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

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

Home and away team

Takoradi March 2013 Report of the Belgian – Italo – Dutch team. Visit from March 9 – March 17 2013.

Home and away team

Home and away team

In March 2013 a team of four Belgian surgeons (Myriam Bruggeman, Paul Van Acker, Marc Huyghe and Casper Sommeling) accompanied by an Italian surgeon (Cecilia Ceribelli), two registrars (Stijn Heyman from Belgium and Annelien Morks from the Netherlands) and a Belgian nurse (Pina Orlando) again visited Takoradi in Ghana. Our main financial sponsor still is the Belgian Section of Abdominal Wall Surgery. We brought meshes (kindly donated by Medri, Covidien Belgium, Bard Italy and Assut Europe), gloves (Cardinal Health/Medline), disposable drapes (Mölnlycke Belgium and Medline) and suture material (Johnson & Johnson). Resterilized polypropylene meshes and so called “Indian meshes” made part of our luggage. Local anesthetics, syringes and needles were donated by Bbraun an BD; only the lidocaine with adrenaline and heavy Marcain was bought by us in Belgium.

This way for Hernia Operation

This way for Hernia Operation

Recovery

Recovery

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

Again “the girls” (Kate, Linda and Benedicte) took good care of us, although they had more difficulties than the years before due to the frequent power cuts. They even proposed us to switch to a hotel, but their “candle light suppers” were much appreciated by us. This year we were lucky to meet Brian Dixon again, who was on “holiday” in Takoradi; however this means trouble shooting for him as a second nature, or as he states it “there are no problems, only challenges”. He contributed again to our mission in several ways, mainly on a logistic level, but also on solving local problems. He even might have solved the problem of running water in Dixcove hospital.

Paul & Brian

Paul & Brian

During the week we organised three teams that rotated in the three different hospitals (Hernia Wing, GPHA and Dixcove). We performed 86 operations in 86 patients, of which nine were children. Again most of the adult patients presented with groin hernias. The total number of operations seems low for the total number of team members but we were plagued by power cuts and interfering caesarean sections. This year in the adult patients two-thirds (51/77) were operated under local anaesthesia, but loco-regional anaesthesia (26/77) was used as a standard in all three locations in the more demanding scrotal hernias, contributing to a better comfort of the patients. The children of course were operated under general anesthesia.

The motivation of the local hospital teams is good and the level of care of the nurse-anesthetics in the three hospitals is high. The equipment in the hospitals is of a reasonable level, but the Dixcove Hospital is in need of sharp scissors and new operation gowns. Although with three teams we still made long days, but once again it was rewarding.

After a long week hard work we had dinner at the the “Gilou” restaurant Friday night together with Bernard Boateng Duah and his wife. On Saturday we made a trip to Green Turtle Lodge, the nicest place to be at the Atlantic Coast, were again we spent a wonderful day. At Sunday morning our group split up. Marc started on a trip of ten days through Ghana. Paul and Myriam stayed another week in Takoradi for holiday; however they were motivated to operate on the patients that were left over from the first week in the GPHA-hospital, so the first two days of their holiday they operated eleven patients (included in the total of 86).

Pina stayed another two weeks in Takoradi to work in the hospital as part of her training to be a specialized nurse. Cecilia, Stijn, Annelien and Casper made the trip back to Accra with a stop at El Mina Castle. Conclusion: again a rewarding mission; if the future team will enclose again as much members as this year we might go to other places in Ghana. We once again want to thank Bernard Boateng for the organization at the local level: selecting the patients on forehand and helping us out during the week.

Special thanks to Brian Dixon, just because being there.

Casper Sommeling, on behalf of the Belgian – Italo – Dutch Mission

The Team

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

The Team

The Team

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

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

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

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

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

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

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

Operating Takoradi

Operating Takoradi

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

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

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

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

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

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

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

Casper Sommeling, on behalf of the Belgian – Italo Mission

In March 2011 a team of three Belgian surgeons (Stefaan Poelmans, Marc Huyghe and Casper Sommeling) accompanied by an Italian registrar (Cecilia Ceribelli) visited Takoradi in Ghana.

Belgian Team, Ghana

Belgian Team, Ghana

We again flew with Lufthansa/SN Airlines, which company we have to thank for giving us the opportunity to bring 15 kg of extra luggage each, so that we could take enough medical material with us. We brought meshes (kindly donated by BBraun Medical NV Belgium, Covidien Belgium, Bard Italy and Assut Europe), gloves (Cardinal Health), disposable drapes (M?lnlycke Belgium), suture material (Johnson & Johnson), local anesthetics (Astra Zeneca and BBraun), analgesics, syringes and needles. After a wearing drive from Accra to Takoradi through some heavy thunderstorms, we arrived very late Saturday night at ‘the Villa’ were we had a good night sleep.

Sunday morning we took a cab to Green Turtle Beach Lodge, were we had a nice and relaxing day. Returning to Takoradi we made a stop in Dixcove were we observed and admired the return of a local fishing boat. In the evening we met Bernard Boateng, who again did the selection of the patients on forehand.The living circumstances in ‘the Villa’ are good. ‘The girls’ (Kate, Lilian and Benedicte) took good care of us. The food they prepared was fine and far better than the Western food served in the local restaurants.

During the week the three surgeons rotated in the three different hospitals (Hernia Wing, GPHA and also for the first time Dixcove), accompanied by Cecilia. We operated on 74 patients, of which seven were children. Most of the adult patients, presented with groin hernias (61, in seven bilateral), in some accompanied by a hydrocele. In most of these patients a Lichtensteinrepair (with standard middle weight polypropylene) was performed. We did not use mosquito nets. Three other patients only had hydroceles.

Most patients were operated under local anaesthesia, but loco-regional anaesthesia was used as a standard in all three locations in the more demanding scrotal hernias, contributing to a better comfort of the patients. The children ofcourse were operated under general anesthesia; in Dixcove the induction was done by the child relaxing on the back of the headnurse walking around.

Casper and patient

Casper and patient

Again this year there were some challenging scrotal hernias, and also the age of the patients we operated on is increasing. The oldest patient was 90 years of age and in good condition!The presence of a registrar is useful; firstly, because she could assist us, but secondly and more important, we could assist her in performing operations, that will lead to more experience for her. She performed ten operations. The motivation of the local hospital teams is good and the level of care of the nurse-anesthetics in the three hospitals is high. The equipment in the hospitals (also in Dixcove) is of a reasonable level, but although we were convinced that we brought enough material, again at the end of the week there was a shortage of drapes, gloves and sutures. As can be understood by the total of operations performed we individually made long days, but it was rewarding. Even the last Friday we operated in the Hernia Wing until after eight o’clock in the evening.

After a long week hard work we had dinner at the Planters Lodge Friday night. On Saturday we made a trip to Bushua beach, were we had a nice day at the beach. Sunday-morning we said goodbye to the girls and were brought to the Kakum National Park, were we made a quick trip to the forest and made the Canopy Walk. Entrance prices were threefold from last year and it starts to look like a ‘tourist trap’. Much more pleasure we had from a visit to the ‘Monkey Forest Resort’ near the Kakum National Park. This resort was founded by a couple from the Netherlands. They try to save left-alone animals, that are brought to them by the locals. A visit is worthwhile (at the right side of the road when you drive to Kakum). After that we had (like last year) a nice meal at the Birawa Beach Restaurant. After a challenging drive to Accra (we were getting a little late) we arrived at Kotoka Airport just in time.

Conclusion: a rewarding mission; due to the fact, that we were with three surgeons, we could operate in Dixcove Hospital, where there is a nice atmosphere and were patients are taking good care of. For this moment we think a mission to Takoradi should consist of three surgeons and one or two registrars. The participation of trainees should be encouraged. Also the presence of a nurse is valuable; a nurse can discuss and control some matters of sterility with the local staff. The presence of an anesthesist in the team seems not so important, because of the qualifications of the local nurse-anesthesists.

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