The Team, Bole

MARCH 2012
The team had initially been set up to travel to the Republic of Cameroon but because of delays in obtaining official letters of invitation needed to obtain visas a late change in destination was enforced. Cameroon will now be visited later on in this year I understand.

The Team, Bole

The Team, Bole

The English (John, Roger and Anna) and German (Guido, Thomas, Lilianna and Cordula) contingents having tentatively approached each other at gate 37 terminal 5 at Heathrow made their introductions and boarded BA81 bound for Accra. The initial omens were not good when take off was delayed by over an hour whilst the ground crew replaced a loose panel in the engine housing and then the in flight entertainment system failed. Things got worse when due to a mix up with communications we were left stranded at the airport for nearly two hours as nobody was waiting to meet us. Fortunately everyone remained very positive and in good humour and we were well looked after by a very attentive security guard and his mate (who were handsomely rewarded!). After a few phone calls by Chris Oppong we were eventually warmly greeted by Adams and Cosmos and transported to the Unique Palace hotel for the night. During the transfer a wrong turn resulted in an unplanned excursion through one of the seedier districts of Accra that has probably remained undiscovered by most tourists to Ghana. At one point we thought that we might never see our German friends again as they disappeared down a side street and we lost phone contact. We did however all manage to meet up at the hotel around 1.30am for a well-earned slumber in air-conditioned rooms.

Rising a little later than initially planned we breakfasted and set off for Bole at around 8.00am. The journey through the capital was relatively pleasant but on reaching the outskirts the main road seemed to vanish and became a mixture of dirt track and large potholes for about 30 miles! These 90 minutes of “entertainment” would have aptly graced any amusement park as a ride called “The Boneshaker”. At the end of this stretch the road turned into a virtually unblemished “motorway” for the next 7 hours giving us a relatively smooth birds-eye view of a typical Sunday in Ghana. The only obstacles on the road were the numerous broken down lorries and the free roaming sheep and cattle that took some avoiding. We arrived at our accommodation at the Cocoa Research Institute of Ghana in good time to meet Dr Joe our medical host and discussed the plan for the week over a very welcome cold Star beer. Compared to the other accommodation in Bole the Guest House was like a 5 star hotel but it was still somewhat basic by European standards. We were however extremely well looked after and the food was very tasty.

Monday started with a brief introduction to the hospital staff and we then unloaded the large amount of equipment and disposables that we had all managed to obtain from various sources in the UK and Germany. It would be very helpful if some shelves could be put up in the “storeroom” to make it easier to find things once they had been stored. We then visited the wards to check “some” patients and after an hour had seen nearly 40 patients (enough for 2 days operating!) with a mixture of hernias and hydrocoeles. Dr Joe had very efficiently recruited all the patients for the week via radio, television, local newspapers and leaflets and we all commend him for his sterling work. The hospital has 2 functioning operating rooms and we therefore divided in to two teams of 2 surgeons mixing the pairings on some days. One of the first patients was a 4-year-old boy who had his hernia operation carried out under ketamine that worked extremely well. During the course of the mission a number of children of similar age were operated on in a similar fashion and there were also a handful of patients who required spinal anaesthetics rather than local anaesthetic. All of these anaesthetics were carried out by Raymond a very proficient Cuban anaesthetist on secondment to Bole for 3 years. He had been accompanied to Bole by his wife (a physician) who was unfortunately struck down for the third time in a year with malaria. She was really quite unwell and this certainly reinforced the fact that we needed to take our anti-malarial medication religiously. The first day saw a total of 18 patients operated on between the two theatre teams and we finished about 7.00pm. What struck us all was the very muscular physique of all the patients especially the males and during the week we did not see one patient who would be classed as even a little overweight. We were also impressed by the sheer size of the hernias and hydrocoeles the likes of which we rarely see in the UK or Germany.

Village, Bole

Village, Bole

Operating, Bole

Operating, Bole

Tuesday started with breakfast at 7.00am which was the first meal so far that didn’t contain cold baked beans! It was then off to the hospital to start what turned out to be a rather gynaecological day. Lilianna (Thomas’s partner) a consultant gyaenocologist was presented with a 24-year-old woman with a grade 3 prolapse caused by a previous very prolonged labour. Her husband would not have intercourse with her and the only treatment normally available to her would entail a hysterectomy. Because of her age this would cause her husband to divorce her, as she would not be able to bear any more children. Lilianna successfully carried out a sacrohysteropexy to the patient’s great delight. Our lists were then interrupted by two emergency Caesarean sections performed by Tamara, a very excitable Cuban gynaecologist, assisted by Lilianna. Again we finished at about 7.00pm.

Wednesday saw nothing out of the ordinary apart from the fact that we became a little more adventurous with our evening meal choosing beef as opposed to the chicken that we had had for every lunch and evening meal up until then.

On Thursday as well as continuing the sterling work in the operating theatre we had the opportunity to visit some of the patients we had operated on in their villages. We did this in two groups to enable work to proceed as normal in the 2 operating theatres. The visits proved to be fascinating not only to see how quickly the patients got back to normal activities but also to experience first hand what life in a Ghanaian village community entailed. We had the chance to talk to the village people and also had the opportunity to visit the local school in Kiape to chat to the teachers and pupils (the latter ranging from age 4 to 14). We also visited Bole senior school where a significant number of pupils are boarders. Cordula the only non-medical member of the team took the opportunity during the rest of the week to explore the town and converse with the local people bringing back many fascinating tales.

Our final day of operating proceeded in a similar fashion to the rest of the week and at about 4pm we actually ran out of patients. We even managed to fit in a number of patients in the afternoon with various lumps and bumps. In total over the week we carried 94 procedures on men, women and children the vast majority under local anaesthetic. We had the opportunity to use sterilised mosquito net meshes that worked extremely well. Unfortunately we were not able to teach any of the Ghanaian doctors since Dr Joe is the only physician in the region and he was kept busy with all the other patients. We operated on 2 local Chiefs during the week and as an indication of their importance we noticed that they were always placed at the front of the queue when they arrived. We also had the opportunity to visit the town’s bustling market on Friday where we were made to feel very welcome with absolutely no hassling. We all commented on how lovely and friendly all the Ghanaians we met were and how they all seemed to be wearing continuous broad smiles and spouting “wicked” laughs (especially Adams!).

As a special treat after we finished on Friday Matron had kindly organised a send off party with drinks, food and even a bit of dancing. It gave the Bole hospital staff chance to thank all of us but more importantly it gave me the chance to thank all of them for making us feel so welcome. The four male surgeons were presented with Chief’s shirts and the females with material celebrating the 50th anniversary of the Ghana Nursing Association to make garments of their choice.

We left early on Saturday morning not looking forward to our 11-hour road journey back to Accra but with extremely fond memories of all of the people we came in to contact with in Bole. Anna would not recommend the goat fufu however!

We would all like to reiterate our thanks to Dr Joe and the staff at Bole hospital. Finally we would also like to thank the Ghana Government for facilitating our mission. We will be visiting again.

John Budd
Team leader

Members of the German Team: Dr. Karl Moser (surgeon), Prof. Dr. Markus Heiss (surgeon), Dr. Andreas Kremer (anesthetist), Marion Koell (photographer)
Organizing Team in La Concordia: Kathia Tinixaray, Sandra Ocampo and Theresa Butron (Madrid)
Scientific Support: Samuel Shillcut.

Andreas Kremer the Anesthesist

Andreas Kremer the Anesthesist

When we arrived after our 16-hours journey from Düsseldorf to Quito, we were heartily welcomed by Sandra and her brother. They brought us in very comfortable cars within 4 hours to La Concordia, where we stayed in the nice Hotel Atos. On the same day we saw around 50 patients in the nearby area de salud 23 which was run by Kathia. This preoperative consultation was very well organized by Kathia and Samuel, who did also an excellent paperwork.

Situation at the Quninde District Hospital
The next day Sandra and Kathia took us to Quininde to the local district hospital, which was 40 minutes drive away. We were welcomed by the leading surgeon and led to the operating area. There we were left alone and really nobody took any notice of us. The whole crew including the surgeon in charge was lying on the patient´s stretchers and was not really willing to help us. A little bit puzzled about this situation we tried to start with the first operation. As we did not bring along drapes and gowns (we were informed by Theresa, that this would be provided) we asked a nurse. She said that we are not allowed to change the gowns between the operations – only the gloves. When we told her that we won´t accept this, she suddenly managed to get enough gowns for us. When we asked for a scrub nurse this was refused and between the operations the floor was not cleaned or the waste taken out. After 6 operations totally working on our own, while the local staff enjoyed a lazy day, we stopped working and complained to Kathia. She took care of this by bringing a nurse from the area de salud 23 to the hospital on the next day. During the week the support from the hospital staff got better and on the last 2 days it can be named good. They crew helped us with the patient transport, cleaned the operating theater and brought us the instruments. This was probably due to the pressure of Kathia and some thankful patients, who complained very forcefully to the manager of the hospital, about how we were treated.

Security
Unfortunately on 2 days parts of our equipment were stolen, although we left it in a locked room in the operating area. I was missing 3 of my 10 hernia sets, 2 presents for Kathia and Sandra and Andreas Kremer 5 bottles of local anesthesia and 3 precious clamps. Even the locks were cut. This was reported by Sandra to the local police, which is still investigating. According to Sandra the hospital is now willing to pay for the stolen hernia sets.

Patient details
64% of patients were male, with patient ages ranging from 10-72 and a median age of 41. Average family size was 4 people – 28% of patients were fathers.
The average years lived with hernia was 8.4 (6 median, 0-36 range). 67% of patients were in pain before surgery and 6% had vomiting. 88% of patients with inguinal hernias received mesh.

Operation details
In total we operated 43 Hernias: 24 inguinal hernias, 2 femoral hernias, 6 incisional hernia, 10 umbilical hernias and 1 epigastric hernia. Three patients (8%) had bilateral hernias, and 5 patients (14%) had two hernias that were not bilateral.
Inguinal hernias were reducible in all but one patient, who had a large inguinoscrotal hernia. 80% of all hernias repaired were primary.
Of 25 inguinal hernias, 24% were H1, 48% were H2, 24% were H3, and 4% were H4. Of the 6 H3 and H4 hernias, the inguino-scrotal component was Of 54 inguinal hernias evaluated, 28% were direct, consistent with an expected 25%-30%.
One lady with a huge incisional hernia was operated with a modified Ramirez procedure

Anesthesia
72% of patients received spinal anesthetic, 22% received local anesthetic, and 6% received general anesthetic. Due to a leak in the anesthetic machine it was one time very dangerous for one of our patients receiving general anesthesia. But Dr. Kremer was able to lead the patient through this difficult time.

Postop Course
Three patients were hospitalized, one for six nights (the lady with the huge incisional hernia). Antibiotic prophylaxis was not used in keeping with European Hernia Society (EHS) recommendations.
In the so-called ICU no nurse took really care of our difficult case. Therefore Dr. Kremer had to keep an eye on this case the whole day. As he was very busy, we had to cancel some of our patients on this day. As we did not want to risk the live of our patients we did not operate 3 additional patients with huge incisional hernias as planned.
Up to now all patients do fine and according to our knowledge no infections occurred.

Summary
Despite the trouble we experienced we had a marvelous time, because our patient were so grateful and Sandra was such a wonderful host. However in accordance with Kathia we advice not to send more teams to this hospital. We think that it is a very good idea to perform the next mission in the Centro de Salud La Concordia, where Kathia is in charge. We will definitely do another mission to La Concordia after this is arranged. We also want to thank Samuel for his excellent record keeping and wish him the best for his wedding next month with the his ecuadorian fiance.

Markus Heiss, me and a local surgeon

Markus Heiss, me and a local surgeon

German American Team 2011

A German/American mission visited three regional hospitals in the area of Takoradi and Dixcove in southwestern Ghana from 14th to 25th July. The first team from Berlin consisted of Dr. Petra W?lkering (anestetist), Zhanna Bourtseva (OP-assistant and scrub-nurse), Manuale Menke (anestetist-nurse) and Dr. Ralph Lorenz (surgeon), who was leading the whole team.

German American Team 2011

German American Team 2011

The second team consisted of MD Timothy Napier (surgeon) from Mauston/Wisconsin, Dr. Karl Spitzer (surgeon) from Munich/Germany and Mario Frey (OP-assistant and OP-attendant) from Hamburg/Germany.

The suspected problems with the excess baggage (ca. 250 kg) on the check in desk where fortunately absent as well as the expected problems with the customs in Ghana. In Takoradi we were kindly accomodated in the Villa, the guesthouse of the Health-Department, where Kate, Lilly and Barbara expected us and supplied us lovingly with all we needed the whole mission through. A big heartfelt thanks to all!

The first two days were taken for acclimatisation and team-building and lead us to the sightseeing-points of the area. On Saturday already we visited on the way to a dreamlike beach of the Gold-Coast also the hospital in Dixcove, a small city westward of Takoradi. In that moment we were not aware that our humanitarian mission was also scheduled for this hospital. During our survey we were struck by the fact that no doctor was around ? he was attending an advanced training course in Accra for two weeks, we later heard.

During our survey in the hospital one patient touched us especially: a six year old boy was accommodated on the same day after a gas-explosion had caused third-degree burns in his face, both arms and both legs – the nurses did the wound treating meanwhile. This case would accompany us throughout the following week. We felt empathy and hoped passionately together with the nurses and attendants to save his life.

On Monday 18th July, we began with our work with two teams in Ports and Harbour Hospital (Takoradi) and in Takoradi Hospital. We performed surgery from 8 am to 8 pm treating as many patients we could. 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 three hospitals under the supervision of Dr. Bernhard Boateng-Duah for their perfect preparation and coordination!

Scrub Nurses, Dixcove

Scrub Nurses, Dixcove

Dr Ralph Lorenz

Dr Ralph Lorenz

The statistics added up to 77 operations on 67 patients within six days: All together 61 inguinal hernias were operated, including 32 inguinoscrotal hernias. 15 patients had a hernia with a 20 cm hernia sac (Kingsnorth classification H3/4-20 and 4 patients were treated with a large-size Hernia with a 30 cm hernia sac (Kingsnorth Classification H3/4-30). Futhermore 9 ventral hernias (6 primary -epigastric and umbilical and 3 incisional hernias) as well as 7 hydroceles were operated.

All of the three hospitals were attended by our teams within those six days. 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 additionally a hydrocele. Anesthetic methods included local as well as general anaesthesia, in certain cases spinal anaesthesia was the preferred method. Besides a postoperative hematoma in one case, all operations were successful without complications. The majority of the patients were outpatients. In addition, we assisted in one emergency-laparotomy and we supervise patients with chronic wounds, accident injuries and a thoracic drain. Mrs. Dr. W?lkerling however managed to give a lot of advices and tricks to the anesthetic nurses in charge. Our wish to instruct other local surgeons could unfortunately not be satisfied, since no Ghanaian surgeon could be present at that time.

The sustainability if our mission resulted mainly in giving away a lot of medicine materials the surgeons are now able to use. Without the generous support of numerous private and company donations as well as from the German Hernia Society this mission would have been unthinkable. We have gained a lot of positive insights through this humanitarian mission. Emotionally most touching was the deep thankfulness of the patients, and last but not least of the nurses and hospital workers.

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. Furthermore, a lot of colleagues in Germany have a lot of interest for that project, and also uttered to participate themselves the next time. The small boy with the severe burns was at the same time attended by our team, especially through giving him urgently needed wound dressings and medicine. After initial fever, he was at the end of our mission ‘out of the woods’, free of fever and the large wounds were healing.

New hope for a new life! We are deeply thankful!

Ralph Lorenz f?r das Team Germany /U.S.

German Team, Takoradi, Ghana 13-21 JUNE 2009

First of all I would like to thank everybody who was involved in establishing Operation Hernia, those who took part in our mission and all the companies and private donators who granted financial and material support.

wolfgang_reinpold

Without their help and sacrifice the mission would not have been possible and successful. A (hopefully) complete list is at the end of this short report. My special thanks go to Dr. Chris Oppong for helping us preparing and organizing the mission; lovely and warm hearted Lilian and Kate for cooking excellent Ghanaian food, brilliant housekeeping and making us feel at home in our accommodation, Dr. Bernard Boateng and Dr. Frank for their excellent patient selection, patient preparation and their support and help during our stay; the outstanding staff of nurses at Port Authority Hospital and Takoradi Hospital and last but not least the excellent team from Hamburg and Gifhorn that accompanied me: Veronika von Blücher, Hilde Kuiken, Janine Priebe and Ingo Leiser (OR-and anaesthesiology technicians), Dr. Corinna Meissner-Kuck and Dr. Rüdiger Lohr (anaesthetists), Dr. Ute Harte (general practitioner), Dr. Matthias Rohr (surgeon).

Our team arrived at Accra airport Saturday evening. We were happy that all 32 boxes with medical goods and equipment had made the trip without damage. It is absolutely advisable to bring medical goods and equipment with the same flight. We had marked the boxes clearly with a red cross. Our flight company had kindly agreed beforehand not to charge extra weight charges.After a short delay due to a traffic congestion in Accra our bus arrived and we had a safe 4 hour trip to Takoradi.

On Sunday Lilian and Kate took us to beautiful tropical Green turtle beach where we had a very pleasant, sunny, and relaxing afternoon. We swam in the Atlantic Ocean and took a short beach walk to a nearby village of fishermen.

In the evening Bernard took us and our equipment to Takoradi- and Port Authority Hospital. We decided that Matthias, Rüdiger, Hilde and Janine would operate in Port Authority Hospital while Corinna, Ute, Veronika, Ingo and I would work in Takoradi Hospital. The operating rooms of both hospitals are sufficiently equipped according to European standards. During most of our operating time we had no running water in Takoradi hospital. Clean water was stored in plastic buckets and tubs. For future missions I would recommend to bring alcohol-based skin disinfection agents. There is always a shortage of drapes and gowns. We brought only 40 sets of drapes, thus we had to use one set for two patients. The nurses were well trained separating a set of drapes in two while maintaining sterility.

From Monday to Friday we performed 65 operations on 61 patients. The vast majority were indirect scrotal hernias, some of them very big. About one third of the operations were performed under local anaesthesia. There was one emergency of a strangulated massive scrotal hernia which required a large omentum resection. Fortunately, a bowel resection was not necessary in any of the cases. We operated on 4 children who all got a high hernia sac ligation. There were 8 ventral hernias, some of them very big. The big ventral hernias were fixed with an open sublay repair, while small umbilical hernias were operated on with a nonabsorbable suture repair. All groin and scrotal hernias had Lichtenstein repair with polypropylene mesh. We had to operate on 4 hydroceles. There were no major complications. Recently Bernard told me on the phone that all patients were followed up and that fortunately there were no wound infections only some minor hematomas and seromas which resolved spontaneously.
The patients were all very well selected and well prepared by the local medical staff. The patients and their relatives were all very thankful, patient and pleasant. Most of them spoke only very little English but the nurses helped us to communicate. We learned some expressions of the local languages and some of the patients laughed about our wrong pronunciation.

Despite the fact that hernia repair is only one of many health issues in Africa, we feel that Operation hernia is an important project that is worth being supported in the future. For all of us the hernia mission was not only an outstanding and heart touching experience which we will never forget, but also a mission of friendship and partnership between Africa and Europe. We are all looking forward to come back to Ghana in the future.

Dr. med Wolfgang Reinpold
Surgeon from Hamburg, Germany

The first German Hernia mission to Takoradi was kindly supported by donations from:
Dieter Adelwarth, Anästhesie Zentrum Hamburg, Jeanette Azzaloni, Sigrid and Hans-Jürgen Beinhorn, Otto Binkele, Praxis Dres. Elke Brüning, Matthias Ewe and Petra Köster-Meyer, Wilhelmsburg, Covidien Deutschland GmbH, Irma Deschka, Deutsche Lufthansa AG, Fa. Freizeit & Hobby, Anita and Fred Gohle, Renate und Ingo Grundmann, Dr. Horst Haeberlin, Johnson & Johnson Medical GmbH (formerly Ethicon), Katholische Kirchengemeinde St. Bonifatius Wilhelmsburg, Margret Kaczmarek, Erika and Kevin Kilpatrick, Brunhilde Kirsch, Lohmann & Rauscher GmbH & Co.KG, Anke and Bernd Malik, Elke Matuszczak, Fa. Medic Zeitarbeit, Dr. Ute Moje, Marianne and Gerhard Nöthlich, Dr. Gerald Paschen, Hans-Jürgen Peschel, Anja Petersen, Ilona Reichwald, Semperit Technische Produkte, Anna Schilling, Thomas Schmidt, Martha and Johann Swoboda, Dietgard Ude-Zalik, Sabrina Wehrmeyer und Frau Wittneben (Reisebüro Wittneben, Gifhorn), Dr. Anke Witte, Barbara and Norbert Wolpers, Christel Wowtscherk, and many others who either didn´t want to be listed or donated anonymously.