The Opening

Operation Hernia Team Inaugurates Hernia Centre in Eruwa, Nigeria December 2012

The Opening

The Opening

We arrived at Eruwa on Saturday 1st December. There were seven members from Madrid hospitals (anaesthetists: Francisco Duran and Miguel Lopez Vizcayno, surgeons: JA Pascual Montero, Teresa Butrón, Patricia Maldonado (resident), internist: Iñigo Espert, nurse: Ana belen Abenoja) who were joined by an additional member from the UK the following day.

The site was the Awojobi Clinic, which started at grassroots level in the 1980’s and has been steadily growing ever since. The clinic was set up to serve the local rural population but the level of care has reached a standard that attracts patients from as far away as Lagos, a 3-4 hour journey by road.

Surgeons & Supporters

Surgeons & Supporters

At work

At work

Work started on the Sunday and continued during daylight hours for five days. The patients would arrive from 8am and the 8 team members formed two surgical teams. Surgery was performed in the purpose built ‘Hernia Centre’ which was opened during the visit. The operations were performed under spinal anaesthesia and operations were predominantly Lichtenstein repairs using locally sterilised mosquito mesh. Workload varied each day depending on the numbers of patients who presented.

There was strong training ethos to the mission. Dr Awojobi has a total of five registrars who initially watched and later performed Lichtenstein repairs under direct Consultant supervision. The hernia centre will remain open after the end of the mission with the registrars operating independently.

Registrars attending for instruction in Hernia surgery

Registrars attending for instruction in Hernia surgery

On a couple of the afternoons we had finished the operating before nightfall and had the opportunity to visit other departments in the clinic. The emphasis is on delivering the highest possible level of health care using available resources. The results are impressive, with most of the departments present that one would expect in a far larger hospital. We also had the opportunity to observe some of the differences in presentation and treatment between European and Nigerian patients. One evening team members assisted local staff with completion of a traumatic amputation in a teenage boy.

The people of Eruwa and were welcoming and friendly and we made a lot of new friends. Over the week we performed at total of 44 operations on 38 patients. They were predominantly inguinal hernia repairs, but we also repaired two femoral hernias, one epigastric hernia, explored one groin for lymphadenopathy and removed a large lipoma without immediate complication. We left Eruwa not only satisfied with the procedures which we had performed but also enthusiastic that the training element of the mission will add to the ‘hernia centre’ and lead to ongoing benefit to the local population once we have returned to our home countries.

Chris Grocock

Surgical Registrar

Adhoc Team – Eruwa, Nigeria 27 JUNE – 3 JULY 2009

Servaise de Kock; South Africa, Ramon Vilallonga; Spain, Andrew Kingsnorth; UK


Operation Hernia’s first outreach to Awojobi Clinic Eruwa (ACE), Oyo State in Nigeria (26 June 3 July) has been a remarkable experience. The outreach followed Professor Andrew Kingsnorth’s site visit to Eruwa earlier this year (see report). Nigerian visa complications at the eleventh hour unfortunately prevented Dr Dave Sanders (from Plymouth, UK, but at the time doing voluntary work in South Africa) from joining the project. The final team consisted of team leader and very able teacher Prof Kingsnorth, charismatic Spanish surgeon Dr Ramon Villalonga and myself from South Africa.

On arrival at Murtala Mohammed International Airport in Lagos on Friday evening I was met by Prof Kingsnorth and our Nigerian host, Dr Yombo Awojobi. We stayed over at the Lasos Hotel where we could discuss the week s programme over supper. Breakfast the next morning was had amidst at least five power cuts. Later we learned that the power has been off in Eruwa for 2 months and most houses have their own generators. Coming from South Africa, the Nigerian environment was not that much different from home. The lack of proper infrastructure for such a rich country as Nigeria came as a shock though!

Traffic in Nigeria is simply chaotic and I was extremely thankful that I did not have to drive myself. Motorbikes carried up to six people and South African potholes suddenly seemed very small to me. Dr Awojobi kindly took us on a sight seeing trip to his alma mater school, Lagos University (where a monument was put up for his late brother, Prof Ayodele O Awojobi, a distinguished lecturer in Engineering). We also visited the Olabisi Onabanjo University Teaching Hospital. We then headed to Eruwa where Mrs Tinu Awojobi and the rest of the family welcomed us and cared for our needs in a very special way throughout the week, including cooking special meals for us.

That evening we unpacked the new Codman surgical instruments donated by Atrium, the mesh donated by Atrium, the Valley Lab diathermy machines from Covidien and the suture material donated by BBraun. Thanks also to Ethicon SA and other sponsors for having made this project possible.

Over the next few days we operated happily using the AM Eye Clinic Theatre on the ACE premises (where beds, gowns and theatre lights are locally made!). Forty-four patients underwent surgery and 52 hernias were repaired, including bilateral femoral hernias in a male patient and a lumbar hernia. We also trained 24 local surgeons, resident surgeons and family practitioners in performing the Lichtenstein Mesh Repair. Most of them still do a modified Basinni repair for lack of mesh availability at a reasonable cost. Most of the trainees could get hands-on experience. We were kindly assisted by Dr Awojobi s staff and his clinic supplied most of the reusable equipment.

We were most impressed with Dr Awojobi s ingenuity in his hospital. His cleverly devised inventions include an autoclave machine, locally produced intravenous fluids, a self-made washing machine, a bicycle wheel driven centrifuge, etc. He is also producing interlocking bricks that are used for building an auditorium to host the 2011 Rural Surgeons World Congress. Rural surgery at ACE is practiced at its best. Much can be learnt from Dr Awojobi s resourcefulness. One gets the impression that patients are cared for in a special way.

Special events included a visit to the local king, an evening party with a live band and neighbours attending in their typical Nigerian attire, visiting a local school and just walking around the village streets. Nigerians are very hospitable and we were always greeted with a You’re welcome!

ADVICE to future teams:

1. Do take operative protective clothing (theatre shoes, plastic aprons and eye protection).

2. Take Malaria prophylaxis and Yellow Fever immunisation.

3. Make sure you have enough memory/batteries for your camera.

4. You will need lots of energy the working days can be long.

In conclusion, taking part in Operation Hernia was an enriching experience for me. I found Prof Kingsnorth’s input especially inspiring. Ramon Villalonga also proved to be a particularly pleasant team mate. I wish Dr Awojobi and the ACE all the best for the future. May Operation Hernia continue to contribute meaningfully to rural surgery.

Servaise de Kock
Surgeon, Ngwelezane Hospital, Empangeni, KwaZulu-Natal, South Africa.