Visit to Ho Hospital November 2014

Report about “Operation Hernia” tour to Ho in Ghana from 15/11/2014 to 23/11/2014

This is the second time I have joined a tour for the charity “Operation Hernia”.

The tour was planned well ahead during 2014 with timely reminders about all the practicalities. These preparations were severely disrupted by the Ebola virus outbreak in some West African countries. For safety reasons, the organising team felt it had to cancel the tour. However, I had booked holidays and flights etc, I was looking forward to the tour and I judged that the risk of Ebola outbreaks in Ghana would most likely be minimal and therefore requested to be allowed to go anyway.

I am very grateful that Mr Chris Oppong supported me in my endeavours and worked hard to make my tour possible.

Living in Shetland it is always a gamble to travel in winter from here. The weather was kind to me and my travel arrangements worked out well.

Having arrived in Accra as planned on the evening of 15/11/2014, I was picked up directly at the airport and brought to a guest house for a comfortable overnight stay and rest. The next day, the Ho Hospital send a comfortable SUV car and very friendly and safe driver to take me to my lodgings in a very fine hotel in the outskirts of Ho. The hospital transportation team took great care of transporting me daily to and fro between the hotel and the hospital. The accommodation was extremely comfortable, safe and friendly and had wonderful African food for me.

From Monday morning to Friday lunch time, I worked in the Ho District General Hospital. The team there were very well organised. They had visits from the “Operation Hernia” teams there for a few years running and had put in a lot of effort to make this a success. They opened a special ward with extra staff to look after the patients. In addition they had an operating theatre with extra staff including nurse anaesthetists ready. I had one of the surgical trainees to assist me at all times. He was already experienced in inguinal hernia repairs as obstructed and strangulated hernias are one of the most common surgical emergencies in Ghana. However, they usually have not had access to surgical mesh and therefore do a darn repair. The trainee was very eager to learn the mesh technique and it was wonderful to have his help preparing the patients and getting to grips with the new environment. And it was good that I could show him a different way of treatment and to see him performing mesh repairs independently after a few days. I also encouraged him to contact Mr Oppong to find out about “mosquito net mesh” and the logistics on how to get that set up in Ghana. And I hope that he will be able to use this in his future career.

Overall, I – or rather we – operated on 26 patients, who had 32 hernias, 2 of which were recurrent hernias. Only 2 or 3 of these were of a size that I recognize from my usual practice in the UK. One patient was about the size of a normal weight patient in the U.K. The other patients were all very slim, rather small, with tough muscles and very large hernias which they had to live with for many years. This makes the operations a bit more protracted and challenging. I very much hope there will be not too many seromas…

The patients were admitted the day before surgery. Co-morbidities were few that we knew about. One patient was NIDDM who checked his own BM. We did him early on the list and he was happy to go back on his medication later that day. 2 patients got postponed for a couple of days as they had not taken their anti hypertensives. A common problem, as the patients do not feel better on the tablets and therefore do not understand the sense of taking them. We were able to operate on both of them later in the week.

The patients were discharged the day after the operation if all was well. This was co-ordinated by the junior doctors of the hospital. As far as I was told, no patient needed to stay longer, except for one. This patient had a large, irreducible, sliding right hernia with a fair bit of small bowel, caecum and some ascending colon in the hernia. Furthermore, I found a tumour – most likely testicular in origin – which was invading the mesentery near the ileocaecal valve. So, we ended up doing a limited right hemicolectomy with end-to-end anastomosis and a right radical orchidectomy as well as the hernia repair. This patient was then sent to the normal surgical ward. My local surgical colleagues were happy to take over the post-operative care. They assured me that they would have done the same and that they are very used to looking after patients with bowel resection due to the frequent emergency presentations of hernias. The patient was recovering well when I left.

Of course, operating in a new environment has its challenges for every surgeon. We like to have the security of the known surroundings and our own routines. I was very grateful, that I had the support of a surgical trainee with local knowledge throughout. It must have been difficult to spare him from the routine hospital work which looked very busy for the far too small work force. I appreciate the thoughtfulness of the local colleagues to give me so much support.

I could see that the local resources were stretched by my lists. I had all the meshes for the hernia repairs and left some behind. I had nearly enough suture material. But of course, there is much more involved: extra staffing, re-sterilisation, gowns, masks and hats, air conditioning to keep this northern visitor from collapsing, lunch time feeding for the team… The theatre staff were wonderful. They stayed cheerful until the cases of the day were done. They were patient with all my funny demands. They kept the lists well organised. They warned me in time when we had to improvise so that I could adjust my expectations.

On the last day, after finishing the last scheduled case, I received a warm “thank you” from the hospital management. I thought I had done fairly well. It was humbling to see that they had a much longer list of cases collected earlier in the year. They had hoped for the full team from “operation hernia” to visit which would have allowed for many more patients to get their hernias repaired. I just hope that it will be a good incentive for the charity to organise the next visit for next year.

I am grateful for everybody in Great Britain and Ghana who worked so hard to allow me to visit Ho Hospital.

I wish the trainee, Mr Bosompem all the best for his future career.

Beatrix Weber