Plymouth team, Takoradi 15-22 NOVEMBER 2009

On the 15th of November at 4am a team of 9 arrived in Takoradi, Ghana. 101 procedures, 3 c-sections and one neonatal resuscitation later they returned. After a comfortable flight for some more than others we arrived at Accra airport to be greeted by Mr Oppong and a team ready to get us to Takoradi. After a bumpy few hours we reached the Villa and the smiling faces of the indispensible girls that would look after us for the next week.

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We brought with us surgical equipment and also clothing- football shirts, chalk, maps. Coffee and cereals are very expensive there and I d recommend bring your own if you can t do without. After some rest we were taken out to see some of the surrounding area and stopped by a village in which a young boy had been diagnosed with talipes last year. This time a girl in her early 20s was brought to our attention she was unable to walk due to a gibbus. We later got her to Dixcove hospital where they commenced her on TB treatment which is free.

We worked from 3 centres; in Takoradi the Hernia centre and Ghana Health Ports Authority Hospital (GPHA) and for the first time the more rural Dixcove. I had the pleasure of visiting all 3 places. We were also joined by 4 surgical senior registrars from the Teaching Hospital in Kumasi, Ghana s second Medical School. This training was arranged by Mr Oppong and Prof Michael Ohene Yeboah.

My first day was at the hernia centre I walked in to theatre (the only place with air-con) and within the first few hours I had encountered the biggest hernia I had ever seen (that is till the next day). Over at GPHA there is only one theatre and one man and I finally had the pleasure of meeting the infamous Dr Bernard Boateng-Duah who was responsible for the smooth running of our stay. His unassuming manner belies the fact that he is responsible for all the cases at GPHA. I would also like to thank him for finding all the hernias and the t-shirt! My day at Dixcove started with a bumpy 45 minute journey in a version of an ambulance and I was sat on a seat. There one doctor covers the hospital and a population of 20,000 and he had a smile to greet us. His skills like many doctors in Ghana ranged from medicine to appendicectomies and caesareans. One theatre meant that occasionally lists were interrupted for emergencies. At all the theatres equipment was basic but the staff expertise made up for it. The sets presented to us were variable in terms of quality and quantity and required an open mind. We often didn t arrive home till gone 7 and my hat goes off to Mr Oppong who did 3 days at Dixcove arriving home at near 10 each night with his team.

If you have never experienced living in a developing country it may not be what you expect. However, I found the villa comfortable and welcoming and it added to the experience. We had air conditioning and running water though I must admit we did have a few power cuts. But who can deny the pleasure of being spoilt every evening with a freshly cooked meal and greeted with true Ghanaian hospitality and warm enquiries as to your day. I have never seen such food and the presentation, thanks to Bridget, it was often spectacular. In addition there was Lillian, Kate and Bernadette who made our stay as stress free as they could. Not only did they help with money changing but also shopping! We finished early on Friday and had an hour by a pool before a celebration meal at a local Ghanaian restaurant.

Our special treat for the weekend was a visit to the stilt village and then on to Green Turtle lodge for a night staying in huts on the beach. On the way to Accra to catch our flight we visited El Mina Fort for a sobering tour of the slave trade. The journey was broken for lunch overlooking the sea at Biriwa resort. After freshening up and a meal we left Accra

Although the system is sometimes frustrating there are many battling to try and make a change. Catching a group of children share one sweet without a second thought and the smiles and laughter brought by simply having their picture taken was a lesson in humility. This was probably the hardest week of work I have done. The days were long and we operated non stop. Also we had to contend with a different environment and were constantly challenged in one way or another – be it a loss of electricity, unfamiliar equipment and the language barrier. But the staff friendly and I had to marvel at their innovation and way they worked to minimise waste. It was physically, mentally and emotionally hard at times but would I do it again- of course!!

I would like to thank all those who supported us in various ways from donations of their time, money, equipment or clothing that made this a special trip possible for us and the people we managed to meet along the way.

Eiling Wu
Surgical registrar

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.

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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.

Team Ghana 2009

Hispano-Belgian Team, Takoradi, Ghana 14-22 FEBRUARY 2009

The Hispano-Belgian team consisting of Ramon Vilallonga (consultant from Spain), Pina Orlando (experienced nurse from Belgium) operated at in Takoradi from February 14-22. Unfortunately, Dr. Casper Sommeling, Dr. Martin Ruppert and the rest of the Belgian team couldn’t come and we had a very busy time in the theatre. We personally finished exhausted every day.

Team Ghana 2009

Team Ghana 2009

After arrival we drove to Takoradi in a raining night. We were welcomed at the guest house by Grace, Lillian and Kate, our hosts for the week who had a lot of pleasure in meeting again Pina because it was her second year.

Sunday we met Dr. Bernhard Boateng and discussed the surgical week . He had planned about 29 patients; 22 in the hernia wing and 7 in the Ghana Ports and Harbour Authority hospital. We underwent for incisional hernias, mango, pineapple and one watermelon hernia repair. Also we had two cases of testicular hydrocoele and a testicular tumour. We performed also and emergency surgery in a patient with a strangulated hernia.

We had a very nice time with all the team there. The operation nurses helped a lot that everything was well organised, especially at the GPHA hospital. Everybody treated us very well and we danced even a lot, sandwiches were very nice

Dr. Bernhard Boateng spend a lot of precious time for us, in keeping us with some activities, even in the late afternoon. However we had time for visiting the harbour, play a game of golf with Georgina (The best golf player in Ghana) and some other activities. We even plan to organize a Golf tournament the next time we will go.

Local Children

Local Children

 

Part of the Team

Part of the Team

The last day in the hospital we were gratefully thanked by the team of nurses for the good works we did with presents. We got a special T-shirt of the hospital and lovely team pictures where taken. We also got one for our own album.

Also Dr Boateng and his team did think about our curves! Special Ghanaian chocolates where given to us by hart. We both were very touched with these gifts !

On Sunday after our arrival, we were taken to the beach and the last Saturday we visited the National Park of Kakum with the lovely guide Rebecca. Finally we went to Cape Coast and Accra where I was dropped to fly back to Spain and Pina picked up her whole family for another nice vacation trip around Ghana.

The Foundation Dr. Vilallonga www.fundacioramonvilallonga.org had taken material for 40 patients, including meshes, 200 bottles of local anaesthesia and Pina took plenty of presents for the kids but also for the friends. So our suitcases were empty at the end of the week. Everything went very well.

Dr Frank and Dr Bernhard deserved and received our deep respect for their work in Takoradi for treating all patients (children and adult) with all diseases (as surgeon, obstetrician etc) with relatively little is an immense responsibility. Also the nurses who we cannot forget because without their organisation we were able to operate. We hope we will be able to support them again.

We are keeping in touch with everybody, and all patients are going fine and will be followed up thru next teams and the local doctors .

The Hernia Wing and GPHA are well equipped but in the Ghana Ports and Harbour Authority hospital theatre we ran out of electricity for 30 minutes and we performed the surgery with a lamp. The nurse asked me Aren t you going to continue, doctor?, I answered after some reflection Of Course . Than we used the flashy glasses whit led lights on who Pina took with her. We, the young surgeons have grown with the electrical cut. The nursing staff are well trained and fun to work with. They work very hard without complaining and put the well-being of their patients first. Dr Frank and Dr Bernard deserved and received our deep respect for their work in Takoradi. Running a hospital and being a generalist physician who treats all patients (children and adult) with all diseases (as surgeon, obstetrician etc) with relatively little is an immense responsibility. They deserve as much support as we can give.

We had a wonderful time thoroughly enjoying performing the operations, meeting Ghanaians and visiting parts of the country.

We will be back!

Ramon Vilallonga
Pina Orlando

Operating Ghana 2009

Operating Ghana 2009

The Probus (UK) Team 20-27 SEPTEMBER 2008

The Probus Surgical Centre in the UK, is a primary care based service, performing a variety of surgical procedures, including abdominal wall hernia repair. All procedures are performed using only local anaesthesia.

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Hernia surgery is a particular interest of the team at Probus and my initial contact with the project was through Professor Andrew Kingsnorth, who was presenting his early experiences in Ghana at an international meeting. I quickly decided that I would like the opportunity to be involved with such an interesting, exciting and worthwhile project. Andrew and Chris Oppong arranged for our visit to take place in September. This allowed us eight months to prepare for our journey.

At this point we began to search for local sponsors to help provide the materials and funding for the trip. In the subsequent months we were helped by many generous individual donors and by the kind support of several retail and pharmaceutical companies. Donations included meshes from Covidien, sutures from Ethicon, gowns and drapes from 3M. By the time of the trip we had secured supplies for all of our disposable needs.

The team consisted of two surgeons, ( John Tisdale and Nick Barwell), one surgeon in training, (Mehdi Masood), two theatre nurses and a medical student. On arrival in Takoradi we were housed at a reasonably comfortable government villa, which was to be our base for the week. During our time at the villa we were exceptionally well looked after by the staff, Lillian, Grace, Kate and Barbara. We were most grateful for their care and attention and send them our thanks and best wishes.

We divided into two teams and used the theatres at the Takoradi hernia unit and the Ghana Ports Authority hospital. As described in previous reports the units are fairly basic by European standards but adequate. Curved artery forceps are in short supply and dissecting scissors blunt but the kit is otherwise satisfactory. The nursing and support staff at both units are very welcoming and helpful. Our thanks to both teams for their support.

Forty three procedures were performed on forty one patients. Most were moderately large indirect inguinal hernias, two recurrent. A small number of ventral hernias were included. Two children were operated on under GA; all other cases were performed under LA. We were also called upon to assist at Caesarean sections and to give advice about other medical and surgical problems.

The social programme, organised by Brian Dixon included visits to local beaches, villages, schools, a rubber plantation, national park, crocodile sanctuary, El-mina castle and much more besides. We were able to distribute gifts of toys and clothing in the villages we visited.

At the conclusion of our stay we reflected on our experiences both as a team and from our personal perspectives. Everyone involved felt that the trip had been a great success and that we had each achieved our personal goals. Success can be measured in many ways but I think the fact that all members of the group have expressed a deep desire to return as soon as possible speaks volumes in itself.

The success of our trip owes a great deal to the hard work, enthusiasm and teamwork of the individuals involved and I offer them my sincere thanks. However without good local organisation in Ghana, Operation Hernia could not flourish. Thanks to our hosts at the hospitals, the medical director, Linda, Bernard Boateng and their teams

Special thanks must also go to Mr Brian Dixon whose efforts were quite remarkable. No person could have done more to ensure the success of the trip and the comfort and enjoyment of the group. Operation Hernia is extremely fortunate to have someone with Brian s commitment and energy working for them. We look forward to returning in the near future to renew our acquaintance with Brian and our many friends in Ghana.

Dr John Tisdale

South Africa Team Report JUNE 2008

The initial request to participate in Operation Hernia in Ghana was through the British Hernia Society from its President Professor Andrew Kingsnorth.

He approached me because of a previous contact we had had when I hosted him as our visitor at the SAGES Annual Gastroenterology Congress several years ago. He also did part of his post graduate studies in Cape Town. I agreed that we should look into the feasibility of participating and he forwarded me details of the initial teams visits during 2005 and soon after details of the web site where more comprehensive details were provided.

One of the prime movers in the UK is Chris Oppong. He is an ex Ghanaian, now working in the UK and is really the man in charge of logistics from the UK side. I did not wish to make this a private arrangement and as such wrote to the Association of Surgeons of South Africa to see whether or not they would give it their support and whether or not they would help with funding the project. Simultaneously, I approached several parties in industry, those particularly involved with hospital care and with repair of hernias. The matter was discussed at the ASSA where mixed sentiments were expressed regarding the distance involved to participate in the workshop and the fact that similar situations occurred in neighbouring countries to South Africa where currently there were no similar projects going on. My own view on this situation was that with no existing projects being available, one should explore how this project worked and perhaps try and use it as a potential model for doing things on a more local basis and to this end I agreed to formulate the team. ASSA gave it their support and asked its constituent societies to contribute to the financial support which indeed they did in the form of the Vascular Endoscopic and Trauma Societies

Several individuals were approached and eventually we settled on a team of 4 individuals. The members were myself, from the Department of Surgery at the University of KwaZulu Natal, Mr Simon Maseme, the Chief Surgeon at Prince Mshyeni Hospital, the theatre matron from Addington Hospital, Linda McKenzie. The most senior member was Mr Roy Wise from private practice, These individuals gave up their free time and agreed to go. We finalized the date and it was to be a ten day trip. This was based on availability of flights into a Accra from South Africa which were costly at approximately R11000 each. We had to route via Lagos to meet our predicted period in Ghana. The sponsorship from industry came from Life Care Hospitals, Johnson & Johnson from their Ethicon Division, Perryhill International. I am extremely grateful to the individuals from these companies who supported the project. In total they contributed R25000 to the project. In addition, they also contributed a variety of different mesh products and sutures for use in Ghana for repairing inguinal and incisional hernias worth a similar amount of money. AstraZeneca kindly donated a significant quantity of local anaesthetic which again was put to good use during the project. These accessories were packed neatly in two boxes.

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We set off on what we knew would be a lengthy trip because of our routing. First stop in Central Africa was the Lagos transit lounge where we had the dubious privilege of watching South African (0) being beaten by Nigeria (2) in Abuja. Next stop Accra a short haul which left only an hour late. On arrival we raised the ire of the customs officials as there was no import certificates for the medical goods and chattels we were carrying. However, with Simon Maseme s charm and my silver hair, we managed to get the boxes through without the need for a back hander or a huge paper trail. Meanwhile Mr. Wise was reporting his lost luggage, fortunately the only item which went missing in transit. This was despite booking all our belongings directly through to Accra together in Durban. This took the edge of what had been rather a long and arduous trip which still had a four hour road trip to go. When we emerged from Accra Airport a whole crowd of people , taxi drivers included, were watching the Ghanians beating Libya 3 0 they were ecstatic. Fortunately, our driver was looking out for us. The four hour evening ride, fortunately in our air-conditioned 4X4 was rather tedious so on arrival at 11pm we were all dead beat.

We arrived at the government villa which initially lacked some creature comforts and had a hot water geyser which was temperamental to say the least. This invigorated us all at various stages with a cold shower. Fortunately, the overall temperature of the cold water was well above zero and so it was refreshing rather than too much of a hardship.

It is important to say something about logistics. Our every need was catered for by Mr. Brian Dixon an oil man who knows how to get things done. He was the Canadian Natural Resources Limited, (A senior independent oil and natural gas exploration, development and production company based in Calgary) man in Ghana taking care of their business off the Ivory Coast. He is a huge asset to the hernia project. He employed three young ladies to look after us in the villa. They were Kate, Grace and Lillian. Lillian is training to be a welder, Kate is training to be a nurse and Grace is their best friend. They cooked for us prepared our packed lunches and pampered to our every need . It cannot be emphasized how much he continues to contribute to the whole ethos of the project. He does make it work and obviously it will be important that there is a transition to whoever provides logistic support in future years when he may have moved on. He had arranged a meeting with the acting Regional Medical Director, Dr Linda Vanotoo and I gave her feedback on our early experiences. The medical discussions focused on the need for provision of more Ghanaian trainees surgeons to assist and to be taught in the procedures. This would extend the potential benefit to create expertise locally which in my mind is essentially the true aim of the project to empower the health system improve the lot of their hernia patients.

We worked at two hospitals, a district hospital with a rather dilapidated exterior Takoradi Hospital. It is the home of the hernia project and on the second floor there is a converted ward which serves as a reception assessment area, operating theatre and recovery room . it has a well equipped small operating theatre and the staff , were to say the least, exuberant in their whole approach to life and to the project in general. The other hospital was the Ghana Port Health Authority Hospital (GPHA) which is a semi-private institution, a small hospital run by two doctors, one of whom is the main local instigator of the project and Chief Medical Officer Dr Bernard Boateng-Duah. He dedicated his operating theatre to the project for the week. His staff were also a delight in a more traditionally manner.

We serviced both hospitals simultaneously which meant we had to split into two pairs. We altered the pairings daily so we all worked with one another We had three trainees at the GPHA who participated and performed part of the hernia repairs that we did there. They were Dr George Tidakbi, MD Diploma in Anaesthesia West African College of Surgeons, Dr Owusu Adjei, MBChB Member West African College of Surgeons, and Bernard Boateng-Duah MD, Diploma in Obstetrics and Gynaecology University of Dublin.

Over the 6 working days we did a total of 61 procedures. We did 3 incisional hernia repairs, one bilateral hydrocele and 57 inguinal hernias, 4 were in young children and all but 2 were indirect hernias. The age ranged from 2 right up to 90. There was one return to theatre, of a large incisional hernia repair, for evacuation of a haematoma. This was 48 hours after the repair which we had fortunately done on our first day of our visit. It highlighted the need for suction drains, which we had not brought, but would have been an asset. My pièce de résistance was a 90 year old who had half his intestine in his right inguinal scrotum, I decided that discretion was a better part of valor and to sacrifice his right testicle. Fortunately, he made an uneventful immediate recovery, and when I saw him the next day he had a very broad smile on his face. It might have been because he had a very pretty nurse on his arm but I liked to think it was because his appendage had been returned to its rightful location. I very much hoped he remained complication free.

After a full weeks work from Monday to Friday, we had a relaxing time on the Saturday and Sunday. The Saturday trip was more hectic and we set off the rain forest and a canopy walk. There we were hosted by Rebecca who is one of the guides who had spend time in the U.K and her botanical knowledge greatly enhanced our trip there. It really was quite an experience and something unique for all of us. On the way back we had the privilege to watch a huge Ghanaian with a panga chop up a coconut so that we could not only drink the milk but also eat the coconut meat within. They also opened a Cocoa Pods which was a novelty for all of us. The cocoa beans within carry a sort of fructose – slime around them which is very tasty and edible. Of course the cocoa from the cocoa beans Ghana main exports and when we visited Takoradi port we found no fewer than 250 trucks full of cocoa beans waiting to be shipped out to make Cadburys chocolate. The port itself had also been the main logistics port for development by CNR of the Baobab oilfield in neighbouring Cote d Ivoire waters . A short ride took us to Hans Cottage where we had refreshments and observed crocodiles in the lake on which the restaurant was built.

The second part of our excursion was a visit to the slave castle at El Mina. This fortress had a long history of involvement in the slave trade. Our guide clearly outlined mans sustained inhumanity to man as a result of Portuguese, then Dutch and then British occupation. It appeared that not one of these pioneering nations had human rights on their mind when they were running the castle. It really was rather a sobering visit and emphasized how the colonial powers truly pillaged Africa in so many ways.

On the Sunday we went west towards the border with the Ivory Coast to a fantastic beach where we all braved the waves, had a leisurely time and a lunch. Again one needed a 4X4 to get to these beaches and we passed through some basic rural villages. The individuals seemed happy enough but one of the lasting memories for me was seeing two little naked infants defecating and urinating, in the company of goats, chickens, pigeons, and hooded vultures, on a rubbish tip. While we were trying to improve the curative services for hernia repair and improve the level of training of local doctors, their were obviously some basic health policy matters that will save many more lives than we can possibly sort out with our efforts.

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We had a wonderful social evening at the Chinese restaurant on the beach and all the girls from the various teams participated to make it a memorable evening. Linda McKenzie had her birthday there and Mr Wise and Brian managed to conjure up some South African wine and a cake was baked by the girls. Her happy birthday song could have done with some more tuneful vocalists but we all enjoyed the evening she turned 22 again!!

On the Monday, we operated on a complication of a giant inguinal scrotal hernia which the Spanish team who finished their stint two weeks ago repaired. It reflects some of the problems with handing over these far from straight forward and long standing hernias to the local resources at the institutions. This aspect needs a more formalized commitment from the local surgeons. They had only two in a town of 500, 000 but they need to be involved in seeing and if necessary treating the complications. It is unrealistic with these types of hernias to suggest that they will all have an uncomplicated course.

On the Monday at lunch time, we had a wind up meeting to discuss the visit and have a two way dialogue on aspects which we felt would improve the interaction. Brian chaired and minuted the meeting. In essence, we were concerned regarding the short term follow-up of the patients and the timeous management of any complications. Obviously the long term follow-up is another issue which I am sure the founder members of the project are anxious to get meaningful data. We were concerned that the reusable drapes did not provide an adequate sterile field and that larger reusable drapes could be sourced locally.

The theatre lights at GPHA needed replaced as they were substandard. We felt also that opiod and local anesthetic drugs would be better sourced locally than brought in by the visiting teams. Even the importation of the meshes should have been more formalized so that import certificates can be achieved ahead of time. It was also felt that accurate stock record should be kept so that teams could be alerted as to the specific deficits in meshes, sutures and suction drains . The specific needs might also be based on the type and size of hernias an individual team would be treating. Hence details on the hernias to be treated should be sent to the team two to three weeks prior to their visit. It was also felt that an earlier start and restricting the number to a maximum of five patients a day would be beneficial. It would allow more time on each case for teaching purposes and to see the cases prior to overnight admission or discharge. In addition it would allow a bit of leeway for double procedures on certain individuals.

The girls at Takoradi decided that we should have some Ghanaian shirts and hats and a little Ghanaian Sarong was duly produced for Linda McKenzie. They really were a delightful bunch and were appreciative of our participation in their project. They had nicknamed Simon, Obolobo which means the large one or if you are being kind it means cuddly one He really related to the girls as the cuddly one. It was a really touching send off.

We set off early on the following morning on our final ride on Accra. We made record time with our new driver and fast vehicle but we were rather anxious when we checked in that we would arrive with our luggage at the other end. On this occasion we had to pick it up in Lagos and so we all got back to Durban with our belongings. Once again washed out after 24 hours on the road. Mr Wise still had the energy to take his dogs round Greyville Race Course before retiring.

I was proud of the whole team in Takoradi and the extent which the local girls went to ensure that we were welcome, well fed and comfortable . All of the South African team which I had the privilege to bring thoroughly enjoyed the trip. We all participated fully and the younger members took our hats off to Mr Wise who s senior participation as he approaches 80 was something for us all to behold. He retains an enthusiasm for his craft that has long deserted and jaded many lesser mortals in surgery. He sustained losing his case and having to wear my underpants and tee-shirts for several days with great aplomb.

It was a worthwhile trip whether it is a sustainable trip or whether it will provide us with an impetus to do things on a local basis remains to be seen. My own view is that it would certainly be worthwhile approaching our current and other funding sources for consistent backing for a project like this. If not for this particular venture, then for other projects where a small team can go on a recurring basis to develop the skills of local doctors. I hope this document kindles some interest in the concept amongst the ASSA executive.

Acknowledgements: I would like to thank all the individuals, companies and societies below for their conceptual support for the project and by translating this into both the financial and product support necessary to make it a reality. Roger, Vash and Sioban from Johnson and Johnson; Michiel from Astra Zenca; Ludwig and Geraldine from Perry Hill; Mike and Ruth from Life Care Hospital Group: SATS from ASSA and the councils of VASSA, SASES, Trauma Society.
I compiled this report on behalf of the Team

Sandie R Thomson

26 JANUARY – 2 FEBRUARY 2008
With three surgeons and two nurses we tried to plan our trip as well as possible with the advanced and forwarded information.

We took meshes (kindly donated by B. Braun Medical NV Belgium), gloves (double pairs), disposable drapes (Mölnlycke Belgium) and gowns (Sterima Belgium), local anaesthetics, analgesics (Paracetamol), syringes and needles, and a lot (two bags) of small gifts and sweets. Bard Benelux partly sponsored our team. After arriving at Takoradi on Saturday night Brian Dixon waited for us and brought us to the Doctor’s Transit Lodge where we stayed the whole week. Due to the Africa Cup the Planters Lodge was not availbale, but we did not miss it. We were taken good care of by Brians team (Kate and Grace), who made a wonderful breakfast, a nice lunch and an even better dinner at night. After arrival at the hospital on Monday morning we could immediately start working, while a strict progam was made beforehand with selection of patients as early as November 2007. Dr. Boateng- Duah (GPHA-Hospital) hopes in the future he can send already a program to the visiting teams.

We could operate in three theaters (two in Takoradi hospital and one in Ghana Port and Harbour Authority Hospital) and did 59 operations on 54 patients (of which seven were children). Important to point out is, that we did not only operate on groin hernias but also nine ventral hernias and two hydroceles. I would advise teams in future to take also meshes for umbilical hernias (type Ventralex) and for preperitoneal repair (type Polysoft) in recurrent hernias. A more extensive repair (retromuscular mesh) for ventral hernia is not easily done under local anaesthesia. We used the Mosquito-mesh only once.

The operation-theatres were well equiped, but the operation-light in GPHA-hospital needs to be renewed. The next mission should also bring new scissors or an instrument to sharpen the scissors. Swan-Morton knives nr. 15 would be wellcome instead of nr. 11 knives. Although we made long days we all felt inspired with our work. Two of us were interviewed by TV Africa while working and this was broadcoasted Africa-wide (Dr. Boateng-Duah promised us a copy on CD-rom). One of the questions asked was how to prevent hernias. We answered there is no prevention for groin hernia, but please come sooner for the operation and do not wait so long.

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In the evenings Brian Dixon took care of us and we managed to visit a football game (Nigeria-Benin), take a tour in the harbour on a boat and visited a village. Friday night we invited managers and doctors from the hospitals, people from the local authorities and members of the Takoradi community for a gala dinner at Planters Lodge (sponored by J&J Belgium) in which we strengthened the bonds between Operation Hernia and Takoradi.

On Saturday, on our way back to Accra, we visited the rainforest, the crocodile lodge and El Mina. After a quick refreshment and a last meal we left Accra on Saturday night to land in Brussels again on Sunday morning.

Our thanks go to the doctors and nurses in both hospitals, the local authorities, Kristie (a Canadian nurse who volunteerly helped us), the local staff (Kate, Grace) and last but not least Brian Dixon, without whom nothing would have run as it did.

We all intend to come back next year.

Casper Sommeling