Prosthetic meshes, 10 sets of surgical instruments (Codman), £3000 donation
2. Covidien – 2 diathermy machines
3. Cook Medical – £2000 to provide the transportation costs of a 40 foot container from Plymouth to Carpenter (see Gallery picture)
4. British Hernia Society – £1500
5. European Hernia Society – 1500 Euros
6. Derriford Hospital Medical Equipment Maintenance Service – redundant equipment including 2 operating tables and a ventilator
7. Collings Park GP Surgery, Plymouth – Little Sister steriliser
8. Anaesthetic drugs from the following donors: Taro (local anaesthetic, adrenaline, midazolam), Fresenius (propofol), Flexicare (LMA and airway filters), BD (cannulas, needles, syringes, spinal needles), Smith Medical (Portex tracheal tubes), Intersurgical (self-inflating ventilation bag = “resuscitator”)

The Probus (UK) Team 20-27 SEPTEMBER 2008

The Probus Surgical Centre in the UK, is a primary care based service, performing a variety of surgical procedures, including abdominal wall hernia repair. All procedures are performed using only local anaesthesia.

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Hernia surgery is a particular interest of the team at Probus and my initial contact with the project was through Professor Andrew Kingsnorth, who was presenting his early experiences in Ghana at an international meeting. I quickly decided that I would like the opportunity to be involved with such an interesting, exciting and worthwhile project. Andrew and Chris Oppong arranged for our visit to take place in September. This allowed us eight months to prepare for our journey.

At this point we began to search for local sponsors to help provide the materials and funding for the trip. In the subsequent months we were helped by many generous individual donors and by the kind support of several retail and pharmaceutical companies. Donations included meshes from Covidien, sutures from Ethicon, gowns and drapes from 3M. By the time of the trip we had secured supplies for all of our disposable needs.

The team consisted of two surgeons, ( John Tisdale and Nick Barwell), one surgeon in training, (Mehdi Masood), two theatre nurses and a medical student. On arrival in Takoradi we were housed at a reasonably comfortable government villa, which was to be our base for the week. During our time at the villa we were exceptionally well looked after by the staff, Lillian, Grace, Kate and Barbara. We were most grateful for their care and attention and send them our thanks and best wishes.

We divided into two teams and used the theatres at the Takoradi hernia unit and the Ghana Ports Authority hospital. As described in previous reports the units are fairly basic by European standards but adequate. Curved artery forceps are in short supply and dissecting scissors blunt but the kit is otherwise satisfactory. The nursing and support staff at both units are very welcoming and helpful. Our thanks to both teams for their support.

Forty three procedures were performed on forty one patients. Most were moderately large indirect inguinal hernias, two recurrent. A small number of ventral hernias were included. Two children were operated on under GA; all other cases were performed under LA. We were also called upon to assist at Caesarean sections and to give advice about other medical and surgical problems.

The social programme, organised by Brian Dixon included visits to local beaches, villages, schools, a rubber plantation, national park, crocodile sanctuary, El-mina castle and much more besides. We were able to distribute gifts of toys and clothing in the villages we visited.

At the conclusion of our stay we reflected on our experiences both as a team and from our personal perspectives. Everyone involved felt that the trip had been a great success and that we had each achieved our personal goals. Success can be measured in many ways but I think the fact that all members of the group have expressed a deep desire to return as soon as possible speaks volumes in itself.

The success of our trip owes a great deal to the hard work, enthusiasm and teamwork of the individuals involved and I offer them my sincere thanks. However without good local organisation in Ghana, Operation Hernia could not flourish. Thanks to our hosts at the hospitals, the medical director, Linda, Bernard Boateng and their teams

Special thanks must also go to Mr Brian Dixon whose efforts were quite remarkable. No person could have done more to ensure the success of the trip and the comfort and enjoyment of the group. Operation Hernia is extremely fortunate to have someone with Brian s commitment and energy working for them. We look forward to returning in the near future to renew our acquaintance with Brian and our many friends in Ghana.

Dr John Tisdale

Czech Hernia Team

Czech Team Report JULY 2008

Stanislav Czudek, Luká Adamčík, Roman Bezděk, Jana Kosturová, Markéta Hanáková, Daniela Juraíková, Urszula Czudková, Kamila Adamčíková, Dorota Havlíková, Kazimír Grochol.

Sweet Welcome to Ghana

Sweet Welcome to Ghana

Many thanks to Brian Dixon, Bernard Boateng-Duah, Kate, Grace, Lillian, Barbara and of course Andrew Kingsnorth and Chris Oppong! We had a wonderful time during our stay in Ghana and Takoradi. Perhaps everything has already been written by the English, Belgian, Polish, and Spanish teams and there is nothing more to add nad we also enjoyed the beautiful beaches, Kakum, Kumasi, and Elmina Castle which were superb. Many thanks of course to the Ghanaian people who showed to us great hospitality and grace. And also the doctors and nurses we were working together with. It was an honour to perform THE FIRST LAPAROSCOPIC PROCEDURE IN TAKORADI I hope The Rotary Club will help and buy a laparoscopic set for the hospitals in Takoradi. Thank you. This is our vision and wishes, which will be very helpful to the Ghanaian people. I would be very pleased to see the laparoscopic set when I visit Takoradi next year.

We met the Czech Ambassador Mr.Křenek and his wife,who visited Takoradi Hospital.Especially thanks to the member of the Czech Embassy Mr.Bruna,who helped Luká Adamčík with organizing our mission. The idea of Andrew, Chris, Brian, Bernard, is wonderful. To continue their future vision we suggest teaching the Ghanaian surgeons in European countries for 2-3 months.We will invite 2-3 young surgeons from Ghana to our country for training.

Laparoscopic Hernia Repair in Sekondi-Takoradi

Laparoscopic Hernia Repair in Sekondi-Takoradi

 

 

Czech Hernia Team

Czech Hernia Team

P.S.
This is just to say thanks to Brian Dixon who arranged a special program for our wives (Urszula , Kamila) who are teachers: We took the opportunity to visit basic village schools – St. Gabriel Anglican Basic School, Norpalm Primary School and a private boarding school, where we took part in lessons and even taught the children. At these schools the welcome we received was very warm from the staff and teachers who were grateful and friendly, the pupils were enthusiastic and well disciplined and very nice. We brought about 100 kg of school things ( exercises books, slips of paper ,crayons, pens, pencils, scissors etc) and gave these to the pupils and their teachers in the schools as a gift from people working in our hospital in Nový Jičín, their friends, children , families and some companies.

Many thanks to Barbara, the teacher in St. Gabriel Anglican Basic School for giving us an unforgettable time at her school among the children. Many thanks to Kate with whom we visited a village and school on a palm farm and gave the children some small gifts . Many thanks to Teresa, the Headmistress of a Catholic boarding girl´s school , for her hospitality and for devoting her time to our visit . Finally , shortly before our departure Brian Dixon organized a brief meeting with the bishop of the Catholic church and we gave him a big box full of toys for children. Seeing how poorly the schools were equipped it amazed us greatly to see the smiling faces of the children and their enthusiasm. They were grateful for every little thing they have (a common soccer ball was the best gift and the greatest surprise for them). I m going to make a presentation about Takoradi schools and show it to my students in the Czech Republic. Thank you for letting us be with you.

Urszula and Kamila

I hope we will meet next year. We thank everybody who assisted us in our mission.

Stanislav Czudek

South Africa Team Report JUNE 2008

The initial request to participate in Operation Hernia in Ghana was through the British Hernia Society from its President Professor Andrew Kingsnorth.

He approached me because of a previous contact we had had when I hosted him as our visitor at the SAGES Annual Gastroenterology Congress several years ago. He also did part of his post graduate studies in Cape Town. I agreed that we should look into the feasibility of participating and he forwarded me details of the initial teams visits during 2005 and soon after details of the web site where more comprehensive details were provided.

One of the prime movers in the UK is Chris Oppong. He is an ex Ghanaian, now working in the UK and is really the man in charge of logistics from the UK side. I did not wish to make this a private arrangement and as such wrote to the Association of Surgeons of South Africa to see whether or not they would give it their support and whether or not they would help with funding the project. Simultaneously, I approached several parties in industry, those particularly involved with hospital care and with repair of hernias. The matter was discussed at the ASSA where mixed sentiments were expressed regarding the distance involved to participate in the workshop and the fact that similar situations occurred in neighbouring countries to South Africa where currently there were no similar projects going on. My own view on this situation was that with no existing projects being available, one should explore how this project worked and perhaps try and use it as a potential model for doing things on a more local basis and to this end I agreed to formulate the team. ASSA gave it their support and asked its constituent societies to contribute to the financial support which indeed they did in the form of the Vascular Endoscopic and Trauma Societies

Several individuals were approached and eventually we settled on a team of 4 individuals. The members were myself, from the Department of Surgery at the University of KwaZulu Natal, Mr Simon Maseme, the Chief Surgeon at Prince Mshyeni Hospital, the theatre matron from Addington Hospital, Linda McKenzie. The most senior member was Mr Roy Wise from private practice, These individuals gave up their free time and agreed to go. We finalized the date and it was to be a ten day trip. This was based on availability of flights into a Accra from South Africa which were costly at approximately R11000 each. We had to route via Lagos to meet our predicted period in Ghana. The sponsorship from industry came from Life Care Hospitals, Johnson & Johnson from their Ethicon Division, Perryhill International. I am extremely grateful to the individuals from these companies who supported the project. In total they contributed R25000 to the project. In addition, they also contributed a variety of different mesh products and sutures for use in Ghana for repairing inguinal and incisional hernias worth a similar amount of money. AstraZeneca kindly donated a significant quantity of local anaesthetic which again was put to good use during the project. These accessories were packed neatly in two boxes.

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We set off on what we knew would be a lengthy trip because of our routing. First stop in Central Africa was the Lagos transit lounge where we had the dubious privilege of watching South African (0) being beaten by Nigeria (2) in Abuja. Next stop Accra a short haul which left only an hour late. On arrival we raised the ire of the customs officials as there was no import certificates for the medical goods and chattels we were carrying. However, with Simon Maseme s charm and my silver hair, we managed to get the boxes through without the need for a back hander or a huge paper trail. Meanwhile Mr. Wise was reporting his lost luggage, fortunately the only item which went missing in transit. This was despite booking all our belongings directly through to Accra together in Durban. This took the edge of what had been rather a long and arduous trip which still had a four hour road trip to go. When we emerged from Accra Airport a whole crowd of people , taxi drivers included, were watching the Ghanians beating Libya 3 0 they were ecstatic. Fortunately, our driver was looking out for us. The four hour evening ride, fortunately in our air-conditioned 4X4 was rather tedious so on arrival at 11pm we were all dead beat.

We arrived at the government villa which initially lacked some creature comforts and had a hot water geyser which was temperamental to say the least. This invigorated us all at various stages with a cold shower. Fortunately, the overall temperature of the cold water was well above zero and so it was refreshing rather than too much of a hardship.

It is important to say something about logistics. Our every need was catered for by Mr. Brian Dixon an oil man who knows how to get things done. He was the Canadian Natural Resources Limited, (A senior independent oil and natural gas exploration, development and production company based in Calgary) man in Ghana taking care of their business off the Ivory Coast. He is a huge asset to the hernia project. He employed three young ladies to look after us in the villa. They were Kate, Grace and Lillian. Lillian is training to be a welder, Kate is training to be a nurse and Grace is their best friend. They cooked for us prepared our packed lunches and pampered to our every need . It cannot be emphasized how much he continues to contribute to the whole ethos of the project. He does make it work and obviously it will be important that there is a transition to whoever provides logistic support in future years when he may have moved on. He had arranged a meeting with the acting Regional Medical Director, Dr Linda Vanotoo and I gave her feedback on our early experiences. The medical discussions focused on the need for provision of more Ghanaian trainees surgeons to assist and to be taught in the procedures. This would extend the potential benefit to create expertise locally which in my mind is essentially the true aim of the project to empower the health system improve the lot of their hernia patients.

We worked at two hospitals, a district hospital with a rather dilapidated exterior Takoradi Hospital. It is the home of the hernia project and on the second floor there is a converted ward which serves as a reception assessment area, operating theatre and recovery room . it has a well equipped small operating theatre and the staff , were to say the least, exuberant in their whole approach to life and to the project in general. The other hospital was the Ghana Port Health Authority Hospital (GPHA) which is a semi-private institution, a small hospital run by two doctors, one of whom is the main local instigator of the project and Chief Medical Officer Dr Bernard Boateng-Duah. He dedicated his operating theatre to the project for the week. His staff were also a delight in a more traditionally manner.

We serviced both hospitals simultaneously which meant we had to split into two pairs. We altered the pairings daily so we all worked with one another We had three trainees at the GPHA who participated and performed part of the hernia repairs that we did there. They were Dr George Tidakbi, MD Diploma in Anaesthesia West African College of Surgeons, Dr Owusu Adjei, MBChB Member West African College of Surgeons, and Bernard Boateng-Duah MD, Diploma in Obstetrics and Gynaecology University of Dublin.

Over the 6 working days we did a total of 61 procedures. We did 3 incisional hernia repairs, one bilateral hydrocele and 57 inguinal hernias, 4 were in young children and all but 2 were indirect hernias. The age ranged from 2 right up to 90. There was one return to theatre, of a large incisional hernia repair, for evacuation of a haematoma. This was 48 hours after the repair which we had fortunately done on our first day of our visit. It highlighted the need for suction drains, which we had not brought, but would have been an asset. My pièce de résistance was a 90 year old who had half his intestine in his right inguinal scrotum, I decided that discretion was a better part of valor and to sacrifice his right testicle. Fortunately, he made an uneventful immediate recovery, and when I saw him the next day he had a very broad smile on his face. It might have been because he had a very pretty nurse on his arm but I liked to think it was because his appendage had been returned to its rightful location. I very much hoped he remained complication free.

After a full weeks work from Monday to Friday, we had a relaxing time on the Saturday and Sunday. The Saturday trip was more hectic and we set off the rain forest and a canopy walk. There we were hosted by Rebecca who is one of the guides who had spend time in the U.K and her botanical knowledge greatly enhanced our trip there. It really was quite an experience and something unique for all of us. On the way back we had the privilege to watch a huge Ghanaian with a panga chop up a coconut so that we could not only drink the milk but also eat the coconut meat within. They also opened a Cocoa Pods which was a novelty for all of us. The cocoa beans within carry a sort of fructose – slime around them which is very tasty and edible. Of course the cocoa from the cocoa beans Ghana main exports and when we visited Takoradi port we found no fewer than 250 trucks full of cocoa beans waiting to be shipped out to make Cadburys chocolate. The port itself had also been the main logistics port for development by CNR of the Baobab oilfield in neighbouring Cote d Ivoire waters . A short ride took us to Hans Cottage where we had refreshments and observed crocodiles in the lake on which the restaurant was built.

The second part of our excursion was a visit to the slave castle at El Mina. This fortress had a long history of involvement in the slave trade. Our guide clearly outlined mans sustained inhumanity to man as a result of Portuguese, then Dutch and then British occupation. It appeared that not one of these pioneering nations had human rights on their mind when they were running the castle. It really was rather a sobering visit and emphasized how the colonial powers truly pillaged Africa in so many ways.

On the Sunday we went west towards the border with the Ivory Coast to a fantastic beach where we all braved the waves, had a leisurely time and a lunch. Again one needed a 4X4 to get to these beaches and we passed through some basic rural villages. The individuals seemed happy enough but one of the lasting memories for me was seeing two little naked infants defecating and urinating, in the company of goats, chickens, pigeons, and hooded vultures, on a rubbish tip. While we were trying to improve the curative services for hernia repair and improve the level of training of local doctors, their were obviously some basic health policy matters that will save many more lives than we can possibly sort out with our efforts.

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We had a wonderful social evening at the Chinese restaurant on the beach and all the girls from the various teams participated to make it a memorable evening. Linda McKenzie had her birthday there and Mr Wise and Brian managed to conjure up some South African wine and a cake was baked by the girls. Her happy birthday song could have done with some more tuneful vocalists but we all enjoyed the evening she turned 22 again!!

On the Monday, we operated on a complication of a giant inguinal scrotal hernia which the Spanish team who finished their stint two weeks ago repaired. It reflects some of the problems with handing over these far from straight forward and long standing hernias to the local resources at the institutions. This aspect needs a more formalized commitment from the local surgeons. They had only two in a town of 500, 000 but they need to be involved in seeing and if necessary treating the complications. It is unrealistic with these types of hernias to suggest that they will all have an uncomplicated course.

On the Monday at lunch time, we had a wind up meeting to discuss the visit and have a two way dialogue on aspects which we felt would improve the interaction. Brian chaired and minuted the meeting. In essence, we were concerned regarding the short term follow-up of the patients and the timeous management of any complications. Obviously the long term follow-up is another issue which I am sure the founder members of the project are anxious to get meaningful data. We were concerned that the reusable drapes did not provide an adequate sterile field and that larger reusable drapes could be sourced locally.

The theatre lights at GPHA needed replaced as they were substandard. We felt also that opiod and local anesthetic drugs would be better sourced locally than brought in by the visiting teams. Even the importation of the meshes should have been more formalized so that import certificates can be achieved ahead of time. It was also felt that accurate stock record should be kept so that teams could be alerted as to the specific deficits in meshes, sutures and suction drains . The specific needs might also be based on the type and size of hernias an individual team would be treating. Hence details on the hernias to be treated should be sent to the team two to three weeks prior to their visit. It was also felt that an earlier start and restricting the number to a maximum of five patients a day would be beneficial. It would allow more time on each case for teaching purposes and to see the cases prior to overnight admission or discharge. In addition it would allow a bit of leeway for double procedures on certain individuals.

The girls at Takoradi decided that we should have some Ghanaian shirts and hats and a little Ghanaian Sarong was duly produced for Linda McKenzie. They really were a delightful bunch and were appreciative of our participation in their project. They had nicknamed Simon, Obolobo which means the large one or if you are being kind it means cuddly one He really related to the girls as the cuddly one. It was a really touching send off.

We set off early on the following morning on our final ride on Accra. We made record time with our new driver and fast vehicle but we were rather anxious when we checked in that we would arrive with our luggage at the other end. On this occasion we had to pick it up in Lagos and so we all got back to Durban with our belongings. Once again washed out after 24 hours on the road. Mr Wise still had the energy to take his dogs round Greyville Race Course before retiring.

I was proud of the whole team in Takoradi and the extent which the local girls went to ensure that we were welcome, well fed and comfortable . All of the South African team which I had the privilege to bring thoroughly enjoyed the trip. We all participated fully and the younger members took our hats off to Mr Wise who s senior participation as he approaches 80 was something for us all to behold. He retains an enthusiasm for his craft that has long deserted and jaded many lesser mortals in surgery. He sustained losing his case and having to wear my underpants and tee-shirts for several days with great aplomb.

It was a worthwhile trip whether it is a sustainable trip or whether it will provide us with an impetus to do things on a local basis remains to be seen. My own view is that it would certainly be worthwhile approaching our current and other funding sources for consistent backing for a project like this. If not for this particular venture, then for other projects where a small team can go on a recurring basis to develop the skills of local doctors. I hope this document kindles some interest in the concept amongst the ASSA executive.

Acknowledgements: I would like to thank all the individuals, companies and societies below for their conceptual support for the project and by translating this into both the financial and product support necessary to make it a reality. Roger, Vash and Sioban from Johnson and Johnson; Michiel from Astra Zenca; Ludwig and Geraldine from Perry Hill; Mike and Ruth from Life Care Hospital Group: SATS from ASSA and the councils of VASSA, SASES, Trauma Society.
I compiled this report on behalf of the Team

Sandie R Thomson

17-27 MAY 2008
Our mission in Ghana was a success. It was over our expectation, especially due to the feeling that local people were really grateful for our presence in Ghana, trying to help them.

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All this started a year ago when we decided to create a group of Spanish surgeons to participate in this project. At the beginning it was not so easy, but finally 18 people decided to be part of the group: 8 general surgeons, 1 paediatric surgeons, 4 anaesthesiologist, 4 nurses and 1 general doctor. We were very impressed with how the group was motivated by the project, even when everyone paid the cost of their trips and of their accommodations from their own pockets and how those days were part of their official holidays in their hospitals. But everything was done generously in order to get one goal: to try to help people.

Out of the 18 persons, 16 were from Sevilla, 1 from Barcelona and 1 from Ourense. Most of us did not have experience in humanitarian missions, so we were a little afraid of how things were going to work out. Once we got all the official documents ready, thanks to our hospitals, the Spanish Association of Surgeons, C Oppong, A Kingsnorth and B Dixon, we started looking for some financial support to the mission: Atlanta-Unicongress supported us by reducing the prices of our flight tickets, and different companies (especially Dipro, Covidien, J and J) and our hospitals (University Hospital Virgen del Rocio, University Hospital Virgen Macarena, USP-Clínica Sagrado Corazón, Hospital de Río Tinto and Hospital Infanta Elena) supported us by supplying meshes and sutures: 15 boxes of 15 kg each with surgical equipments and anaesthetics drugs were taken to Ghana. On the other hand, our baggages were full of toys and school materials.

At arrival (Saturday 17th), everything was organized, a bus took us to Takoradi and next morning we went to Green Turtle beach, a paradise, a nice beach full of palm trees to relax the day before we started working. The local culture is so different, Barbara, one of the local girls who looked after us during the week, told me she did not understand why Europeans like the beach so much and to lie down under the sun. We were impressed by the local people, the way of thinking, the colours, the smile in the face of the children, the nature and the way of living. It is a poor country, but we did not see people starving, it seems they work very hard to guarantee their own meal, and none of them asked us for money. We have good feelings after the first day, the people were happy to have us there, we felt safe and the environment was very friendly.

The next 5 days, we worked very hard in 3 hospitals: Takoradi hospital, GPHA hospital, and the regional hospital at Cape Coast. We worked for almost 12 hours a day in each of the 5 operation theatres which we covered in the 3 hospitals. We have performed the largest hernias we have ever seen in adult people and in children; we have also performed cases after multiple surgeries in their groin, multirrecurrent hernias which were very difficult problems to be solve. Very difficult cases, being exhausted by the end of the day, but we were all very happy, very satisfied, since you can see in the face of all our patients they were very grateful to us. The environment in the operating theatres was very friendly with local nurses, they were very professional and they made things easier. By the end of the five days, 146 hernias in 130 patients were performed, including 6 children (the youngest was 4 months old). During our stay we also had the opportunity to teach the local surgeons, I would call them better the local heroes (Dr Frank was in charge with one colleague of Takoradi hospital with 40 beds, he had to visit the patients, to do ultrasounds, to perform caesareans, emergency surgery, I would say he has to cover all the specialties) how to perform a large umbilical hernia and a large incisional hernia. On the other hand, we were the first group with anaesthesiologists, which was very helpful for the local nurse, especially regarding spinal anaesthesia. One of the anaesthesiologists of our group had also the opportunity to give a lecture on local anaesthetics and spinal anaesthesia.

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The evenings were very interesting, getting to know downtown Takarodi and Cape Coast is a unique experience and, although we were exhausted, there was always sometimes to seat the group together around a table with the local beer and share our experience. Brian Dixon also took us to visit a little village, to get to know another aspect of the real Ghana. You can see how they live, how their houses are made, how the produce the palm oil, and how happy the people are with our presence. We also had the chance to go to visit the bishop of the western region of Ghana to give him all the toys and the school material we took with us, to guarantee that all was handed to the people who needed them most.

Being a large group is a real problem for the local organizers, but the effort of Brian Dixon (and the company he works for, CNR), Bernard Boateng-Duah and Michael was very important to organize everything. They took care of every single detail to make us feel comfortable, to advise us about the local cultural aspects. We want to thank all of them and especially the enormous effort of Brian Dixon for being present everyday to make sure that everything was well organized. The four girls who looked after us in the government villa were very important to us to make us feel like at home. They were always smiling and making are stay so easy. They prepared local food for the whole group every single day, they looked after us and they even prepared on the last day a cake with the flag of Sevilla, which they found it in internet. We all want to thanks to Grace, Kate, Barbara and Lillian.

The last day, on our way to the airport we had the chance to visit Kakum National Park and Elmina Castle. Impressive places you should not miss when you visit Ghana.

Long trip and back home, but you can see in the face of the people of the group how satisfied they were. We were a nice group of friends that we enjoyed very much trying to help people. It was worthy to be part of this project, especially if we solve a problem to 130 patients, and we made children happier for a moment with the toys and school material which the local people enjoyed with us,.
We are happy to have the chance to have this experience and we think next year the whole group will be back, and after sharing our experience with the people of our hospitals maybe we have to create more than one Spanish group.

Salvador Morales-Conde
Coordinator of the Spanish group

23 FEBRUARY – 8 MARCH 2008
Only two surgeons (Maciej Śmietański and resident Kamil Bury) can enjoy the mission according to difficulties in financial support offered by local medical companies in Poland. Finally we would like to thank Covidien Poland, Gore and J&J for the meshes and sutures, Hartmann for surgical drapes and gloves and the authority of the Medical University of Gdansk Hospital (Marek Labon). All other expenses (flights, accommodation, fuel) were paid by us.

In 9 days of work in the hospital we have done 67 procedures in 58 patients. Not only inguinal hernias were treated, also umbilical and middle line hernias and hydrocoele cases were present in the treated group. We found the hospital facility convenient for hernia surgery, in fact very similar to conditions in Poland some 10- 15 years ago. Also to work with not full equipped operation room was nothing new for us, so it was not making any difficulties in our activity. All the people we met were very friendly and helpful, offering a lot of time and heart to the patients and us.
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We had the possibility to check the patients one week after the surgery. In this short follow-up only one haematoma occurred in the patient operated for bilateral scrotal hernia. This patient needed conservative treatment and we advised him to come back to the hospital during the next two weeks for a control visit.

According to the local culture many patients promised to pray for us for many days, so I believe that never in my life did so many people pray for me at one time. Also one of the patients, the judge from the court in the town of Axim invited us for a trip and meal. It happened that he organized the trip to the historic places connected with first president of Ghana Kwame Nkrumah (his home, his mother s home, the river next to the house) and finished with meeting with all his living relatives dressed in traditional clothing. To express our pleasure a post card originally signed by first Polish president Lech Walesa will be sent to these people.

Enormous help was also offered for us from Brian Dixon and Bernard Boateng-Duah. Without this help the whole mission would have been impossible.

During our stay I meet also the Executive Director of the Teaching Hospital in Kumasi (one of two Medical Universities in Ghana) speaking about the problems of introducing mesh repairs in Ghana. The lecture about standards of groin hernia repair in Europe and USA was given during the meeting of the local doctors association. I had to answer a lot of questions and had to explain all the mesh methods to the audience.

What we advise to all the following participants of the hernia project is to stay in the country for a few days extra to enjoy the seaside and make some trips to other towns. We spent 5 days visiting Kumasi, the water village of Nzalazu, Tarkwa gold mine and dancing with a village party on the Saturday night (live drum music and gospel singers). Missing the direct contact (and local gin) will be a mistake on the way to meet and understand the people of Ghana.

Our participation in next year’s mission is decided.

Maciej Śmietański

26 JANUARY – 2 FEBRUARY 2008
With three surgeons and two nurses we tried to plan our trip as well as possible with the advanced and forwarded information.

We took meshes (kindly donated by B. Braun Medical NV Belgium), gloves (double pairs), disposable drapes (Mölnlycke Belgium) and gowns (Sterima Belgium), local anaesthetics, analgesics (Paracetamol), syringes and needles, and a lot (two bags) of small gifts and sweets. Bard Benelux partly sponsored our team. After arriving at Takoradi on Saturday night Brian Dixon waited for us and brought us to the Doctor’s Transit Lodge where we stayed the whole week. Due to the Africa Cup the Planters Lodge was not availbale, but we did not miss it. We were taken good care of by Brians team (Kate and Grace), who made a wonderful breakfast, a nice lunch and an even better dinner at night. After arrival at the hospital on Monday morning we could immediately start working, while a strict progam was made beforehand with selection of patients as early as November 2007. Dr. Boateng- Duah (GPHA-Hospital) hopes in the future he can send already a program to the visiting teams.

We could operate in three theaters (two in Takoradi hospital and one in Ghana Port and Harbour Authority Hospital) and did 59 operations on 54 patients (of which seven were children). Important to point out is, that we did not only operate on groin hernias but also nine ventral hernias and two hydroceles. I would advise teams in future to take also meshes for umbilical hernias (type Ventralex) and for preperitoneal repair (type Polysoft) in recurrent hernias. A more extensive repair (retromuscular mesh) for ventral hernia is not easily done under local anaesthesia. We used the Mosquito-mesh only once.

The operation-theatres were well equiped, but the operation-light in GPHA-hospital needs to be renewed. The next mission should also bring new scissors or an instrument to sharpen the scissors. Swan-Morton knives nr. 15 would be wellcome instead of nr. 11 knives. Although we made long days we all felt inspired with our work. Two of us were interviewed by TV Africa while working and this was broadcoasted Africa-wide (Dr. Boateng-Duah promised us a copy on CD-rom). One of the questions asked was how to prevent hernias. We answered there is no prevention for groin hernia, but please come sooner for the operation and do not wait so long.

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In the evenings Brian Dixon took care of us and we managed to visit a football game (Nigeria-Benin), take a tour in the harbour on a boat and visited a village. Friday night we invited managers and doctors from the hospitals, people from the local authorities and members of the Takoradi community for a gala dinner at Planters Lodge (sponored by J&J Belgium) in which we strengthened the bonds between Operation Hernia and Takoradi.

On Saturday, on our way back to Accra, we visited the rainforest, the crocodile lodge and El Mina. After a quick refreshment and a last meal we left Accra on Saturday night to land in Brussels again on Sunday morning.

Our thanks go to the doctors and nurses in both hospitals, the local authorities, Kristie (a Canadian nurse who volunteerly helped us), the local staff (Kate, Grace) and last but not least Brian Dixon, without whom nothing would have run as it did.

We all intend to come back next year.

Casper Sommeling