Visit to Ho Hospital November 2014

Report about “Operation Hernia” tour to Ho in Ghana from 15/11/2014 to 23/11/2014

This is the second time I have joined a tour for the charity “Operation Hernia”.

The tour was planned well ahead during 2014 with timely reminders about all the practicalities. These preparations were severely disrupted by the Ebola virus outbreak in some West African countries. For safety reasons, the organising team felt it had to cancel the tour. However, I had booked holidays and flights etc, I was looking forward to the tour and I judged that the risk of Ebola outbreaks in Ghana would most likely be minimal and therefore requested to be allowed to go anyway.

I am very grateful that Mr Chris Oppong supported me in my endeavours and worked hard to make my tour possible.

Living in Shetland it is always a gamble to travel in winter from here. The weather was kind to me and my travel arrangements worked out well.

Having arrived in Accra as planned on the evening of 15/11/2014, I was picked up directly at the airport and brought to a guest house for a comfortable overnight stay and rest. The next day, the Ho Hospital send a comfortable SUV car and very friendly and safe driver to take me to my lodgings in a very fine hotel in the outskirts of Ho. The hospital transportation team took great care of transporting me daily to and fro between the hotel and the hospital. The accommodation was extremely comfortable, safe and friendly and had wonderful African food for me.

From Monday morning to Friday lunch time, I worked in the Ho District General Hospital. The team there were very well organised. They had visits from the “Operation Hernia” teams there for a few years running and had put in a lot of effort to make this a success. They opened a special ward with extra staff to look after the patients. In addition they had an operating theatre with extra staff including nurse anaesthetists ready. I had one of the surgical trainees to assist me at all times. He was already experienced in inguinal hernia repairs as obstructed and strangulated hernias are one of the most common surgical emergencies in Ghana. However, they usually have not had access to surgical mesh and therefore do a darn repair. The trainee was very eager to learn the mesh technique and it was wonderful to have his help preparing the patients and getting to grips with the new environment. And it was good that I could show him a different way of treatment and to see him performing mesh repairs independently after a few days. I also encouraged him to contact Mr Oppong to find out about “mosquito net mesh” and the logistics on how to get that set up in Ghana. And I hope that he will be able to use this in his future career.

Overall, I – or rather we – operated on 26 patients, who had 32 hernias, 2 of which were recurrent hernias. Only 2 or 3 of these were of a size that I recognize from my usual practice in the UK. One patient was about the size of a normal weight patient in the U.K. The other patients were all very slim, rather small, with tough muscles and very large hernias which they had to live with for many years. This makes the operations a bit more protracted and challenging. I very much hope there will be not too many seromas…

The patients were admitted the day before surgery. Co-morbidities were few that we knew about. One patient was NIDDM who checked his own BM. We did him early on the list and he was happy to go back on his medication later that day. 2 patients got postponed for a couple of days as they had not taken their anti hypertensives. A common problem, as the patients do not feel better on the tablets and therefore do not understand the sense of taking them. We were able to operate on both of them later in the week.

The patients were discharged the day after the operation if all was well. This was co-ordinated by the junior doctors of the hospital. As far as I was told, no patient needed to stay longer, except for one. This patient had a large, irreducible, sliding right hernia with a fair bit of small bowel, caecum and some ascending colon in the hernia. Furthermore, I found a tumour – most likely testicular in origin – which was invading the mesentery near the ileocaecal valve. So, we ended up doing a limited right hemicolectomy with end-to-end anastomosis and a right radical orchidectomy as well as the hernia repair. This patient was then sent to the normal surgical ward. My local surgical colleagues were happy to take over the post-operative care. They assured me that they would have done the same and that they are very used to looking after patients with bowel resection due to the frequent emergency presentations of hernias. The patient was recovering well when I left.

Of course, operating in a new environment has its challenges for every surgeon. We like to have the security of the known surroundings and our own routines. I was very grateful, that I had the support of a surgical trainee with local knowledge throughout. It must have been difficult to spare him from the routine hospital work which looked very busy for the far too small work force. I appreciate the thoughtfulness of the local colleagues to give me so much support.

I could see that the local resources were stretched by my lists. I had all the meshes for the hernia repairs and left some behind. I had nearly enough suture material. But of course, there is much more involved: extra staffing, re-sterilisation, gowns, masks and hats, air conditioning to keep this northern visitor from collapsing, lunch time feeding for the team… The theatre staff were wonderful. They stayed cheerful until the cases of the day were done. They were patient with all my funny demands. They kept the lists well organised. They warned me in time when we had to improvise so that I could adjust my expectations.

On the last day, after finishing the last scheduled case, I received a warm “thank you” from the hospital management. I thought I had done fairly well. It was humbling to see that they had a much longer list of cases collected earlier in the year. They had hoped for the full team from “operation hernia” to visit which would have allowed for many more patients to get their hernias repaired. I just hope that it will be a good incentive for the charity to organise the next visit for next year.

I am grateful for everybody in Great Britain and Ghana who worked so hard to allow me to visit Ho Hospital.

I wish the trainee, Mr Bosompem all the best for his future career.

Beatrix Weber

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

Operationn Hernia team in Rwanda

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

INTRODUCTION

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

Operationn Hernia team in Rwanda

Operationn Hernia team in Rwanda

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

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

BURDEN OF HERNIA DISEASE IN RWANDA

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

HOSPITALS

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

PATIENT RECRUITMENT

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

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

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

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

TRAVEL AND CUSTOMS

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

MEDICAL REGISTRATION

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

ACCOMMODATION

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

TRAINING OF DOCTORS

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

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

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

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

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

CLINICAL OUTCOME

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

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

Table 1

Table 1

CLINICAL OUTCOME

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

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

Table 2

Table 2

Change of policy.

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

MEDICAL EQUPIMENT DONATED

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

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

ACKNOWLEDGEMENTS

Ministry of Health

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

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

Medical Teams

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

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

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

FUTURE PLANS

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

CHRIS OPPONG, CHAIRMAN OPERATION HERNIA

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

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

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

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

Waiting in line

UK team in St Vincents hospital, Aliade, Nigeria – February 2014

Operation Hernia – St Vincent’s Aliade, Nigeria

February 1st- February 10th 2014

The time was not long since I first visited St Vincent’s Hospital, Aliade in Nigeria, September 2013 with the team from Operation Hernia.

February 2014 I was the leader and founder of the next mission.

Waiting in line

Waiting in line

The need of help is ongoing as the nr of people in need is very high in the region.

I had short time to prepare my team but I had the trust on the people I left behind, the operating theatre staff, Peter, Benjamin, Lawrence, Francis and Simon to be part of the team.

The news to go back was very welcome by everyone at St Vincent, Sisters of Nativity, Sister Helen and Sister Rose as well as Dr Austin Ella, who organized the preparation, in Nigeria.

In the attempt to organize my team, with a surgeon with Pediatric surgery experience, I met Mr. Ogedegbe, Consultant General, Breast and Pediatric Surgeon in London, who he is Nigerian, one more reason to approach him and ask if he was willing to join the team. After few weeks he gave me a positive answer.

Preparing the theatre

Preparing the theatre

Pre-op inguino-scrotal hernia

Pre-op inguino-scrotal hernia

The team was made of two Consultants Surgeons, Mr. Ogedegbe and I.

We were planning to use the local anesthetic cover.

We arrived in Abuja Sunday morning 2nd Feb. Welcome by the Pharmacist Dada and our driver Simon, who they help us to take our staff and drove us all the way to St Vincent’s, Aliade.

We had a very warm welcome by Sister Rose, Sister Helen, all the local theatre staff and the locals, as they know how to welcome their visitors.

The work started Monday 3rd February, 08:00 am, a crowd of people was already waiting to see us.

We started seeing them, to create our day’s list. Most of the people did not know the exact date of birth, their age was guessed; the dry season easy left the white earthy dust on their body, easy to guess the distance and the way they had travelled to reach us.

Mr. Ogedegbe and I with the local theatre staff, Peter, Benjamin, Lawrence, Francis, Simon and Pharmacist Dada, coordinated our work and started operating by 10 am. The following days, to Saturday 8th/Feb. from 08:00 to 18:30.

Sister Rose and Sister Helen they were making our stay comfortable, as much as possible, with plenty of food and cool drinks to keep us going.

Spigelian hernia

Spigelian hernia

The six days of work we accomplished 75 operations, repairing hernias. 7 cases were bilateral, 15 were women and 8 children from age of 2+ to 15 year old. 8 cases were done under GA. One of the cases, a recurrent inguinal hernia on a yang man early thirties needed, team effort work and was converted form LA to GA, he was admitted to the word and discharged well two days latter.

All the rest of the patients were discharged on the same day.

To build this mission in a short time a number of people and companies supported me.

1)Ansell Healthcare Europe, for the Gammex surgical gloves. We thank Mr. Garry Brinn for his assistance.

2) Swan – Morton, for the supply of Disposable Surgical knifes. We thank Miss Tracy Liggins for her assistance.

3)Mr. Andrew Kingsnorth, Operation Hernia Charity, supplied us with the Mosquito Mesh.

4)NHS Trust.

5)Senior Theatre Nurse Margaret had gathered some of the essential materials, she sent to me, after she had to postpone her trip for family reasons. An extra luggage, I had to pay at BA of 117 pounds. The payment was raised from the financial support of my Greek friends from UK, who their help made this mission easier to be accomplished. Their names are following.

Father Andreas and Presvitera Alkmini, Father Damianos, Mr. and Mrs. Loizou,

Mrs. S Katsarou, Mrs. M Stelianou, Serafim and Andrie Kyriakides from St Panteleymon Greek School.

I am happy to know, Mr. Ogedegbe will continue his support to St Vincent’s Hospital.

Sister Rose, Sister Helen, the Operating theatre team with the Pharmacist, and all their people, all are congratulated on their efforts for improvements they achieve.

We hope, in future, Operation Hernia and Mr. Andrew Kingsnorth to support more Surgeons towards, this destination.

Zoe Vlamaki MD FRCS

Team leader and founder of the 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.