In surgery, Eruwa, Nigeria

Leighton Hospital Team with others, Eruwa, Nigeria 8-14 AUGUST 2009

 Arriving in Nigeria with all our luggage

Arriving in Nigeria with all our luggage

MY DIARY: Saturday 8 August

I (Nicola Eardley) arrived at Magdi Hanafi’s house at 6:00 am to find him still asleep! After he hurriedly got dressed, we packed the car and set off for Manchester Airport with our luggage and three boxes full of medical equipment. We met Ginny Long (theatre sister) at the airport, and checked in without any problems, although some swapping of contents between bags was needed to ensure that we didn’t exceed our weight allowance! We flew to Heathrow airport where we met up with Professor Kingsnorth and Eyston Vaughan-Huxley, a surgical trainee who had just finished his F2 year. We boarded the plane and unfortunately were delayed for an hour on a hot day without air conditioning (hotter than we were in Nigeria!), but eventually we took off and had a smooth flight to Lagos.

When we arrived at Lagos Airport, we were relieved to see that our luggage had also arrived, having survived the transfer at Heathrow’s Terminal 5. Customs questioned their contents, but allowed us to pass without any problems. We were warmly met by Dr Oluyombo Awojobi and his son at the airport. From there they took us to a hotel near the airport where we were able to wash (in the dark due to a power cut!) and have dinner. Over dinner we briefly discussed the following day’s itinerary before heading to bed (again in the dark due to another power cut!). Many of us were then woken with a start during the night when the electricity came back on and so did the lights and television!

Sunday 9 August

We had an early start with breakfast at 7:00 am. We checked out and packed the cars and off we went. Dr Awojobi had a busy day planned for us. We drove through the traffic of Lagos and once we were at the periphery of the city we stopped to visit the town where Dr Awojobi grew up. He told us all about his family and visited the grave of his elder brother, a respected engineer. We then went to a church, which had been built by his grandfather, and visited his grave. We then travelled for another hour to visit Dr Awojobi’s mentor and teacher, Professor Ajayi. He made us feel very welcome, discussing with us the difference between the old and new schools of medical education, over a cup of tea whilst sat on the front lawn of his house. After an hour or so we set off again and then stopped at his brother s house where we had a fantastic lunch. We thanked him and his wife and then set off to go and pay a visit to Dr Awojobi’s mother-in-law before the last leg of our journey to Eruwa. It was a long journey and we could see why it was best to travel during daylight hours as some of the roads were in very poor condition. Ten hours after we set off from our hotel in Lagos we arrived at Dr Awojobi’s home. We were warmly greeted by Tinu, his wife, and the rest of the family, and sat down to a nice dinner before heading back to our hotel to rest before our work was to begin the next day.

The Leighton Hospital team

The Leighton Hospital Team

In surgery, Eruwa, Nigeria

In surgery, Eruwa, Nigeria

Monday 10 August

Another early start, meeting at 7am (apart from Magdi who overslept again and met us at 7.15!). We had met Richard Salam, an anaesthetist, at the hotel on the previous night and that morning he told us how he had crashed his car on the journey from Lagos to Eruwa. We were amazed when we saw the photograph of his wrecked car that he had managed to escape with only minor cuts and bruises! We were driven to Dr Awojobi’s house and had breakfast before walking across the fields to the clinic. We were introduced to Kareem, the operating theatre supervisor, whom we were to find invaluable over the forthcoming days, and also some junior theatre helpers. In the operating theatre we found two operating tables for twin operating. We unpacked our boxes of supplies, which included gowns, gloves, local anaesthetic, antibiotics, analgesia, sutures, dressings, finger-switch diathermy, diathermy plates, sharps boxes and surgical scrub fluid and skin prep, in fact pretty much everything we needed to repair the hernias!

We met up with some Nigerian doctors, surgeons and GPs, who had come along to get some experience of performing hernia repairs with mesh. Professor Kingsnorth gave a lecture to the local doctors about the Lichtenstein repair and then we set to work. We examined the patients in the consulting room (2 patients at a time stood in the room, naked except for a sheet which they wrapped themselves in) and then they walked into theatre and climbed onto the table. Here they were given oral antibiotics and analgesics before lying down.

The vast majority of our operations were adult inguinal hernia repairs and all but the biggest (and I mean big!) were performed under local anaesthetic. Even the bilateral hernias could easily be repaired under local anaesthetic as our patients were, on the whole, nice and slim. We starting operating, assisted by the Nigerian doctors who were keen to learn. They had varying skills and all had differing aims and objectives of what they wanted to learn from us. For some it was how to perform a Lichtenstein hernia repair well, for some it was simply a matter of learning all about aseptic technique, tissue and instrument handling and effective suturing and knot tying. We kept working like a conveyor belt, interrupted only by lunch which was brought to us in lunch boxes. After only a 30 minute break we were operating again! All in all in the first day we performed thirteen procedures on ten patients. During the course of the day and also at the end of the day we visited the patients in the ward area, where they were usually surrounded by many family members before we discharged them home. Many travelled home on a motorbike just a few hours after their surgery! After a long day we walked back to the house and sat drinking tea and talking about our day until dinner was served. We then headed back to the hotel to rest before another busy day.

Tuesday 11 August

Another early start. Professor Kingsnorth and Dr Awojobi headed off on a trip to look at potential locations in Nigeria for further Operation Hernia missions. Today was to turn out to be slightly more adrenaline filled! Magdi Hanafi had to deal with a patient who had a right neck swelling and bilateral inguinal hernias. He started with the neck swelling and immediately encountered a difficult dissection and lots of pus. The internal jugular vein was injured and he found himself in a situation where he had to control venous bleeding with no suction, bad light, pus filling the wound, no provision for extra swabs and as an assistant, a GP who had very little operative experience. Fortunately he managed to get control, suture the tear in the vein, dissect out and excise the cyst, all under local anaesthetic and sedation! The second case was no easier, a 40 year old lady with the build of Magdi and an incisional hernia from a lower midline caesarean section. After a failed spinal she had to have a general anaesthetic with ketamine. It proved to be another difficult procedure as bowel was immediately underneath the skin with no peritoneal covering. There were several Nigerian doctors around who wanted to learn and scrubbed with each case. It was a relief to all that the remaining cases for the day were relatively straight forward.

Wednesday 12 August

An early wake up call this morning as they decided to turn the generator on at the hotel at 5am. Another busy day in theatre. We saw a 65 years old man with a scrotal swelling reaching down to his knees. This didn’t appear to be a hernia as it was very hard in some areas and cystic in others and he had only had an inguino-scrotal hernia repair a month before. It turned out to be a giant haematoma which was evacuated and included an orchidecomy.

Thursday 13 August

Slight stress this morning as the patient who had had the giant haematoma evacuation was nowhere to be seen, He has already gone home, even though he had a drain in situ (the finger of a glove acting as a drain!). Other patients relatives chased him up in a car and brought him back from the road. We were able to remove the drain and redress his wound. Professor Kingsnorth and Dr Alowojobi arrived back this morning and operated with us. They operated together on another giant inguinal hernia. After another long day we had a tour of Eruwa and got to see the original clinic before it moved to its current site. We were also fortunate enough to meet the chief (Oba) of Eruwa in his palace.

Friday 14 August

All packed and ready to go but a few more operations to perform before we left. Our tally for the week was 49 operations, the vast majority being performed under local anaesthetic, and no major complications. We set off for the airport, thanking everyone for their hospitality and a few hours later we arrived at Lagos airport. A long journey back home and plenty of time to think about the next mission

Leighton Hospital Team: Magdi Hanafy, Nicola Eardley and Virginia Long.
Others: Andrew Kingsnorth, Eyston Vaughan-Huxley (surgical trainee), Richard Salam (anaesthetist)

Theatre Superviser Kareem

Theatre Superviser Kareem