Operation Hernia Team in Ho

Operation Hernia Mission to Ho, Ghana – October 2016

Operation Hernia thanks the clinical and administrative staff at the Volta Regional Hospital in Ho, Ghana for an excellent week of hernia surgery this year. We also thank Mr Chances who graciously hosts us at his beautiful hotel.

Operation Hernia Team in Ho

Operation Hernia Team in Ho

Operation Hernia first travelled to Ho in 2011. Volunteers have returned every year since. This year’s team included Miriam Adebibe, Naami McAddy, David Defriend, Odd Mjaland and Kelly Shine. Each one of us has been on at least one prior trip to Ho. This is proof that Ho has a way of calling us back!

Surgical team working in the operating theatre

Surgical team working in the operating theatre

As a volunteer I find these trips restorative. We help patients every day at home. However the pace and the administrative frustrations can lead to burnout. Overseas, the privilege of helping others is so obvious. Despite a busy day, there is time to reflect on the joy of meaningful work. In the evenings all seriousness gives way to laughter, storytelling and dance!

If you are a surgeon, an anesthesiologist or a medical student reading this and contemplating your first international volunteer experience, I encourage you to reach out to Operation Hernia. Come and join us!

Kelly Shine

Prof Akoh, Dr Debra and the hospital staff

Hernia Training Workshop at Cape Coast Teaching Hospital, Ghana, 17-21 October 2016

Prof Akoh, Dr Debra and the hospital staff

Prof Akoh, Dr Debra and the hospital staff

Itinerary

I arrived Accra on 15 October, spent the night at the Baptist Guest House and was driven to Cape Coast on 16 October. I was housed at the Samrit Hotel about 1.5 km from the hospital for the duration of my stay and had breakfast and dinner there every day. Lunch was usually provided in the operating theatre. I returned to Accra airport on 21 October and to the UK thereafter.

Activity

Table 1

Table 1

Prior to our arrival, 25 patients were organised for surgery. Attempts to recruit more patients during the week were only partially successful. The majority of the procedures were performed under local anaesthesia, with a few under spinal and two incisional hernias under general anaesthesia.

Training

1. The lectures were well attended by trainees, senior hospital doctors and medical students. The academic morning on Friday was well appreciated and turned out to be an effective use of the “surplus” day due to our clearing the surgical list by Thursday afternoon.

2. The theatre facilities were excellent with a team that was well motivated and hard-working. Theatre efficiency could be improved by developing standard operating pathways involving ward preparation, theatre reception and recovery of both inpatient and day case patients.

3. There were approximately ten trainees (including one who travelled ten hours to attend the workshop) who were divided into two groups. Though they were all very keen and they took turns to assist, perform in part and or do the whole procedure, one felt that the opportunities could have been better to allow concentrated training of each candidate as we have done elsewhere.

4. This was very much a joint effort between Operation Hernia and Cape Coast Teaching Hospital (CCTH) as Prof Debra and Dr Morna actively took part in the programme.

5. It is praiseworthy that CCTH surgeons cancelled their elective cases during that week to allow the theatres to be devoted to hernia training.

Recommendations

1. Formally establish CCTH as a centre for Operation Hernia training in Mesh Repair. It may be necessary to involve both the Ghana College of Surgeons and the West African College of Surgeons in this venture.

2. Encourage CCTH to research the effectiveness of prophylactic antibiotics for mesh repair of abdominal wall hernias.

3. Formalise arrangement with Plymouth Hospitals NHS Trust for sterilising “Affordable Mesh” in order to ensure a steady supply to low income countries.

Participant Evaluation

Dr Morna is collating these and will produce a mini-report in due course.

Thank you for the opportunity to contribute in this deeply satisfying way. We owe a depth of gratitude to Dr Mona and Prof Debra and their teams for making the program a great success.

Jacob A Akoh, Consultant Surgeon

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

Report of Operation Hernia.nl’s Mission to Ghana, January 2016

Our recent missions to Keta and Sunyani in Ghana took place from 9 – 17 January 2016. They were heart-warming adventures focussing on both treatment and education.

It is a great honour to inform you that the Dutch team of “Operation Hernia” recently finished a successful seventh mission in Ghana. “Dutch Operation Hernia” started in 2009 with three dedicated surgeons and has expanded significantly over the course of the years. This year a team of 15 went to Ghana to use their surgical skills to treat children and adults with inguinal hernias.

The prevalence of inguinal hernias in Ghana is high (7.7% among male citizens) and nearly 25% of patients have to cease professional activities due to their symptoms. Despite these numbers elective hernia surgery is rare in this country. Elective surgical programmes are unusual in Ghana as many regular government hospitals are understaffed (with an average of only nine doctors per 100,000 citizens). Consequently, 80% of patients with a symptomatic inguinal hernia remain untreated. Besides a fundamental effect on daily activities these untreated hernias bear a substantial health risk with mortality rates of up to 80% in case of incarceration and strangulation.

Therefore, the key aims of ‘Operation Hernia’ are treating as many patients as possible and, at least as important, teaching local doctors to perform hernia surgery independently. After having treated 143 patients and having trained nine local doctors we look back on a very successful week in both respects. We are delighted to provide you with some of our impressions.

As soon as we arrived in Ghana, all 15 doctors were divided into two groups; on Sunday the 10th January one group took a short flight to Sunyani whereas the other group went by road to Keta.

Keta mission (8 physicians, supervised by Dr Boerma and Dr Garssen)

As soon as we got out of the car we smelled the African odour of little bonfires and heard warm African music played at the small road-side shops. The weather was beautiful with a warm sun and blue sky. We instantly enjoyed the great beach vibe in town. The beautiful hostel we stayed in, situated along Ghana’s southern coastline, was even more beautiful and relaxing.

The next morning, the hospital bus picked us up from up from our hostel to take us to the hospital. Keta Hospital is a lovely, small and clean provincial hospital with 300 beds and 5 medical officers. After a short walk through the hospital gardens on our way to theatre, we were welcomed by the friendly theatre staff. After a short introduction we started with the operations. A total of 70 hernias were operated by the Keta group. Inguinal hernias (severity grade H1 to H4) were treated with a Lichtenstein procedure, using meshes which were brought from the Netherlands. Although the main focus was inguinal hernias, other hernias such as umbilical and incisional hernias were also operated by the team. Local, spinal and ketamine anaesthesia were used.

The hospital staff and the Dutch Operation Hernia team worked well together. Local doctors were joining the operations to learn and practice Lichtenstein procedures. We were very pleased to hear that one of the medical officers even performed a Lichtenstein procedure on an incarcerated hernia on his own, one week after we left!

In the evening we spent time enjoying real Ghana life. We swam in the sea, listened to music, danced with local people and enjoyed the local food. We had a nice interaction with colleagues from the hospital who we invited for diner on the last night. The hospital administrator gave a beautiful speech and thanked us for all the effort. On Friday afternoon we finished the last surgical procedures and travelled back to Accra. But not before a thousand pictures were taken and all telephone numbers were exchanged.

Sunyani mission (7 physicians, supervised by Dr Simons)

After an impressive flight through inner Ghana we arrived in Sunyani, the capital town of the Brong-Ahafo Region with over 250,000 citizens. We were welcomed by Professor Tabiri, a well-respected surgeon born and bred in Sunyani and one of his residents, Dr Eric Owusu.

We took up residence in a nice lodge after which we were introduced to the team and, more importantly, to our patients in Sunyani Regional Hospital. We were impressed by the warm welcome and by the great facilities including well-maintained surgical theatres in this large teaching hospital.

The next morning, after an inspiring speech by the hospital’s medical director, we started with a fruitful team briefing in which the plans for the upcoming week were discussed.

As soon as everybody was aware of these plans surgery could start. Teams of Dutch surgeons, Ghanaian medical officers and Ghanaian scrub nurses made a great effort to treat all 75 patients who had responded to ‘the call for treatment’. Similar to the Keta mission, the most frequently performed procedure was mesh-based inguinal hernia repair using local anaesthetic. For exceptional cases of irreducible and recurrent hernias spinal anaesthesia was available. Children with inguinal hernias were treated under anaesthesia with Ketamine.

By using instructional videos, lectures, but of course most importantly hands-on-training, local medical officers became familiar with the common surgical procedures. Many of them will work independently in small medical posts throughout the country and we have high hopes that hernia surgery will be part of their ‘arsenal’.

Professor Tabiri proved to be an outstanding host next to an experienced surgeon. He showed us around in his hometown, enabling us to fully absorb the Ghanaian culture. What struck us was the inexhaustible optimism and hospitality that was present everywhere we went. During a memorable final evening local gifts from both Sunyani and Amsterdam were exchanged and inspiring words were spoken. Within one week a solid team had been formed and we all regretted that it already was time to say goodbye.

On Friday evening we were reunited with the Keta group in Accra. We stayed at the lodge close to the beach and shared all experiences of the past week. After some leisure time we had to go back to the airport to catch our flight to Amsterdam. Time had gone by so quickly!

We are very grateful for a fantastic experience and we would like to thank all the sponsors below who have made this journey possible. We are all looking forward to expand our mission with the “Dutch Operation Hernia” team next year!

Dutch Operation Hernia Teams: Maarten Simons, Djemila Boerma, Frank Garssen, Suzanne Gisbertz, Nanette van Geloven, Eddy Hendriks, Jonathan Vas Nunes, Anne Ottenhof, Bert van Ramshorst, Wouter Derksen, Frank IJpma, Theo Wiggers, Ellen Reuling, Charlotte Loozen, Maarten Anderegg

Sponsors & partners: Chris Oppong of Operation Hernia, MRC-Foundation Medline Atrium Medical, Departments of Anaesthesia & Pharmacy of: Academic Medical Center, Amsterdam, Amstelland Hospital, Amstelveen, Flevo Hospital, Almere, OLVG Hospital, Amsterdam, Sint Antonius Hospital, Nieuwegein, Ter Gooi Hospital, Hilversum, University Medical Center Groningen, Groningen