The Opertaion Hernia Team in Takoradi

OPERATION HERNIA MISSION: OCTOBER 2016 TAKORADI, GHANA

TEAM LEADER – MR SHINA FAWOLE (CONSULTANT SURGEON)

TEAM MEMBERS – MR CHRIS MACKLIN (CONSULTANT SURGEON), MS HANNAH WELBOURN (CONSULTANT SURGEON), MELANIE PRECIOUS (ADVANCED ODP), LISA MACKLIN (RGN), VICKY ARMITAGE (ODP), EMMA UPCHURCH (SURGICAL SpR), MICHAEL KELLY (SURGICAL SpR).

The Opertaion Hernia Team in Takoradi

The Opertaion Hernia Team in Takoradi

On the 8th October 2016 we began our mission to Ghana. I joined a team of three consultant surgeons, three theatre nurses, and two surgical registrars.

We arrived in Accra late on Saturday evening where we met the other teams who were also planning to spend the next week operating across Ghana. The Baptist Guest House was our base in Accra. Right from the get-go the Takoradi team was very welcoming and inclusive of an outsider into their clan. I learned that this team (in some variation) has been traveling to Takoradi to perform Operation Hernia missions for the last eight years.

The following morning in torrential rain, we travelled to Takoradi. After a 4-hour drive we reached our destination, a house owned by the municipal government that has been utilized for visiting surgical teams from UK, Netherlands and Germany. At this residence, Lillian and her team of helpers looked after us fantastically. Their attention to details was remarkable. Every morning, hot water (for showering) and breakfast was ready, and every evening we were treated to diverse and wonderful Ghanaian culinary experiences. Their care and attention to us was extraordinary, and I thank them profoundly.

During the five days operating in Takoradi (Monday to Friday), three surgeons operated in three hospitals/medical centres (The Hernia Centre, Ghana Ports and Harbour Authority Hospital (GPHA) and Dixcove Medical Centre). Screening of suitable cases was already performed by Dr Boateng (Medical Director of GPHA Hospital), who was also always available to help and provide local advice. This planned organization facilitated immediate starting of operating on Monday morning. The majority of cases included primary and recurrent inguinal hernias, ventral/umbilical hernias and some paediatric hernias. On average, each centre operated on 8-10 cases per day. The majority of cases were performed under either spinal or local anaesthesia. Over the 5 days, a total of 103 procedures were performed. The working day was intensive with late finishes, but was filled with an atmosphere of both camaraderie and satisfaction. Both local nursing and anaesthetic staff were always adaptable to rapidly processing patients thus maximizing the impact of the mission.

Our last evening at the Hernia Centre with our celebratory Ghanaian shirts given to us by the medical team

Our last evening at the Hernia Centre with our celebratory Ghanaian shirts given to us by the medical team

Finally, I would like to thank Operation Hernia and ASiT for awarding me the Shorland Hosking Fellowship and the immense experience of participating in this mission.

Michael E. Kelly

Surgical SpR Dublin, Ireland

The team prepare to set off from Accra on the journey to Takoradi

Operation Hernia Report: November 2015 Mission to Takoradi, Ghana.

On the 21st November our team of six began our journey to Ghana. We comprised two consultant surgeons, Shina Fawole and Chris Macklin, a consultant anaesthetist, Josie Brown, a paediatric theatre sister, Lisa Macklin and two surgical registrars, Steve Pengelly and myself. We arrived in Accra on Saturday evening and spent the night at the Baptist Guest House before setting off for Takoradi on the Sunday. We managed to sneak in a trip to the beach on the Sunday and prepare for what turned out to be a very busy week of operating.

The team prepare to set off from Accra on the journey to Takoradi

The team prepare to set off from Accra on the journey to Takoradi

We spent the next five days operating at two hospitals in Takoradi; the Hernia Centre and the Ghana Ports and Harbour Authority (GPHA) Hospital, both of which have hosted Operation Hernia teams many times in the past. The patients had been selected prior to our arrival, coordinated by Dr Boateng, Chief Medical Officer of GPHA Hospital, which meant that there was no hanging around on the Monday and we were able to dive straight into work.

Over the 5 days, across the two hospitals, we operated on a total of 83 patients, including 8 children. In total, as a team we fixed 72 inguinal hernias, 7 other hernias (umbilical, epigastric and incisional) and 4 hydroceles. Needless to say, fitting in these numbers meant long and intensive days, and the local theatre staff and nurse anaesthetists worked incredibly hard to ensure we were able to get through all the patients. There was never any question of not sending for the next patient.

The Operation Hernia team plus the local staff at the Hernia Centre in Takoradi

The Operation Hernia team plus the local staff at the Hernia Centre in Takoradi

As previous volunteers have already attested to, the hernias seen were much larger than those commonly seen in the UK, meaning that the operations themselves were more challenging (and fun), particularly given the variability of the instruments as well as the occasional black out. The main difference was seeing the impact that our service had on the patients. With large hernias, many patients were unable to work and thus, a hernia repair can mean a return to work and the opportunity to provide for their families.

Operation hernia was an amazing and invaluable experience. Aside from the operative experience, it provides an opportunity to see and experience a different culture and provide new insights into our own practise. I am grateful to the other members of the Operation Hernia team and the local staff for making the experience so enjoyable and worthwhile. Special thanks has to go to Shina and Chris for their patience in training which enabled me to operate on large and challenging hernia, and to Lillian and her team who fed us remarkably well (considering the lack of electricity at times) during the trip.

Emma Upchurch, General Surgery Registrar

Missions
November 2013
Mission to Takoradi

The team arrived in Accra on the evening of Saturday 2nd November 2013. As a registrar in General Surgery this was my first trip with Operation Hernia, but I was travelling with experienced Operation Hernia member Melanie Precious and fellow first-timer Nicola Perrin, both Operating Department Practitioners, along with a large supply of surgical and anaesthetic equipment. The rest of our group comprised of Chris Macklin (Consultant Surgeon), Jurij Gorjanc (Consultant Surgeon from Austria and President of the Slovenian Hernia Society), Khaled Ismail (Consultant Anaesthetist), Beverley Parker (Registrar in Anaesthesia), Rafay Siddiqui (Registrar in General Surgery), and our team leader Shina Fawole (Consultant Surgeon), on his seventh Operation Hernia mission to Takoradi.

After a late-night dinner and an initiation to the unconventional practices of Ghanaian taxi drivers (including rolling backwards down the hill to start the engine, and opening the passenger side door to get the radio to work!), we spent our first night in the comforts of the Baptist Guest House. After a minor drama with an early-morning altercation between Melanie and a cockroach (“don’t you dare come any closer to me…!!) we set off on the three and a half hour minibus journey to Takoradi. We received a very warm welcome from our host Lillian and her helpers at the villa in Takoradi, and they even arranged a solar eclipse to mark our arrival! After unpacking our medical supplies we spent a relaxing and enjoyable afternoon at the Busua Beach Resort. In the evening we were visited by Dr Bernard Boateng, Chief Medical Officer of the Ghana Ports and Harbour Authority (GPHA) Hospital, and the plan for the week was set out.

On Monday morning the hard work really began. Each day a team of between two and four of us travelled to Dixcove Hospital, GPHA Hospital and the Takoradi Hernia Centre. The patients had been assessed and selected by Dr Boateng beforehand, and after a brief ward round to review all of the patients for the day, and decide on the most appropriate anaesthesia, the list started. We were warmly welcomed at all three hospitals, and worked alongside the local theatre teams and nurse anaesthetists, who were particularly skilled at spinal anaesthesia. Between the teams we operated on 105 hernias and 7 hydroceles in 107 patients, including 19 paediatric patients and 6 patients with recurrent hernias. Fifty-seven patients were operated on under spinal anaesthesia, 24 had a local anaesthetic and 26 had a general anaesthetic.

The days were long and intensive, but it was undoubtedly worth all the hard work to be able to achieve so much in just 5 days of operating. The impact that we were having on the patients was clearly apparent; I particularly remember one elderly gentleman who had travelled for nearly twelve hours to have his hernia repaired. The children were amazingly brave and compliant, not a word of objection or a tear from even the youngest ones. On one of the days at Dixcove Hospital, a local surgeon attended our list, and we were able to show him how we use the hernia meshes to reduce the recurrence rate for inguinal hernias. As a team we were fortunate enough to have both a Consultant Anaesthetist and a very skilled Anaesthetic Registrar with us, and as well as enabling us to operate on more children by means of general anaesthesia, it was also clear that the local nurse anaesthetists benefited from the training and advice they provided. Likewise, our experienced Operating Department Practitioners, Melanie and Nicola, were able to work alongside, and pass on their expertise to, the local theatre staff.

But it was not just the patients and the local theatre staff who benefited from our mission. All of the Operation Hernia team members gained invaluable experiences from the trip, which provided us with insights into our own practices in the UK and an appreciation of our own privileged situations, as well as improving our ability to adapt to challenging situations and make the best possible use of the minimal resources available. We are all especially proud of Melanie, for mastering the art of the scrotal bandage, after what was, it has to be admitted, a rocky start! As a group we are very thankful to Shina for his guidance, support and unwavering encouragement, unperturbed by any obstacle, apart from those baby lizards! Despite problems with an intermittent water supply, Lillian and her team ensured that we were comfortable, well fed and well looked after for the whole week, and we all appreciate her efforts.

From a personal perspective I feel very privileged to have been given the opportunity to be a part of such a fantastic, life-changing organisation. I am grateful to the other members of the team who were all wonderful colleagues and companions, and who provided much friendship, support and laughter. As a trainee surgeon I am particularly grateful to Chris, Shina and Jurij, whose patience and skill in training enabled me to operate on more challenging hernias than I have ever encountered before. I hope that I will continue to be involved in future missions with Operation Hernia.

Hannah Welbourn, ST8 General Surgery