Welcome to Operation Hernia

Welcome to Operation Hernia

Welcome to Operation Hernia

Following a really successful trip to Farafenni in January 2011 an enlarged team comprised of the original group from Estonia led once again by Surgeon Juri Teras and a new team from the UK lead by Surgical Registrar Michelle Tipping ventured once again into the depths of Africa to build on the valiant efforts of the Estonians earlier in the year.

Having linked up with the Estonian team via e-mail before departure our UK contingent was large: 1 consultant anaesthetist – Scott Farmery, 2 consultant surgeons – Mr Andrew Wan (UGI) & Mr Andy Ramwell (Colorectal), 1 senior scrub nurse Adrian Kasparian, 2 surgical trainees Hannah Wright (FY2) and myself (ST4), and two general volunteers Christopher Mason and Helen Durance.

We arrived a day after the Estonians which was lucky as they were able to organise transport for us to the hospital, even then, the amount of supplies we had managed to secure seemed to take our hosts by surprise! 100kg of drapes, a surgical operating table, 1 portable ultrasound machine, 8 volunteers, 10 bulging bags and a huge box of donated vacuum packed teddy bears. One small hospital ambulance and half the length of the country along a pot-holed African road later, we all knew each other much better than when we set off! The adventure had officially started.

We found the hospital and the breath-taking hospitality exactly as described by the Estonian team. Baboucarr Saine, Mr Bondi and Sainey Dibba once again went out of their way to make us feel at home and we stayed in the same accommodation they had used previously.

As the Estonian team had made a head-start we were already almost up & running on arrival. The plan was to get three theatre teams working so we could maximise the work we could do. We managed to get enough resources together to get two theatres running simultaneously and got started with the first patients. The UK team had discussed our long-term mission prior to arrival as well as our immediate objectives. We left the UK with aspirations to help train local people to start doing their own hernia repairs. Once we started we realised that the needs of the hospital were a lot more basic. It became apparent very quickly that basic theatre practice & education was desperately needed. Basic knowledge regarding concepts of sterility and instrument handling were just unknown. So, we started at the beginning. Luckily due to the size of our team we could educate and develop practice as we went along and by the end of our time things were much improved although it will take time and effort to train surgical nurse practitioners to the standards required to complete their own repairs.

Another basic concept which needed addressing was the organisation of supplies in the hospital. As we explored we found lots of locked rooms containing boxes & boxes of donated supplies but no-one seemed to know what was in them! This was where our extra non-clinical volunteers made a huge impact. Using a lot of elbow grease and any of the surgical team not currently operating they re-organised the whole of the hospital surgical supplies into 2 labelled rooms so that everyone knew what was there and how to find everything. This also came in extremely handy when we were asked to see other surgical problems that didn’t involve hernias but needed treatment! Safe to say the hospital does not need any more urinary catheters or neonatal ITU equipment!!!

This was a great hospital to visit and the enthusiasm they have as hosts clearly shows they appreciate the efforts of the volunteers who give up their time to go. It is a place where people are keen to improve and develop to offer the best possible for their patients. We see a long-term future for Operation Hernia in this hospital although the two things I would recommend as vital for future teams (apart from all your surgical kit) . CO2 monitors for the anaesthetist to assist with childrens hernias and head torches; some-things never change!

Inguinal hernia repair under local anaesthesia

Inguinal hernia repair under local anaesthesia

The local market

The local market

Rural Gambia

Rural Gambia

After several months of planning, fund and equipment raising landed Team Estonia in Banjul, the capital of The Gambia. There were three of us – anesthesia would be covered by Dr Kristjan Kalling, a resident surgeon Dr Martin Adamson from Estonia, a resident surgeon Slawomir Koziel from Poland and myself as consultant surgeon.

Instantly were we greeted by dry hot air of Africa, the Smell of Africa as we used to call it. It’s just not the high temperature but the different scents in the air: smoke, rotten food, dirt and ocean – it all makes together an unique flavor one can only get in Africa. Jim Jallow, our man in The Gambia, greeted us in the airport. We had been talking over phone some times and exchanged a lot of emails and now indeed he was there to take us to Leybato Motel on the beach. Nothing fancy, no 5 star resort, but neat and tidy place a bit further away from the touristic attractions and noise. A place for travelers and expats as Lonely Planet puts it. And a place with a wonderful kitchen! So after some days of waiting and a meeting with Permanent Secretary of Ministry of Health where we had the opportunity to give a short presentation on Operation Hernia, we were free to go to Farafenni, our final and only destination in The Gambia.

Travel there was an adventure in itself. Although Jim Jallow had promised to provide free transportation to the site, nothing of the kind happened. So finally we simply crossed the Banjul river with a ferry and rented a local taxi to take us the 150km along the north bank to Farafenni. Taxi-drivers shouting, fighting, grabbing our luggage, begging for some money – it all only put some colors onto our journey. Police checkpoints everywhere along the road, in some we had to produce also some id-s, well hidden so far in the underwear.

But Farafenni hospital greeted us with warmth and sincerity that really took breathless, especially after adventures in Banjul. CEO Alhagi Saine, hospital manager Baboucarr Saine and our constant companion Sainey Dibba, the communication officer of Farafenni Hospital were the nicest people we have met in Africa so far and to be honest it seemed these guys really do need help in Farafenni. Although the hospital is state run and financed, the possibilities for patients in The Gambia are by far not the same we are used to in Europe. We were able to collect some medical equipment, surgical instruments, meshes and sutures which we donated to Farafenni hospital. We could also take along a cardiac monitor, that we left later in the OR, we hope it will find good usage. Medical personnel. Nurses are mostly local, Farafenni people, and to be honest very capable. Doctors on the other hand are mostly Cubans spending year or two in the hospital and afterwards being replaced by others. No surgeon had been around for a year. And patients were simply waiting. When the word spread that we were around, patients started to come from close and far, some came even from Senegal. Talking to them wasn’t easy, Mandinka and Wolof was beyond us, but local nurses were very helpful. Specially capable of solving all possible problems was Mr Bondi, anesthesia nurse who was running the OR and usually also giving anesthesia.

The hospital. A beautiful two storey building, built some 10 years ago with different pavilions for specialties all connected by hallways. Second floor of the hospital is used mostly as a huge storeroom, lack or inadequate electrical supply prevents them to use elevators. A Man with golden hands could get work there easily… Next team going to Farafenni could take an OR technician along, so many things needed to put in order and working state. But patients kept coming and we operated as many as possible. Electrical supply was from 9-16, afterwards some hours of generator supply, so head-torches were of good usage. Small children, older children, young people, old people, people with small hernias, people with huge hernias, people we could operate and people we had to put on hold for next teams to come.

Living conditions. Motel AMCR: again a place for travelers, the best in town. Clean and mostly quiet. We were lucky to get every morning transportation by Mr. Dibba. And every evening after work a nice guided tour to some interesting spot: either a local village, border-town in Senegal or something else fascinating and beautiful.

So in conclusion. Farafenni is definitely a place in need. In need for surgeons, anesthesiologists, technicians. To take supplies along would be nice, but there was a lot also around waiting for someone to put it into order and work. And most important: Farafenni needs us to show we care. It is definitely an Operation Hernia destination.

J’ri Teras