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

Report of Operation Hernia’s Mission to Ho Volta Regional Hospital
November 2013

The Stats!

Location

Volta Regional Hospital in Ho, located in the Volta Region to the west of Ghana
Approximately 3 hours drive from the capital city, Accra

Personnel

From the UK: 3 consultant surgeons, 2 surgical registrars, one scrub nurse
Charge nurse Sister Josephine, who managed everything!
More than 10 theatre staff who rotated between recovery and theatre
Experienced anaesthetic nurses who could give spinals faster than we could scrub!

Patients

98 patients were recruited, 97 patients operated

Facilities

Initially three theatres, with the fourth emergency theatre being made available to us on the final 2 days.

Fixed operating lights and mobile lights
Sutures, gloves, instruments and mesh were brought by the team
2 diathermy machines present from previous trips, we brought a third
Unfortunately no air conditioning was available due to maintenance

Hospitality

We received 5-star treatment from hospital administration and theatre staff
Food and water between cases
Constant care and attention to our every need!

The Story

We congregate at the Baptist Guest house prior to departing to Ho. We meet Mr Oppong who has already arrived early, full of energy and knows everyone’s name. We all feel instantly special. We meet Bernard our hospital representative, who has already been coordinating things behind the scenes. A quick breakfast is followed by us loading up into our respective vehicles and the journey to Ho begins. It a beautiful 2.5hr trip, but one full of contrasts. The beautiful lush landscapes give way all too frequently to little townships, were the even from our vehicle we can see the poverty that so many live in. Grand buildings are side by side with mud huts, small mansions next to tin shacks. Our driver is enthusiastic, and often has to be reminded that we are not thrill seekers. The road is in relatively good condition with the usual perils of overloaded motorcycles, formula one-esque taxi drivers and the ubiquitous tro-tro (public minibus).

Our prayers are answered and we arrive safely at our accommodation. Our residence can only be described as beautiful. To say more would be to tempt you to join the mission for all the wrong reasons!

After a brief lunch we visited the Volta Regional Hospital. We meet the director of surgery, his administrator, head of finance and a senior surgical resident. We are welcomed into a conference room as if we were visiting dignitaries! After introductions and a heartfelt welcome it is time to see the rest of the hospital and staff. It’s a relatively new building, we are told as we walk around. All the buildings are bungalow style sprawling as far as eye can see. Fortunately the walks between the buildings are shaded. The first thing commented on however by our senior visiting surgeon was the ample parking available. I think this alone made his day!

On to the ward to see the patients preoperatively. They have been selected over a period of months, and are eagerly awaiting our arrival. As we enter the ward they have been patiently waiting for us and applaud spontaneously. After a warm welcome by the ward sister, complete with crushing hugs, we begin to see the patients. All the patients are admitted the night before surgery. We reviewed 21 patients, there was only one DNA. What impressed all of us was how organised the nursing and medical teams had been. From blood results to simple clinical notes, everything was in place, and we were able to review and assess all the patients in just over an hour. An impossible feat in the UK! We returned back to our accommodation in the evening, arms full of food that had also been gifted to us.

The week is made up of grueling 15 hours shift days where we operate, ward round, clinics and data collect tirelessly, whilst supported by the brilliant hospital staff, who do overtime to allow us to finish the cases. Our fatigue is quickly forgotten when we see the gratitude of the patients when their operation is completed. Most have travelled many miles to arrive, and wait patiently for their turn with no complaints.

We were pleased to finish all operations successfully on Friday with no complications. We were rewarded with our first social night out where we went for dinner and drinks, dressed in traditional wear that had been gifted to us by the Hospital staff. We left the following day, all of us promising to return the following year!

Special Thanks

To all the theatre staff at Volta Regional Hospital, Bernard, and Mr Chris Oppong.

Miriam Adedibe

Naami McAddy

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 Leighton & Derriford team

Leighton & Derriford Hospital Team, Carpenter 1-14 NOVEMBER 2009

Magdi Hanafy, reporting.

The Leighton & Derriford team

The Leighton & Derriford team

On the last day of October 2009 the Leighton Hospital team arrived at 7:00 am to my house in two mini-buses. I opened my garage and we shifted all 22 boxes and bags filled with our and medical equipments to one of the buses, and headed off to Manchester Airport. We took turn, transporting our luggage, upstairs to departures, where BA opened a check-in counter especially for us. 22 luggage counted and checked- in without problems. We flew to Heathrow, terminal 5. Janet and I noticed people walking around wearing a T shirt with GHANA written on it. She went and talked to some of the ladies and we discovered they were the Canadian team who have just arrived from Toronto on their way to Accra and then Carpenter. We introduced ourselves and met with Dr. Jennifer Wilson their team Leader. She explained to us the way they were introduced to Carpenter through Mrs Mensah, who is originally from Canada. The Canadian group have met Prof Kingsnorth two years ago when they were travelling to Ghana, and a new destination for Operation Hernia was born. We had a potential problem with Ginny s ticket as it was a free ticket donated by British Airways. We were told that if the plane was full she would have to wait for the next available place which could be the next day. That could cause a problem as we had to travel by land to Carpenter the next day. I could not have left her to travel alone the day after. Luckily there were enough spaces on the plane and we boarded together to Accra.

In Accra airport we made a long queue (at least two hundred meters) extending from customs and excise to the trucks and buses waiting for us outside the terminal. People with their trolleys loaded with boxes, hockey bags full of medicines etc… (Total of 102 pieces of luggage). We went to the hotel in Accra where we spent the night after meeting with the Plymouth team and Prof Kingsnorth who arrived on Ghana Airlines two hours beforehand.

The next morning we were waken up at six a.m. had a breakfast and off we started our journey to Carpenter. That took 12 hours, including three stops. We arrived in a big compound next to the village. Mr and Mrs Mensah have prepared our accommodation AND OUR DINNER. We were accommodated in a large compound with security and all facilities in constant supply, electricity, water, transport.etc. We were told about the project they are running and the efforts they are doing in sustaining this community. We went to our rooms. Each room had from one to three beds, each with mosquito net and a washing bag. Rooms and toilets are clean. The area is calm. It rained twice on that day.

The next day we woke up early in the morning, warm weather. We went early to operating theatres (which were empty rooms) and started opening the boxes and distributing the equipment on both theatres, knowing what is available and what is not. Craig, Ali, Helen, Dee, Janet, Ginny worked hard mobilising heavy equipment into both theatres with the help of the local boys. We gave Brenda, three bags of children school equipment we brought as a gift to the community. By the middle of the day it became very hot, and we became tired. We started screening patients for HIV and listing them for an appropriate operation, i.e. local or general. We did not have enough nurses, but a surplus of surgeons. We had to sit down in the night and arrange a rotating list between us to see who is doing what, when. We all had lunch together. The Canadians started work already, screening people from the compound. We started operating at three o clock, finished two operations in each theatre, and had to stop when night fell down, due to inability to work with only headlight, and insect s invasion. We had dinner and Prof started to organise our list for the next day. With that number of surgeons and staff the work had to be organised so that nobody would be left out, and others would not feel tired. We listed ten patients per theatre for the whole day, a big task. We had to go early to bed as we decided to start at first light, to reduce the likelihood of working in the dark, at the end of the day.

One of many operations performed each day

One of many operations performed each day

 

Patient care

Patient care

Tuesday 03 November 2009

Woke up early at six a.m. Perry Board before me. A quick shower before everybody else and off we went to theatre. Patients were there waiting for us. A quick ward round, yesterday’s patients were seen and discharged, new patients were allocated to their rooms, Ali started to excel, in organising the local helpers and the flow of patients. Theatres were prepared by Craig, Ginny, Dee and Janet, and we started one after the other. We performed 20 patients with 26 procedures. We finished late after sunset. When all the insects concentrate where light is shining (i.e. the wound). The air-conditioners started to fail. We started screening for the next day and allocated lists for both theatres. I was asked to go to the community with the Canadian team. I had dinner and went to bed early.

Wednesday 04 November 2009

Off with the Canadian team to the nearest village one hour away. A big organised place was set up for us. Chiefs waiting to great us, and each medical, nursing and pharmacy group was allocated a room. The Canadian team was prepared for the invasion by all the local population with and without any illnesses. But many of them have already been triaged by David Mensah, so those with genuine complaints were allowed to be examined. The day started very busy, and we had lots of surgical referrals until things started to calm down by 2:00 pm and I managed to see medical conditions as well, bringing me back to the old days in medical school. I have diagnosed malaria, yaws, and chest problems. I was very happy with the experience. At the end of the day, we gathered to be greeted by the chiefs who offered us gifts of vegetables and a ram as a token of gratitude. We went on to our vehicles for the long trip home which we had to reach before sunset.

Thursday 05 November 2009

Raj’s day out in the villages today. I have had a whole list on my own and managed to finish five cases in the morning. Prof did many cases as well, in the afternoon Richard managed a list on his own while we were seeing new cases and making the lists for tomorrow. Ginny did not feel well and had to retire. Many of us have been falling for slight diarrhoea, and exhaustion from heat. Especially when the air conditioners in Brenda operating room packed up and the room turned into a sauna. We had dinner together that was followed by a speech of thank you for Prof Kingsnorth, Jane and Ginny before their leaving home on the next day. They were thanked and praised.

Friday 06 November 2009

I started a GA list after Breakfast. Prof Kingsnorth and Ginny said their Good byes and left for Accra. Richard was out in the villages today. Raj went on to do the local anaesthetics list in Brenda s theatre when the A/C packed up again. But he continued operating. The last patient on my list was Kunako Koene a 120 years old man. We do not know whether this is true or not but he was very old. He had bilateral inguinal hernias. He was booked for general anaesthetic. He weighed 32 kgs. Walked with a light stick. We helped him up to the table, Perry started his anaesthesia and I performed the two operations. We decided to wake him up and recover him in theatre where the A/C is still working. When he woke up he asked the interpreter to tell us. I pray to God for all those people who came from far away, leaving their families, and jobs and countries to treat us for free, may God may bless you all. May God reward you and give you all the money that you need and more, not only you, but your children as well during and after a long life. Most of us started crying as we were very touched. He continued praising us while we all stood surrounding the operating table looking at him. The interpreter was quick and flawless. We were amazed at his way of thinking and talking, the way he realises all what is happening to him, the confidence that he had, the strength to go through such an operation at such an age, the wisdom and presence of mind. We helped him down from the table, gave him water to drink, and walked him to his room. The same evening at dinner David asked me to say what happened. In the middle of the talk I was so emotional I had to stop.

Saturday 07 November 2009

Raj was exhausted yesterday and took the morning off. I started the GA list and Richard the LA list. We went to see all the Patients and the old man Kunako Koene was doing very well. We kept both lists light, but still finished at 8:00 o clock. We managed to see all the patients for Monday s lists. At the evening we had dinner together and went to Brenda and David s house for tea and had a lovely evening with Craig s magic and a nice game. We went to sleep late.

Sunday 08 November 2009. Our Day off.

After a late breakfast we went to the buses heading for the church. While driving we found Richard s (one of our theatre helper staff) motor bike on the road with him standing with a piece of cloth against his head, full of blood. He had a fall while driving to Church. He sustained a small laceration to the scalp and a deep wound to the left knee that was bleeding profusely. I decided to take him back to the theatre in the compound and Janet offered to come with me. We cleaned his wounds, infiltrated them with Local anaesthetics and prepared our instruments. All the wounds were debrided, edges freshened, foreign bodies removed. The scalp wound was easily closed with sutures. The knee injury was deep reaching the patella. The quadriceps tendon was torn in two. I had to suture the tendon with interrupted number 1 ethilon. Then subcutaneous tissue than skin, with silk. We bandaged the wound for the day and provided antibiotics, pain killers etc.

In the afternoon David took us in a tour around the compound. Not known to us, there were fish farm and an ostrich farm as well. Nice big trees surrounding the farm from its fruits the ladies extract oil that is sent to Body Shops around the UK.

Bernard came to visit us on his way to Takoradi from the North. During the evening meal Chris Oppong arrived as well. We had dinner together. And sat down to chat over a cup of tea, discussed the next morning list before retiring.

Part of the Leighton & Derriford team

Part of the Leighton & Derriford team

Tuesday 10 November 2009

We woke up early and did a ward round, changed the dressings, and prepared the rooms to accommodate today s patients. I went for breakfast and followed the Canadian team to the school in Carpenter. On that day there was a queue of patients with only hernias. I examined and listed 61 hernia patients and examined 16 non hernia patients.

I operated on a patient under local anaesthetic and evacuated two abscesses from her neck and her pubis. A man came back two days after a hydrocoele operation, with melena and fainting attacks, I examined him and found no problem with the scrotal wound. I decided to resuscitate him on the floor in the clinic, with fluids first. Followed by transfer to the compound. He felt much better after the fluid load and proton pump inhibitors he was given. There was some confusion about whether to send him to a nearby hospital or to continue treating him in the compound. I heard that Raj is not feeling well and decided to come back around 3:30 to the compound and theatres. I managed to help with two cases on Brenda s list. Finished at 9:00 o clock pm and went for dinner. Than a shower and sleep.

Wednesday 11th November 2009

I had a whole day list. Started by a large irreducible indirect inguinal hernia under GA that did not have any contents in the thickened hernia sac. But there were a large prolapsed diverticulum of the bladder sliding with the sac that I could not identify. I injured the bladder and corrected the whole with two layers of viryl. I finished the repair and inserted a urinary catheter. The patient did very well. I operated on two children afterwards followed by adults. We finished the day at 8:00 pm, having hit more than 140 patients.

We had a nice dinner together, had a nice chat and were congratulated by the team on the achievement. By that time 146 patients and 186 procedures.

Thursday 12th November 2009

I woke early as usual went and packed two boxes full of sutures and gloves and the remaining medicines. After Breakfast we had a meeting down in the garden, when the old man Kunako Koene came with David to give us a speech, thanking all of us on the care that he had received and giving us praise and praying for us. Brought few more tears down. Jennifer controlled her tears while giving a speech. The Canadian team gave the man a small gift, and we thanked him for his kind words.

I felt tired and left theatre to have a quick siesta. Janet, Craig, Perry, Helen, Sarah and Ali all were in theatre logging numbers of meshes left (95), packing the instruments, theatre furniture and equipment in one room and closing the doors for next year.

We still had to operated on some facial lumps, clean wounds, change dressings and evacuate abscesses. The final count was 191 procedures on 151 patients. The next day we said Good bye and travelled home on a long trip of 11 hours inland drive, six hours overnight flight and one hour internal flight to arrive home 28 hours afterwards on Saturday 14th November 2009. Still much quicker than our Canadians colleagues.

Conclusions: This mission was exceptional, our achievements were as follows
– 191 surgical procedures in 151 patients in 8 ½ days.
– Collection, packing and transportation of 16 bags of medical equipment.
– Listing patients with hernias for next year. (60 pts/day)
– Helping support the Canadian Medical Team. Canadian team supporting us with medications, bandages, dressings etc.
– All in all, a Life Changing Experience!

Leighton Team: Mr Magdi Hanafy (Surgeon), Dr Perry Board ( Anaesthetist), Dr John Kerslake (General Practitioner), Dr Helen Simpson (Trainee surgeon), Sister Virginia Long (Theatre Manager) Sister Janet Burrows (Theatre Sister).

Plymouth Team: Professor Andrew Kingsnorth (Surgeon), Dr Jane Kingsnorth (General Practitioner), Mr Raj Dhumale (Surgeon), Mr Richard Dalton (Surgeon), Mr Craig Brown (Theatre Manager) Sister Dee Richards (Theatre Sister), Miss Sarah Hasted (Volunteer), Sister Alison Stout (Ward Sister), Dr Stephen Lewis ( Consultant Gastro-enterologist).

German Team, Takoradi, Ghana 13-21 JUNE 2009

First of all I would like to thank everybody who was involved in establishing Operation Hernia, those who took part in our mission and all the companies and private donators who granted financial and material support.

wolfgang_reinpold

Without their help and sacrifice the mission would not have been possible and successful. A (hopefully) complete list is at the end of this short report. My special thanks go to Dr. Chris Oppong for helping us preparing and organizing the mission; lovely and warm hearted Lilian and Kate for cooking excellent Ghanaian food, brilliant housekeeping and making us feel at home in our accommodation, Dr. Bernard Boateng and Dr. Frank for their excellent patient selection, patient preparation and their support and help during our stay; the outstanding staff of nurses at Port Authority Hospital and Takoradi Hospital and last but not least the excellent team from Hamburg and Gifhorn that accompanied me: Veronika von Blücher, Hilde Kuiken, Janine Priebe and Ingo Leiser (OR-and anaesthesiology technicians), Dr. Corinna Meissner-Kuck and Dr. Rüdiger Lohr (anaesthetists), Dr. Ute Harte (general practitioner), Dr. Matthias Rohr (surgeon).

Our team arrived at Accra airport Saturday evening. We were happy that all 32 boxes with medical goods and equipment had made the trip without damage. It is absolutely advisable to bring medical goods and equipment with the same flight. We had marked the boxes clearly with a red cross. Our flight company had kindly agreed beforehand not to charge extra weight charges.After a short delay due to a traffic congestion in Accra our bus arrived and we had a safe 4 hour trip to Takoradi.

On Sunday Lilian and Kate took us to beautiful tropical Green turtle beach where we had a very pleasant, sunny, and relaxing afternoon. We swam in the Atlantic Ocean and took a short beach walk to a nearby village of fishermen.

In the evening Bernard took us and our equipment to Takoradi- and Port Authority Hospital. We decided that Matthias, Rüdiger, Hilde and Janine would operate in Port Authority Hospital while Corinna, Ute, Veronika, Ingo and I would work in Takoradi Hospital. The operating rooms of both hospitals are sufficiently equipped according to European standards. During most of our operating time we had no running water in Takoradi hospital. Clean water was stored in plastic buckets and tubs. For future missions I would recommend to bring alcohol-based skin disinfection agents. There is always a shortage of drapes and gowns. We brought only 40 sets of drapes, thus we had to use one set for two patients. The nurses were well trained separating a set of drapes in two while maintaining sterility.

From Monday to Friday we performed 65 operations on 61 patients. The vast majority were indirect scrotal hernias, some of them very big. About one third of the operations were performed under local anaesthesia. There was one emergency of a strangulated massive scrotal hernia which required a large omentum resection. Fortunately, a bowel resection was not necessary in any of the cases. We operated on 4 children who all got a high hernia sac ligation. There were 8 ventral hernias, some of them very big. The big ventral hernias were fixed with an open sublay repair, while small umbilical hernias were operated on with a nonabsorbable suture repair. All groin and scrotal hernias had Lichtenstein repair with polypropylene mesh. We had to operate on 4 hydroceles. There were no major complications. Recently Bernard told me on the phone that all patients were followed up and that fortunately there were no wound infections only some minor hematomas and seromas which resolved spontaneously.
The patients were all very well selected and well prepared by the local medical staff. The patients and their relatives were all very thankful, patient and pleasant. Most of them spoke only very little English but the nurses helped us to communicate. We learned some expressions of the local languages and some of the patients laughed about our wrong pronunciation.

Despite the fact that hernia repair is only one of many health issues in Africa, we feel that Operation hernia is an important project that is worth being supported in the future. For all of us the hernia mission was not only an outstanding and heart touching experience which we will never forget, but also a mission of friendship and partnership between Africa and Europe. We are all looking forward to come back to Ghana in the future.

Dr. med Wolfgang Reinpold
Surgeon from Hamburg, Germany

The first German Hernia mission to Takoradi was kindly supported by donations from:
Dieter Adelwarth, Anästhesie Zentrum Hamburg, Jeanette Azzaloni, Sigrid and Hans-Jürgen Beinhorn, Otto Binkele, Praxis Dres. Elke Brüning, Matthias Ewe and Petra Köster-Meyer, Wilhelmsburg, Covidien Deutschland GmbH, Irma Deschka, Deutsche Lufthansa AG, Fa. Freizeit & Hobby, Anita and Fred Gohle, Renate und Ingo Grundmann, Dr. Horst Haeberlin, Johnson & Johnson Medical GmbH (formerly Ethicon), Katholische Kirchengemeinde St. Bonifatius Wilhelmsburg, Margret Kaczmarek, Erika and Kevin Kilpatrick, Brunhilde Kirsch, Lohmann & Rauscher GmbH & Co.KG, Anke and Bernd Malik, Elke Matuszczak, Fa. Medic Zeitarbeit, Dr. Ute Moje, Marianne and Gerhard Nöthlich, Dr. Gerald Paschen, Hans-Jürgen Peschel, Anja Petersen, Ilona Reichwald, Semperit Technische Produkte, Anna Schilling, Thomas Schmidt, Martha and Johann Swoboda, Dietgard Ude-Zalik, Sabrina Wehrmeyer und Frau Wittneben (Reisebüro Wittneben, Gifhorn), Dr. Anke Witte, Barbara and Norbert Wolpers, Christel Wowtscherk, and many others who either didn´t want to be listed or donated anonymously.

Spanish Team, Takoradi, Ghana 16-23 MAY 2009

The Spanish mission 2009 is done!!!! Lots of satisfactions and lots of difficulties, but we feel again that our support to the people in Ghana is important and highly-valued by the Ghanaians.

Spanish Team 2009

Spanish Team 2009

Large hernias, hydroceles and different emergencies were treated by a very well-balanced team of nurses, anaesthesiologists, general surgeons and paediatric surgeons. Spain is excited about the Operation Hernia Project and about having the chance to help people in developing countries. In fact many professionals asked about the possibilities of going to Ghana and so we ended up by creating two teams, the first one being composed of 14 professionals, including 3 nurses, 4 anaesthesiologists, 1 paediatric surgeon, 5 general surgeons and 1 allergist who supported the local doctors and nurses as a general doctor.

First of all, we would like to thanks our institutions who supported the project with drugs and equipment and specially by letting 14 professionals leave for Ghana in the middle of the local situation in which we live nowadays in our hospitals, the University Hopsital Virgen del Rocío (Sevilla), USP-Clínica Sagrado Corazón (Sevilla), Hospital Rio Tinto (Huelva), Hospital Infanta Elena (Huelva) and Hospital del Mar (Barcelona). A total of 11 people from Sevilla, 2 from Huelva and 1 from Barcelona who were locally also supported with an investment of money for surgical equipment, air tickets, toys and cloth for the children by Diputación de Sevilla, Ludociencia, Viajes Atlanta, Sevilla FC, Ecija Balompié, Betis Moda, La Caixa, Fundación Roviralta and los amigos de Juan .

Secondly, we would especially like to thank the local people who looked after us, Dr Bernard Boateng-Duah for organizing everything in the three hospital were we worked, we are aware of the amount of extra work for him that means such a large group such as the Spanish one going to Takoradi: Michael Danso, by giving the support of the Takoradi hospital to the project and taking care of the luggage that did not arrive in Accra with us; the girls that looked after us at the house, the lovely Kate, Lilian and Barbara, who are inside everyone s hearts; and of course, to the local professionals of the health systems of Ghana, the nurses, who works together with us these days to perform 100 surgical procedures, always happy and making things easier for us, and to the two local doctors who were involves in the project, Ernest and our friend Dr Frank, who we are going to miss next year in case he move to other part of the country.

This year we had the chance to work in four operating rooms, at the two surgical theatre of Takoradi hospital, at GAPOA and at Nana´s hospital, a small rural hospital surrounded by the jungle with no running water in which doctors are able to help people with very low resources. One hundred surgical procedures in 83 patients were performed in 5 days by a team of Spanish professionals who are very involved in this project. We all are happy to hear that the number or giant hernias are decreasing in the area since the project starts in 2005, which means that things are working and that it is very important to keep supporting the project next years.

This is an analysis of what we did, what we saw and what we think about this year mission, but overall what it is in the deep of our hearts is two basic things: the face of the Ghanaians giving us thanks, with a smile in their face, after the surgery when they were still having pain; and the spirit of friendship of a group of 14 people who leave their family for 8 days and their hospitals and spend an important amount of money out of their own pocket to try to solve a situation to someone who s it. Ana, Fran, Miguel and Hilario, our 4 anaesthesiologists did an extra excellent work by handling very difficulties situations, especially with the little children since they did not have the anaesthetic drugs and only a oxygen needed for a general anaesthesia in these cases, it took more than five hours for a little child to wake up from a general anaesthesia, but they are top professionals and they know how to handle themselves in these situations. Paco, our paediatric surgeons, running from one hospital to another during these days, covering the cases scheduled in each operating theatres, performing the largest hernias he has ever seen, and showing the humanity with children of an experienced surgeon. Manolo, Rosa and Patricia, our 3 nurses, teaching the local nurses how to treat difficult wounds, assistant the surgeons in the OR, supporting the anaesthesiologists during the local, spinal and general anaesthesias and during the advanced cardiopulmonary resuscitation needed in some cases to solve very difficulties situations, especially with little children. Salva, Antonio, Juan, María, Marisol, the 5 surgeons, the ones always ready to operate any complex case, like the re-recurrent and giants Ghanaian hernias, and always ready to solve any surgical emergency during these days. And the lovely Virginia, who supported Dr Frank during these days by offering him different solutions to the different cases with the support of the drugs that we brought with us.

Everyone of them had an important mission, the only thing we missed was that it was an important group of professional that could support local nurses and doctors to teach them our knowledge to be adapted to what they have here, but we hope to do it next year, because our dream is to keep being involved in this project and continue our support for the people who need it.

Salvador Morales-Conde

Grace, Lilian, Kate and Brian

Dutch Team, Takoradi, Ghana 10-19 JANUARY 2009

The Dutch team consisting of Maarten Simons (consultant), Frank Garssen (experienced tropical doctor and surgical resident) and Astrid Huiberts (surgical resident) operated at in Takoradi from January 10-19.

Grace, Lilian, Kate and Brian

Grace, Lilian, Kate and Brian

We had a wonderful time thoroughly enjoying performing the operations, meeting Ghanaians and visiting parts of the country. After arrival we drove to Takoradi arriving there at 2 a.m. being welcomed at the guest house by Brian Dixon and our hosts for the week Kate, Lilian and Grace. We are very grateful for all the effort that was put into making our trip a success. Brian was closing down his office but this did not stop him from worrying about our wellbeing 24 hours a day. On our final day when we were traveling back to Accra he called us 23 times informing whether the drive was OK, if we had found Rebecca our guide, if the lunch was OK and if enough salt was added to Frank’s sandwich. The girls were a delight. Cooking wonderful meals and joining us for trips to the market and the beach. We will not forget their singing on the way from the beach back to Takoradi. Beautiful songs and beautiful voices. We were sad the car drive was over. We hope that the girls will continue being part of Operation Hernia and certainly that Brian will stay involved. It is hard to imagine the stay without his help.

Sunday we met Bernhard Boateng and discussed the week. He thought we were with two teams and had planned 40 patients; 25 in the hernia wing and 15 in the Ghana Ports and Harbour Authority hospital. We agreed to try to help all the patients by spreading them over the week and working in two teams on the last day. In 5 days we managed to perform 40 operations in 38 patients. We had taken material for 40, so our suitcases were empty at the end of the week. Everything went very well. The Hernia Wing and GPHA are well equipped. The nursing staff are well trained and fun to work with. They work very hard without complaining and put the wellbeing of their patients first. We operated on five children, two women, two bilateral, two recurrences and almost all hernias were scrotal. Very educating for the two residents! We performed one orchidectomy for an ectopic testis and scrotal hernia and for a huge hydrocele a hemiscrotectomy in an old man. With Bernard the residents performed drainage and excision of an infected mesh with a fistula of two months. The patient had come quite late with this complication. This is of course the nightmare of operating with mesh and everything must be done to keep the complication rate at an acceptable low percentage. We gave prophylactic antibiotics and Bernard had chosen to give all a 5 day cure of Stafoxil. Sterility in the OR is good. Rules are abided by although lack of enough drapes and running water can be a disadvantage. We used large meshes that before the first patient were cut into 8 smaller meshes and kept them under a sterile drape during the day. Dr Frank and Dr Bernhard deserved and received our deep respect for their work in Takoradi. Running a hospital and being a generalist physician who treats all patients (children and adult) with all diseases (as surgeon, obstetrician etc) with relatively little is an immense responsibility. They deserve as much support as we can give.

We truly hope to hear if there are complications of our work. The infected mesh that we had to remove in a young adult was hopefully an exception and infrequent complication. It would be a good idea to have all patients put into a databank so that results can be monitored more closely. We spoke about this with Bernhard and he would come with a proposal for some research in this area.

We performed a small study into the EHS classification system. All hernias were independently by the three of us scored for type of hernia preoperatively (H classification) and peroperatively (EHS). We hope to publish the results in 2009-10.

The second weekend we stayed at Axim beach. Very relaxing. We played soccer with the local kids, swam in the wonderful sea and enjoyed the sunshine. Sunday we were picked up by Brian and the crew that sang us back to Takoradi. Monday we visited the rain forest, Hans Cottage and Elmina. Finally on Monday evening we were on our way home. We will be back.

Maarten Simons
Frank Garssen
Astrid Huiberts

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