Supplies in Magdi's garage

This time preparation started a long time beforehand almost more than a year ago. The team scheduled to go at the beginning was completely different from the team who actually traveled. This is due to twelve of those who originally expressed interest, apologizing at different times due to personal reasons and two withdrew due to separate skiing accidents one two months beforehand and one a week before the trip. We managed to recruit five surgeons, one anaesthetist, one anaesthetic practitioner, six theatre nurses, one ward nurse, two highly skilled helpers, and one medical secretary.

Supplies in Magdi's garage

Supplies in Magdi’s garage

This year’s trip faced more difficulties than previous years. British Airways withdrew the charity support and we had to book the normal way, and pay for all extra luggage. Fund raising was difficult and many struggled to meet their own cost let alone the other expenses. It was extremely difficult to get everybody together to help packing our medical equipments and know what else we needed to buy before we go. We had to diversify our sources of buying medicines to find the cheapest possible antibiotics, pain killers, local anaesthetics, meshes… etc.

The team efforts that made this mission a success, were amazing. We managed to fill up 55 boxes and bags each 23 kgs as required by BA. We had to wait till Christmas time and bought the tickets during a sale to obtain the cheapest possible fares. We have repaired our equipments with the help of our hospital engineers free of charge, Eschmann, donated two more sterilizers and one diathermy machine. We bought all necessary plates, gowns, light sources, computer printer’s cartilage, papers and all the medicines required to treat 300 patients. We have successfully arranged transport for 15 boxes with Intercare to meet the team flying from London Heathrow in time for check in. Our biggest achievement was collecting all these boxes from Accra Airport and passing through customs. After searching a sample of boxes, they let us all go, British and Canadians with more than 200 pieces of luggage. We deposited the bags next to the truck and came back in the arrivals to collect more loaded trolleys, until all luggage were accounted for and loaded onto the truck.

Logistics

Logistics

Operation Hernia team with local support

Operation Hernia team with local support

One observation was the smooth gelling between those who came before with more experience in these missions, and the new recruits who were a little apprehensive. They did not feel outsiders, they were helped and joined in the efforts from day one and felt how important and valued their service is. The work this year was less tense, more organized, easy, calm and effective. We have achieved almost the same result as the mission last year but we were less exhausted. Practice makes perfect, add to that good preparation and commitment.

The other observation was the friendship that is getting stronger between all workers, either, Ghanaians, Canadians or British and (Antje from Germany). The interdependence is growing every year. We know each other by name and we are cared for by a designated physician who is approached by anybody who falls sick from both expatriate teams. One of our nurses had an accidental needle stick. She was tested and the patient consented and tested for HIV. She was started on prophylactic antiretroviral immediately and was cared for by this designated doctor and nurses. She never felt alone and this support brought her back to work after 48 hours.

All adult patients were tested for HIV, and cared for as other patients but with more measures of protection. We tested each child for malaria when listed for an operation and started them on treatment if positive. We did not know how long we should keep the children on anti-malarial before we can safely operate on them. Our paediatrician, Dr Ellison consulted local community nurse Ernestina and both agreed that three days of treatment would be enough. Dr Ellison was consulted as well on a three years old child with a hernia who our anaesthetist Dr Tony was not happy to put to sleep because of chest wheezes. She decided the child requires a year’s treatment to improve his asthma before he could be safely operated upon under general anaesthesia.

24hrs postop strangulated inguinal hernia repair

24hrs postop strangulated inguinal hernia repair

We have managed to provide not only the direct care which we are capable of delivering but created the same hospital atmosphere of internal interdisciplinary referrals and consultation that improved our safety net and supplied more confidence and satisfaction in our capabilities.

This atmosphere allowed us to tackle one of the biggest challenge we have ever faced in our missions to date. A 35 year old man arrived with a strangulated hernia, three days before our departure date. He had his hernia in that position for a little more than 24 hours. We asked him why he did not go to a nearby hospital? He said “I do not want to die, the doctors are on strike and if they were not, I was told that nobody within 100 miles has the experience to operate on such a condition.”

He was sweaty with rapid pulse, in pain and distressed. We made the decision we will operate on him, and started resuscitation with what was left of the IV fluids, antibiotics pain killers etc we catheterized him. Dr Tony the anaesthetist decided to give him spinal anaesthesia with sedation rather then to put him to sleep as we were not sure about his oral intake before the operation. When we opened the sac the black bowel emitted offensive gangrenous odour. We had to extend the incision laterally and superiorly and there were more gangrenous bowel in the abdomen caught between the two loops in the hernial sac. We proceeded to do resection of 60 cm of small bowel and caecum and primary sutured anastomosis. The problems were the postoperative care, the IV fluids, IV antibiotics, observations, dealing with any complications. The other problem of recurrence of the hernia -as we did not put a mesh or attempt any repair- was of secondary importance. What was amazing was that the nurses came out with intestinal clamps already sterilized that I did not know we had them. When I asked as to where they got them from, they said it was me who brought them.

I knew I had to care for the patient overnight as we had less nurses than surgeons. We could not afford loosing a nurse the next day as that would put one theatre out of action. Many nurses from the British and Canadian teams offered to help. I have only accepted the help of Chris Mann who helped me with the operation. He observed the patient till midnight and I took over after that.

The Canadian team kindly supplied all the fluids, antibiotics and analgesia required. We the surgeons were not prepared for such cases (a lesson well learned). The patient had a monitor recording and hourly observations for two days. We recorded his intake and output. He received seven and half liters of fluid in the first 24 hours. He had three liters of urine output and the rest was sweat. His tachycardia gradually settled, temperature back to normal, the urinary catheter and the drain were removed on the second postoperative day. Early morning on the third day he opened his bowel three times and he was allowed soup which he appreciated. The day we were traveling back we typed all the operative information and post operative care, and gave him a copy and the local nurse a copy to deliver to the care centre with instruction on the remaining two days needed for antibiotics administration and dressing changes. We left him with lots of gifts, and some money to support his family till he can get back to work as a farmer.

The whole team from all nationalities has supported us in delivering the best care to this patient. A force from up above helped us to succeed, and protected him from complications.

This story tells us we not only have the skills to cure ailments but we can also save lives. These skills carry responsibilities and we should be prepared for that. Together with these medical skills, preparation, communication, team work, respect and love, supporting each other in work and difficult decisions, re important attributes. These are talents we learn and implement in our missions and daily lives, because they work.

This man’s wife told us “without you I would have been burying my husband now, thank you for not making our children orphans and me a widow”.

Magdi Hanafy

Consultant Surgeon

Mid Cheshire Hospitals NHS foundation Trust

Volunteer for Operation Hernia.

On behalf of Team Carpenter 2013 (Ghana-Canada-UK-Germany)

Team members

Leighton, UK Magdi Hanafy, Paul Sutton, Janet Burrows, Jackie, Sara Watson

Northampton, Rob Hicks, Sue Johnson

Canada Lawrence Turner, Ira Bloom, Teresa Buckley

Inverness Morag Hogg

Germany- Antje Haupt

Southampton Sarah Hasted

Operation Hernia to Carpenter, Northern Ghana. November 2011

One of my most rewarding experiences -this trip should be recommended to everyone. As a Consultant Surgeon, I joined the Operation Hernia Team for the trip to Carpenter in Northern Ghana. The trip is organised to coincide with the visit of a Canadian Team , called Ghana Health Team and together we spent two weeks away. We operated for 10 days and during our time in Ghana; together with the Ghana Health team we screened 10,000 patients, treated 5000 patients and repaired 290 hernias.

The Operation Hernia team comprised of 5 surgeons, 1 anaesthetist, an anaesthetists assistant, 4 nurses and Sarah our non-medic. Magdi Hanafy, a Consultant Surgeon from Leighton was our Leader. This is his 5th trip to Carpenter, and on this occasion Magdi and Andrew Kingsnorth had recruited a team from far and wide. Lawrence Turner from Vancouver, Paul from Manchester, Morag from Inverness, Sarah from Southampton, Sara, Jackie and Janet from Leighton, Antje from Germany and Sue and myself from Northampton.

There is a lot of planning required fro a successful trip. Behind the scenes, Magdi had been busy chasing sponsors, begging, borrowing and collecting equipment and supplies, which we would need. Prior to leaving all the required equipment was checked and packed into boxes, each weighing 23kgs. In addition there were all sorts of fundraising activities to help support this and future Operation Hernia trips.

It was with some trepidation that I headed to Heathrow with Sue to meet the team. I had no real idea of what was in store. We all met on Saturday morning in Terminal 5 Heathrow and after a hearty lunch took off for Accra. The plan was to stay the night in Accra and then take a 12-hour drive north to Carpenter. There was great excitement as all of our kit was loaded onto a lorry for the journey north. The 60 Canadian hockey bags all filled with essential medical supplies overshadowed our 24 cardboard boxes.

Carpenter is a small village in Northern Ghana. The village comprises of a few houses (mud huts with thatched roofs), a water pump, a primary school, and the church. We were staying on a compound run by the NEA – Northern Empowerment Association. This is an organization whose aims are to improve health, nutrition and water supply, improve education, reduce local conflict and improve farming techniques (grid-nea.org/). It is led by Dr David Mensah and his wife Brenda, who organize the local aspects of our visit. The logistics of 60 healthcare professionals from Canada and the UK, coming to work for 2 weeks, not to mentions the organization of seeing 10000 patients cannot be underestimated. For anyone concerned we were looked after extremely well and a considerable amount of effort had been put into ensuring that our accommodation and food would enable us to maintain the hard work over the 2 week period.

We arrived on Sunday evening and our first hernia patients were scheduled for surgery on Monday morning. These were patients whom had been listed for surgery the previous year by last years Operation Hernia Team. The morning was spent unpacking. This year we had 3 operating theatres to use, David’s theatre, Brenda’s theatre and a newly prepared room called Moses theatre, named in memory of David’s father who died of a strangulated hernia when David was a boy. Each theatre was of basic design. Two theatres had an operating table, the third an operating trolley. The windows were sealed with polythene sheets and each room had a very much needed air conditioning unit. By the end of Monday each theatre had a table full of the necessary equipment and the shelves of the storeroom were full to bursting.

We quickly got into our routine of a busy hernia factory. The patients came from all over Northern Ghana and a few from neighboring Burkino Faso. They stayed at the local school until called for surgery. Each morning we were greeted by the wonderful site of the day’s admissions sitting under the shade of a large tree in the central courtyard of our “Surgical Block”. A typical day was 11 or 12 procedures. Most of the hernias were inguinal, many large and some enormous. Other cases included many hydroceles, epigastric hernias, umbilical and para -umbilical hernias, and lipomas. 90% of cases were done under local, the very large or children being done under General or local and sedation. As each day went by, I found myself adjusting my scale of size as my confidence to do large hernia under local anaesthetic increased.

The work was hard; the days were hot and long. With a small team it was a real challenge to run three theatres all of the time. There were 4 scrub nurses and so for many days there was no relief. After the first day there were only 2 diathermy machines. There was a limited supply of essential equipment and this had to be managed. Despite all of this there was the requirement for good practice. All patients had antibiotics and analgesia and a name band prior to surgery. A brief WHO check was performed to ensure ‘right patient – right operation – right side’. All children were screened for malaria prior to surgery and surgery delayed for a few days if positive until treated. Patients were screened for HIV at a pre-assessment to ensure that the whole team was aware of the patient’s status prior to the procedure. Between cases instruments needed to be washed and sterilized in a mobile sterilizing unit in each theatre. We were supported in our work by a team of local men, employed by the NEA, who acted as interpreters, theatre porters, Chaperones, admissions clerks and discharge coordinators! They were a very efficient team.

The Ghanaian people are wonderful. They were very kind, appeared very happy and so grateful for the work we were doing. The best time to see this was during the visit to the villages with the Canadian Ghana Health team. Each day of the first week the GHT headed to different local villages, organized by David Mensah and his team. One of the surgeons accompanied the offering a surgical opinion when required and listing new patients for next year’s trip. I had the opportunity to accompany them to the village of Yaara. The organisation of the team was impressive. I arrived to a sea of colour and noise. Yellow and white awning provided shade for waiting patients. Different areas had been allocated to Health Screening, Paediatrics, Dentists, General Practice, Dentists, Ophthalmology, Diagnostics and Pharmacy. This was the first opportunity that many of these people had of ever seeing a doctor. It was a big event for the village. Each day in the village started with a welcome from the Chief and the village elders and the Canadians often came home with gifts of goats and Yams, given in thanks.

I came away with lasting memories and new friendships and would thoroughly recommend this trip to anyone who is considering going. I enjoyed the surgical challenges and the environmental challenges. This takes you away from the comfort of your normal theatre, your favorite scrub nurse, your particular light and your must have suture! The days are long and tiring but very rewarding. I really enjoyed the opportunity to work alongside the Canadian team, led by Dr Jennifer Wilson. I will always remember the gratitude expressed by some of the patients and the inspirational leadership of Dr David Mensah.

Rob Hicks

Consultant Surgeon

Northampton General Hospital

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).

First mission to Carpenter, Bole District, N. Ghana 14-31 OCTOBER 2008

On the plane travelling to Ghana in November 2007 we met a Medical Team of Canadians lead by Dr Jennifer Wilson. The Team was bound for Carpenter to work with the Northern Empowerment Association-Ghana Rural Integrated Development (NEA-GRID) organisation.

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The NEA is the brain-child of Dr David Mensah and his wife Brenda who have given their lives to helping the rural poor around the desperately underprivileged area of Carpenter, where David was born. The NEA has improved life for the local community by provision of infrastructure, fresh water from wells, training of farmers, school buildings, fish farming, poultry husbandry and disbursement of micro-credit to women s groups.

After a preliminary site visit by in February 2008 and the consent of Dr Mensah, Operation Hernia began to plan a very ambitious mission to perform Hernia Surgery at Carpenter, where Hernias are epidemic in the people of the surrounding villages. No clinic or hospital previously existed. One of the buildings of the NEA compound was to be prepared as a rudimentary hospital with pre-assessment rooms, recovery rooms, examination rooms and two operating theatres . The nearest hospital or anything resembling a rudimentary healthcare facility is a distance of 30 kilometres.

A container to equip the two operating theatres together with the necessary supplies was sent out in advance loaded with redundant equipment supplied by Derriford hospital (Plymouth, UK) and the consumables required for the surgery. The surgical team comprised 8 members with an anaesthetist. In addition UK members joined the Canadian Medical team (two doctors, one dentist and two general Volunteers).

oh_image_27_m

It was a true pioneering adventure, with a few scares on the way – one in a patient with a giant “below-the-knees hernia! We operated on 76 patients and performed 93 procedures. The Canadian medical team set up mobile clinics in the surrounding villages (some a distance of 3 hours drive away by 4-wheel drive station wagon through the Volta swamps) and treated patients with a variety of tropical diseases. The number of hernias in the Northern Region is staggering – the local Medical Assistants surveyed 50 local villages (population estimate about 50,000 living in primitive conditions with no roads, electricity, or running water ) and stopped counting at 700! This equals a prevalence of at least ten times the expected level.

Along the way the Team enjoyed warm, enthusiastic and joyful hospitality from the local Chiefs, Elders and villagers. Cuisine was prepared from local produce and the tropical, torpid mosquito-ridden nights were brightened by the stunning sights of a billion African stars. There are plans to repeat this mission in 2009.

Our Sponsors for this mission were as follows:
1. Atrium Medical – Prosthetic meshes, 10 sets of surgical instruments (Codman), £3000 donation
2. Covidien – 2 diathermy machines
3. Cook Medical – £2000 to provide the transportation costs of a 40 foot container from Plymouth to Carpenter (see Gallery picture)
4. British Hernia Society – £1500
5. European Hernia Society – 1500 Euros
6. Derriford Hospital Medical Equipment Maintenance Service – redundant equipment including 2 operating tables and a ventilator
7. Collings Park GP Surgery, Plymouth – Little Sister steriliser
8. Anaesthetic drugs from the following donors: Taro (local anaesthetic, adrenaline, midazolam), Fresenius (propofol), Flexicare (LMA and airway filters), BD (cannulas, needles, syringes, spinal needles), Smith Medical (Portex tracheal tubes), Intersurgical (self-inflating ventilation bag = “resuscitator”)