The Opertaion Hernia Team in Takoradi

OPERATION HERNIA MISSION: OCTOBER 2016 TAKORADI, GHANA

TEAM LEADER – MR SHINA FAWOLE (CONSULTANT SURGEON)

TEAM MEMBERS – MR CHRIS MACKLIN (CONSULTANT SURGEON), MS HANNAH WELBOURN (CONSULTANT SURGEON), MELANIE PRECIOUS (ADVANCED ODP), LISA MACKLIN (RGN), VICKY ARMITAGE (ODP), EMMA UPCHURCH (SURGICAL SpR), MICHAEL KELLY (SURGICAL SpR).

The Opertaion Hernia Team in Takoradi

The Opertaion Hernia Team in Takoradi

On the 8th October 2016 we began our mission to Ghana. I joined a team of three consultant surgeons, three theatre nurses, and two surgical registrars.

We arrived in Accra late on Saturday evening where we met the other teams who were also planning to spend the next week operating across Ghana. The Baptist Guest House was our base in Accra. Right from the get-go the Takoradi team was very welcoming and inclusive of an outsider into their clan. I learned that this team (in some variation) has been traveling to Takoradi to perform Operation Hernia missions for the last eight years.

The following morning in torrential rain, we travelled to Takoradi. After a 4-hour drive we reached our destination, a house owned by the municipal government that has been utilized for visiting surgical teams from UK, Netherlands and Germany. At this residence, Lillian and her team of helpers looked after us fantastically. Their attention to details was remarkable. Every morning, hot water (for showering) and breakfast was ready, and every evening we were treated to diverse and wonderful Ghanaian culinary experiences. Their care and attention to us was extraordinary, and I thank them profoundly.

During the five days operating in Takoradi (Monday to Friday), three surgeons operated in three hospitals/medical centres (The Hernia Centre, Ghana Ports and Harbour Authority Hospital (GPHA) and Dixcove Medical Centre). Screening of suitable cases was already performed by Dr Boateng (Medical Director of GPHA Hospital), who was also always available to help and provide local advice. This planned organization facilitated immediate starting of operating on Monday morning. The majority of cases included primary and recurrent inguinal hernias, ventral/umbilical hernias and some paediatric hernias. On average, each centre operated on 8-10 cases per day. The majority of cases were performed under either spinal or local anaesthesia. Over the 5 days, a total of 103 procedures were performed. The working day was intensive with late finishes, but was filled with an atmosphere of both camaraderie and satisfaction. Both local nursing and anaesthetic staff were always adaptable to rapidly processing patients thus maximizing the impact of the mission.

Our last evening at the Hernia Centre with our celebratory Ghanaian shirts given to us by the medical team

Our last evening at the Hernia Centre with our celebratory Ghanaian shirts given to us by the medical team

Finally, I would like to thank Operation Hernia and ASiT for awarding me the Shorland Hosking Fellowship and the immense experience of participating in this mission.

Michael E. Kelly

Surgical SpR Dublin, Ireland

Home and away team

Takoradi March 2013 Report of the Belgian – Italo – Dutch team. Visit from March 9 – March 17 2013.

Home and away team

Home and away team

In March 2013 a team of four Belgian surgeons (Myriam Bruggeman, Paul Van Acker, Marc Huyghe and Casper Sommeling) accompanied by an Italian surgeon (Cecilia Ceribelli), two registrars (Stijn Heyman from Belgium and Annelien Morks from the Netherlands) and a Belgian nurse (Pina Orlando) again visited Takoradi in Ghana. Our main financial sponsor still is the Belgian Section of Abdominal Wall Surgery. We brought meshes (kindly donated by Medri, Covidien Belgium, Bard Italy and Assut Europe), gloves (Cardinal Health/Medline), disposable drapes (Mölnlycke Belgium and Medline) and suture material (Johnson & Johnson). Resterilized polypropylene meshes and so called “Indian meshes” made part of our luggage. Local anesthetics, syringes and needles were donated by Bbraun an BD; only the lidocaine with adrenaline and heavy Marcain was bought by us in Belgium.

This way for Hernia Operation

This way for Hernia Operation

Recovery

Recovery

After arriving at Accra, late Saturday night, for the first time we stayed at the Ghana Baptist Mission. The following Sunday we made the trip to Takoradi, meanwhile visiting Kosa Beach.

Again “the girls” (Kate, Linda and Benedicte) took good care of us, although they had more difficulties than the years before due to the frequent power cuts. They even proposed us to switch to a hotel, but their “candle light suppers” were much appreciated by us. This year we were lucky to meet Brian Dixon again, who was on “holiday” in Takoradi; however this means trouble shooting for him as a second nature, or as he states it “there are no problems, only challenges”. He contributed again to our mission in several ways, mainly on a logistic level, but also on solving local problems. He even might have solved the problem of running water in Dixcove hospital.

Paul & Brian

Paul & Brian

During the week we organised three teams that rotated in the three different hospitals (Hernia Wing, GPHA and Dixcove). We performed 86 operations in 86 patients, of which nine were children. Again most of the adult patients presented with groin hernias. The total number of operations seems low for the total number of team members but we were plagued by power cuts and interfering caesarean sections. This year in the adult patients two-thirds (51/77) were operated under local anaesthesia, but loco-regional anaesthesia (26/77) was used as a standard in all three locations in the more demanding scrotal hernias, contributing to a better comfort of the patients. The children of course were operated under general anesthesia.

The motivation of the local hospital teams is good and the level of care of the nurse-anesthetics in the three hospitals is high. The equipment in the hospitals is of a reasonable level, but the Dixcove Hospital is in need of sharp scissors and new operation gowns. Although with three teams we still made long days, but once again it was rewarding.

After a long week hard work we had dinner at the the “Gilou” restaurant Friday night together with Bernard Boateng Duah and his wife. On Saturday we made a trip to Green Turtle Lodge, the nicest place to be at the Atlantic Coast, were again we spent a wonderful day. At Sunday morning our group split up. Marc started on a trip of ten days through Ghana. Paul and Myriam stayed another week in Takoradi for holiday; however they were motivated to operate on the patients that were left over from the first week in the GPHA-hospital, so the first two days of their holiday they operated eleven patients (included in the total of 86).

Pina stayed another two weeks in Takoradi to work in the hospital as part of her training to be a specialized nurse. Cecilia, Stijn, Annelien and Casper made the trip back to Accra with a stop at El Mina Castle. Conclusion: again a rewarding mission; if the future team will enclose again as much members as this year we might go to other places in Ghana. We once again want to thank Bernard Boateng for the organization at the local level: selecting the patients on forehand and helping us out during the week.

Special thanks to Brian Dixon, just because being there.

Casper Sommeling, on behalf of the Belgian – Italo – Dutch Mission

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

17-27 MAY 2008
Our mission in Ghana was a success. It was over our expectation, especially due to the feeling that local people were really grateful for our presence in Ghana, trying to help them.

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All this started a year ago when we decided to create a group of Spanish surgeons to participate in this project. At the beginning it was not so easy, but finally 18 people decided to be part of the group: 8 general surgeons, 1 paediatric surgeons, 4 anaesthesiologist, 4 nurses and 1 general doctor. We were very impressed with how the group was motivated by the project, even when everyone paid the cost of their trips and of their accommodations from their own pockets and how those days were part of their official holidays in their hospitals. But everything was done generously in order to get one goal: to try to help people.

Out of the 18 persons, 16 were from Sevilla, 1 from Barcelona and 1 from Ourense. Most of us did not have experience in humanitarian missions, so we were a little afraid of how things were going to work out. Once we got all the official documents ready, thanks to our hospitals, the Spanish Association of Surgeons, C Oppong, A Kingsnorth and B Dixon, we started looking for some financial support to the mission: Atlanta-Unicongress supported us by reducing the prices of our flight tickets, and different companies (especially Dipro, Covidien, J and J) and our hospitals (University Hospital Virgen del Rocio, University Hospital Virgen Macarena, USP-Clínica Sagrado Corazón, Hospital de Río Tinto and Hospital Infanta Elena) supported us by supplying meshes and sutures: 15 boxes of 15 kg each with surgical equipments and anaesthetics drugs were taken to Ghana. On the other hand, our baggages were full of toys and school materials.

At arrival (Saturday 17th), everything was organized, a bus took us to Takoradi and next morning we went to Green Turtle beach, a paradise, a nice beach full of palm trees to relax the day before we started working. The local culture is so different, Barbara, one of the local girls who looked after us during the week, told me she did not understand why Europeans like the beach so much and to lie down under the sun. We were impressed by the local people, the way of thinking, the colours, the smile in the face of the children, the nature and the way of living. It is a poor country, but we did not see people starving, it seems they work very hard to guarantee their own meal, and none of them asked us for money. We have good feelings after the first day, the people were happy to have us there, we felt safe and the environment was very friendly.

The next 5 days, we worked very hard in 3 hospitals: Takoradi hospital, GPHA hospital, and the regional hospital at Cape Coast. We worked for almost 12 hours a day in each of the 5 operation theatres which we covered in the 3 hospitals. We have performed the largest hernias we have ever seen in adult people and in children; we have also performed cases after multiple surgeries in their groin, multirrecurrent hernias which were very difficult problems to be solve. Very difficult cases, being exhausted by the end of the day, but we were all very happy, very satisfied, since you can see in the face of all our patients they were very grateful to us. The environment in the operating theatres was very friendly with local nurses, they were very professional and they made things easier. By the end of the five days, 146 hernias in 130 patients were performed, including 6 children (the youngest was 4 months old). During our stay we also had the opportunity to teach the local surgeons, I would call them better the local heroes (Dr Frank was in charge with one colleague of Takoradi hospital with 40 beds, he had to visit the patients, to do ultrasounds, to perform caesareans, emergency surgery, I would say he has to cover all the specialties) how to perform a large umbilical hernia and a large incisional hernia. On the other hand, we were the first group with anaesthesiologists, which was very helpful for the local nurse, especially regarding spinal anaesthesia. One of the anaesthesiologists of our group had also the opportunity to give a lecture on local anaesthetics and spinal anaesthesia.

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The evenings were very interesting, getting to know downtown Takarodi and Cape Coast is a unique experience and, although we were exhausted, there was always sometimes to seat the group together around a table with the local beer and share our experience. Brian Dixon also took us to visit a little village, to get to know another aspect of the real Ghana. You can see how they live, how their houses are made, how the produce the palm oil, and how happy the people are with our presence. We also had the chance to go to visit the bishop of the western region of Ghana to give him all the toys and the school material we took with us, to guarantee that all was handed to the people who needed them most.

Being a large group is a real problem for the local organizers, but the effort of Brian Dixon (and the company he works for, CNR), Bernard Boateng-Duah and Michael was very important to organize everything. They took care of every single detail to make us feel comfortable, to advise us about the local cultural aspects. We want to thank all of them and especially the enormous effort of Brian Dixon for being present everyday to make sure that everything was well organized. The four girls who looked after us in the government villa were very important to us to make us feel like at home. They were always smiling and making are stay so easy. They prepared local food for the whole group every single day, they looked after us and they even prepared on the last day a cake with the flag of Sevilla, which they found it in internet. We all want to thanks to Grace, Kate, Barbara and Lillian.

The last day, on our way to the airport we had the chance to visit Kakum National Park and Elmina Castle. Impressive places you should not miss when you visit Ghana.

Long trip and back home, but you can see in the face of the people of the group how satisfied they were. We were a nice group of friends that we enjoyed very much trying to help people. It was worthy to be part of this project, especially if we solve a problem to 130 patients, and we made children happier for a moment with the toys and school material which the local people enjoyed with us,.
We are happy to have the chance to have this experience and we think next year the whole group will be back, and after sharing our experience with the people of our hospitals maybe we have to create more than one Spanish group.

Salvador Morales-Conde
Coordinator of the Spanish group