Land of the Blue Sky

Fourth Year for Operation Hernia in Mongolia September 2013

Land of the Blue Sky

Land of the Blue Sky

Mongolia 8-20 September, International Team

Country

Mongolia is a country on the central part of Asian plateau situated between China and Russia. In Europe Mongolia is known as a low-income country, where the healthcare system has poor infrastructure and old equipment – in my opinion it is not truth in 100%. Mongolian people are also known as a very proud and brave nation – and this is absolutely true. The best chance to see all wonders of The Land of Blue Sky is to travel by car (better to take 4×4). What a traveller can see, meet and taste are beautiful and breathtaking landscapes, hospitable herdsmen who own totally 40 million horses, goats and sheep (the goats and sheep were very important for the team). The taste of a mutton stew, horse meat, tea with goat’s milk and especially khoomis is something what cannot be forgotten. Let’s say something about Operation Hernia in Mongolia – because it was the main goal of this trip for all of us.

Team

It was a pleasure to work with this truly International Team comprising Andrew Kingsnorth (UK); Maciej Śmietański Poland), Kamil Bury (Poland), Teresa Butron (Spain), Giorgio Giorgobiani (Georgia) and Martin Kriz (Sweden). We received huge support from every surgeon that we met on our route but especially we are grateful to Dr. Naraa and Dr. Sanchın and Enkhee

A herdsboy

A herdsboy

Performance at the National Theatre

Performance at the National Theatre

Journey

We landed at the airport of Chinggis Khan – Ulan Baatar (UB) on Sunday morning – as it turned out we all flew from Moscow on the same flight so there was no problem with the gathering. After breakfast we set off on a journey through the wilderness of Mongolia.

During the two-day trip we drove nearly 400km, we spent one night in the middle of nowhere and during the same night we took part in a Mongolian wedding. A lot of drinks and strange meals – but it was a marvellous experience. On the way back to UB at the special invitation of one of the surgeons we were able to take part in a horse race – a lasting impression and experience that we will never forget. After returning to UB we were divided into two teams. The team I was operating at the University Hospital and the other at the prison hospital. Operations performed at prison hospital resulted in three interviews for Mongolian TV and an invitation to dinner by the Head of the prison hospital. During our stay in UB, thanks to the hospitality Dr Naraa, we admired a fabulous performance in the National Theatre. The performance presented the culture and history of Mongolia in a magnificent way.

Teaching

Teaching

Operation Hernia

We operated on 78 cases, which included 20 children, 16 prisoners and 4 reconstructions including Ramirez and one cholecystectomy. We had a mixture of incisional and inguinal cases. The operating lists were tightly-organized but thanks to very good organization of work in the operating theatres we had no problems with performing all procedures. So we were able to do cases ourselves or assist and teach the Mongolians surgeons as appropriate. Andrew, Teresa and Martin gave lectures to the local surgeons. In the opinion of Mongolian surgeons the topics were well chosen and the knowledge gained will be very helpful in normal everyday work.

In a nutshell– the work was the same as on every Operation Hernia mission – early start in the morning for a post-operative ward round, followed by assessing into the new cases, then operating all day long and in the evening… night life in UB.

The great success of that mission was mainly possible because of the distinguished capacity for teamwork of every participant. All team-members expressed their wish to participate on the next humanitarian mission under the auspices of Operation Hernia.

We will be back…

For Operation Hernia from Ulaan Baatar

Kamil Bury

Campaign poster

2 weeks at Sergio E Bernales Hospital, Lima Sept 21 to Oct 7 2012

Campaign poster

Campaign poster

I’m Anna Pascual, a Medical Student. I took part in the Humanitarian Expedition led by the Spanish Dr Teresa Butrón and her surgeons’ team in the Cooperative Project in Lima (Peru) conducted from the 21st of September until the 7th of October. We have spent two weeks in the Sergio E Bernales Hospital of Lima full of great experiences and unforgettable moments that day by day have made us grow as people and as a team.

The team of Surgeons in Action’s Foundation that have worked in this expedition for 2 weeks in the Hospital Sergio E Bernales of Lima has been made up by three General Surgeons (Drs Teresa Butrón, Pepa Castillo and Carmen Martinez), two Plastic Surgeons (Drs Palmira Garcia and Ana Lopez), a Paediatric Surgeon (Dr. Alejandro Unda), two Anaesthesiologists (Drs Manuel Gabaldón and Paula Tardáguila), a Haematologist (Dr. Rosario Butrón), a Medicine student (Anna Pascual) and an Economist (Maria Barroso). The Doctors came from different hospitals in Madrid and Malaga, and in my case from Barcelona. So I didn’t know anybody and I thought that it would be difficult getting myself adapted to the different tasks and the way of working of each member of the team, but nothing was how I had expected, in fact, in two days I could feel as if I was one useful Doctor more in the team: I assisted the hernia operations, I did a part of the data base, I helped the anaesthesiologists when they required me… and I learnt everything about the operating theatre at the same time I felt more useful every day.

After 11 hours of flight (and 7 hours of difference between Spain and Peru) the team arrived on Saturday morning at Lima’s city. We were exhausted, but in order to carry out the mission, Dr Butrón, our team’s leader, motivated us to start working hard that same morning. We planned some operations for the next Monday and we did 5 hernia’s operations on patients that had been arranged for that same day. That was how the Expedition started.

In the operating theatre

In the operating theatre

One of our younger patients

One of our younger patients

During the next two weeks we worked so hard and enjoyed of our work at every moment. We finished each day satisfied with all the operations we had done and satisfied because of the happiness of our patients after being operated or when they went back home. Also some patients with huge hernias came to thank us for having solved their problem. So we could feel so satisfied and happy for the work we had done.

We were living in Coma’s town, near the Hospital. Every morning when we left to work and every night when we went back to the hostel we could see the poverty and the needs that they had in that area. Also the Hospital was under minimums, and one of the things that shocked us more were the bad conditions of the shared bedrooms (8 beds per room) in front of our operating theatres. Observing around us we knew that our help would always be useful there.

Our main objective was to operate on as many hernias as we could in order to solve the maximum number of cases (we couldn’t solve the sanity of the city but we could improve the life of the people we operated on) and avoid the recurrences. One of the problems we saw was that most of the hernias were recurrent (and when we opened the incisions there weren’t any muscles and tissues anatomy) because of the technique used there (Bassini or sometimes herniorrafy or other incorrect techniques), but our surgeons knew that with the technique we were using, the hernioplasty and others based on free tension techniques, like Lichstenstein’s technique, we could avoid the hernias’ recurrences. That’s why the aim of our surgeons was to teach the Surgery Residents at the Hospital the free tension techniques we used and spread them. In two weeks we couldn’t do much more things, but it was enough for us, we were so satisfied.

During the two weeks we spent there we operated a total of 98 hernias and 17 procedures of plastic surgery, and 13 patients of the total were children. So the biggest volume of patients have been for hernia’s surgery. Among all the hernias we’ve operated on, 52 were inguinal, 23 umbilical, 12 epigastic, 6 crural and 5 incitional hernias.

Marketplace at Ollantaytambo

In addition, I would like to say that not everything was just working. One of the first afternoons we attended to a congress of the General Surgeons Society of Peru, where two of our surgeons gave a Symposium about opened abdomen: Dr Butrón gave the paper about “Negative pressure therapy in abdominal wall wounds” and Dr Castillo “Components separation technique”, both chaired by the Professor Juan Jaime Herrera, President of the General Surgeons Society of Peru. Furthermore a part from surgery and more surgery, we had one Sunday to visit some beautiful corners and squares of Lima and one full weekend that we spent in Cuzco and the lovely Machu Picchu. And for our merit, to conclude our task in Lima, we received the gold medal from the Department of Health of the Peruvian government.