Report from a German-British Mission in Rwanda, February 2013
Rwanda – a country on the move: after the genocide with up to 1 million victims almost 2 decades ago Rwanda has evolved rapidly. As one of the countries with the lowest corruption index Rwanda announces an accelerated growth and has established a compulsory school attendance for children free of charge. The government with president Kagame undertakes great efforts in the future program 2020 in the field of birth control, generation of energy and environment. In recent years a revolutionary health system was established: every citizen of Rwanda pays a very low contribution for a health insurance and every citizen gets a primary health care. But there are still a lot of problems: for example there are only 221 physicians for 12 million inhabitants available in Rwanda (0.2 per 10 000 inhabitants comparing to Germany 36.0 per 10 000) and 4050 nurses (*World Health Statistics 2012).
After the exploratory mission by Chris Oppong in February 2012 a plan to come back with a big operating team of 12 German and British Healthcare-Professionals could be realized: this bi-national team stayed from 08th to 18th February in two regional hospitals in Nyamata and Remera Rukoma.
The first team from Berlin consisted of two surgeons, Dr. Ralph Lorenz and Dr. Jens Heidel and the anesthetists Dr. Maral Miller as well as and two theatre nurses, Ines Kuhl and Peggy Grassmann.
The second international team consisted of the three surgeons MD Chris Oppong from Plymouth, Dr. Karl Spitzer from Munich and Dr. Christine Kosch from Berlin, the anesthetist Dr. Petra Wölkerling from Berlin, the theatre nurses Helena Azevedo und Sandra Gess from Plymouth and the anesthetic nurse Carolin Dauksch from Berlin.
The expected problems with the excess baggage (24 boxes with more than 500 kg) on the check in desk where fortunately absent as well as any kind of conflict with the customs in Rwanda. The only surprise in Kigali was that we had to remove all plastic film from the boxes, since Rwanda’s law has placed a ban on imports of any plastic bags and packing. So Kigali is a very clean city with no plastic waste at the roadside – what a difference that makes!
Pastor Osee from the Legacy of Hope aid organization had prepared everything perfectly: not only did he organize a really warm welcome at the airport in Kigali with temperatures of 25 degrees Celsius after a long flight from freezing Germany – he also arranged a beautiful accommodation in a nice guesthouse in Kigali.
A big heartfelt thanks to Pastor Osee with his team!
After the first two days for acclimation and team-building, we already visited on Saturday both hospitals for the last preparations. On the following day, the whole teams visited the King Faisal hospital, the biggest and model-hospital in Rwanda by invitation of the CEO Dr. Jean Bosco Butera. We were deeply impressed about the perfectly equipped facilities.
On Monday 11th February we began with our work with two teams in both hospitals, performing surgery from 8 am to 8 pm with as many patients as we could. Still, there were many patients on the waiting list.
At this point we would like to say a deep-felt thank you to the regional persons in charge as well as to nurses and attendants in the two hospitals under the supervision of Dr. Alfred Rutagengwa (medical director of the Nyamata Hospital) and Dr. Kalinda Viateur (medical director of the Remera Rukoma Hospital) for their perfect preparation and coordination!
The statistics added up to 95 operations on 78 patients within five days:
All together 72 inguinal hernias were operated, including 20 hernias in children and 17 inguinoscrotal hernias. In one case of an incarcerated hernia with chronic abscess formation there was a need for an emergent resection of the small bowel.
Furthermore 10 ventral hernias (epigastric, umbilical and incisional hernias) as well as 14 hydroceles were operated.
Nearly all patients apart of the younger patients were supplied with a mesh. Thanks to the generosity of companies’ donations in all cases original meshes could be used instead of mosquito-nets. All currently possible open operation-techniques like SHOULDICE, LICHTENSTEIN, Plug and Patch and TIPP were applied. The diagnostic findings however cannot be compared to European standards. Nearly all hernias were indirect, mostly with a small defect but with a large hernia sac. In certain cases there was additional a hydrocele.
As anesthetic methods we used mostly general anesthesia with laryngeal masks, in certain cases also local anesthesia and spinal anesthesia. The majority of Patients stayed for one or two nights in the hospital since their journey home would have been too long.
All operations were successful without complications and all patients were discharged from the hospitals during our stay.
The long-term sustainability of this mission resulted not only in giving away a lot of medical equipment the surgeons are now able to use, but also in educating the local Professionals. The surgeons were trained step-by-step in doing Hernia repair with meshes and the local anesthetists received supervision by our anesthetists Marla and Petra. Last and not least our nurses gave a lot of advice and techniques to the nurses in charge. It was an excellent team-work in these mixed teams from Rwanda-Germany and UK. After one week of training Dr. Elda Balikwisha – a young surgical resident at Nyamata hospital has perfectly performed a Lichtenstein Repair by himself – a big success!
After the return to Kigali we got two more personal contacts with people. A Meeting with the president of the Surgical Society of Rwanda Dr. Emile Rwamasirabo has developed a vision of a closer collaboration in case of education. So it might be possible to organize a hernia workshop for all surgeons during a next mission in Rwanda.
A very ceremonial and emotional finish of our humanitarian mission was a church service on Sunday in Kigali with Pastor Osee and a congregation that cheerfully welcomed the European visitors. And after this stressful working week the German team travelled through this beautiful country with its breathtaking landscapes.
Without the generous support of numerous private and company donations as well as the unselfish commitment of all team members this mission would not have been thinkable. The great success of that mission was mainly possible because of the distinguished capacity for teamwork of every participant.
We have gained a lot of positive insights through this humanitarian mission. Emotionally most touching was the deep thankfulness and appreciation of the patients, and last but not least of the nurses and hospital workers. During one week an outstanding personal and cooperative partnership had developed.
All team-members expressed their wish to participate on the next humanitarian mission.
We are deeply thankful and we look forward meeting again in Rwanda!
Ralph Lorenz für das Team Germany /U.K.