Operation Hernia Team in Ho

Operation Hernia Mission to Ho, Ghana – October 2016

Operation Hernia thanks the clinical and administrative staff at the Volta Regional Hospital in Ho, Ghana for an excellent week of hernia surgery this year. We also thank Mr Chances who graciously hosts us at his beautiful hotel.

Operation Hernia Team in Ho

Operation Hernia Team in Ho

Operation Hernia first travelled to Ho in 2011. Volunteers have returned every year since. This year’s team included Miriam Adebibe, Naami McAddy, David Defriend, Odd Mjaland and Kelly Shine. Each one of us has been on at least one prior trip to Ho. This is proof that Ho has a way of calling us back!

Surgical team working in the operating theatre

Surgical team working in the operating theatre

As a volunteer I find these trips restorative. We help patients every day at home. However the pace and the administrative frustrations can lead to burnout. Overseas, the privilege of helping others is so obvious. Despite a busy day, there is time to reflect on the joy of meaningful work. In the evenings all seriousness gives way to laughter, storytelling and dance!

If you are a surgeon, an anesthesiologist or a medical student reading this and contemplating your first international volunteer experience, I encourage you to reach out to Operation Hernia. Come and join us!

Kelly Shine

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

Report of Operation Hernia’s Mission to Ho Volta Regional Hospital
November 2013

The Stats!

Location

Volta Regional Hospital in Ho, located in the Volta Region to the west of Ghana
Approximately 3 hours drive from the capital city, Accra

Personnel

From the UK: 3 consultant surgeons, 2 surgical registrars, one scrub nurse
Charge nurse Sister Josephine, who managed everything!
More than 10 theatre staff who rotated between recovery and theatre
Experienced anaesthetic nurses who could give spinals faster than we could scrub!

Patients

98 patients were recruited, 97 patients operated

Facilities

Initially three theatres, with the fourth emergency theatre being made available to us on the final 2 days.

Fixed operating lights and mobile lights
Sutures, gloves, instruments and mesh were brought by the team
2 diathermy machines present from previous trips, we brought a third
Unfortunately no air conditioning was available due to maintenance

Hospitality

We received 5-star treatment from hospital administration and theatre staff
Food and water between cases
Constant care and attention to our every need!

The Story

We congregate at the Baptist Guest house prior to departing to Ho. We meet Mr Oppong who has already arrived early, full of energy and knows everyone’s name. We all feel instantly special. We meet Bernard our hospital representative, who has already been coordinating things behind the scenes. A quick breakfast is followed by us loading up into our respective vehicles and the journey to Ho begins. It a beautiful 2.5hr trip, but one full of contrasts. The beautiful lush landscapes give way all too frequently to little townships, were the even from our vehicle we can see the poverty that so many live in. Grand buildings are side by side with mud huts, small mansions next to tin shacks. Our driver is enthusiastic, and often has to be reminded that we are not thrill seekers. The road is in relatively good condition with the usual perils of overloaded motorcycles, formula one-esque taxi drivers and the ubiquitous tro-tro (public minibus).

Our prayers are answered and we arrive safely at our accommodation. Our residence can only be described as beautiful. To say more would be to tempt you to join the mission for all the wrong reasons!

After a brief lunch we visited the Volta Regional Hospital. We meet the director of surgery, his administrator, head of finance and a senior surgical resident. We are welcomed into a conference room as if we were visiting dignitaries! After introductions and a heartfelt welcome it is time to see the rest of the hospital and staff. It’s a relatively new building, we are told as we walk around. All the buildings are bungalow style sprawling as far as eye can see. Fortunately the walks between the buildings are shaded. The first thing commented on however by our senior visiting surgeon was the ample parking available. I think this alone made his day!

On to the ward to see the patients preoperatively. They have been selected over a period of months, and are eagerly awaiting our arrival. As we enter the ward they have been patiently waiting for us and applaud spontaneously. After a warm welcome by the ward sister, complete with crushing hugs, we begin to see the patients. All the patients are admitted the night before surgery. We reviewed 21 patients, there was only one DNA. What impressed all of us was how organised the nursing and medical teams had been. From blood results to simple clinical notes, everything was in place, and we were able to review and assess all the patients in just over an hour. An impossible feat in the UK! We returned back to our accommodation in the evening, arms full of food that had also been gifted to us.

The week is made up of grueling 15 hours shift days where we operate, ward round, clinics and data collect tirelessly, whilst supported by the brilliant hospital staff, who do overtime to allow us to finish the cases. Our fatigue is quickly forgotten when we see the gratitude of the patients when their operation is completed. Most have travelled many miles to arrive, and wait patiently for their turn with no complaints.

We were pleased to finish all operations successfully on Friday with no complications. We were rewarded with our first social night out where we went for dinner and drinks, dressed in traditional wear that had been gifted to us by the Hospital staff. We left the following day, all of us promising to return the following year!

Special Thanks

To all the theatre staff at Volta Regional Hospital, Bernard, and Mr Chris Oppong.

Miriam Adedibe

Naami McAddy

Outside the OR

Alyssia McEwan reports
November 2012

Outside the OR

Outside the OR

Medical Student Experience (Alyssia McEwan) – Operation Hernia – Ghana, Nov 2012

Africa. I really had no idea what I was getting myself into when I bought my plane ticket to Accra, Ghana. It had taken a year to solidify the plans to join the Operation Hernia team – a year filled with board exams, medical school rotations, and sleep deprivation. It was hard to believe that the day had finally come to board the flight.

My first impression of Accra – the heat was sweltering! After traveling 10 hours from New York City in the aftermath of Hurricane Sandy, the hot African sun beating down was particularly impressive. I had already begun to feel the camaraderie and team mentality that was brewing amongst the United States members of our Operation Hernia Team. Our portion of the team was composed of: Dr. Pedro Cordero, the surgeon from the US team who I had the privilege of working with during my third year surgery rotation and who was instrumental in my being involved in this mission; Aida St. John, a theatre nurse who I had worked with also during my surgery rotation; Carol Turner, a traveling theatre nurse who I met for the first time on this mission; Peter Dixon, a surgical resident from New Jersey; and myself, a fourth year medical student from NYC. From the very beginning of our journey – dealing with missing documents, our bus breaking down on the way to the airport and a variety of other minor meltdowns – it was clear that we were bonding, whether we liked it or not!

The first time that we were all together with the entire team was outside the house where we were staying in Accra. Meeting the Chair of the Board of Trustees of Operation Hernia and lead consultant of the UK team, Dr. Chris Oppong was wonderful – he greeted me with a huge hug and said “call me Chris!” which broke any barriers of formality that could have theoretically been in place. We met the two registrar surgeons from the UK that morning (after a brief hello the night before)– Dr. Surajit Sinha and Dr. Frank McDermott. Immediately it was clear that we would all get along and that this was going to be an extraordinary trip.

The trip from the capitol city of Accra to the much smaller town of Ho was eye opening. Little tiny villages speckled amongst lush green countryside. Small children running around in near-nothing, women dressed exquisitely in form fitting clothing of the most captivating colors, people carrying a variety of items in baskets on their heads, goats, and a lot of selling, trading and working. Structurally-sound thatch roofed houses and above all a sense of community which was obvious in each of these villages, even while driving past at 55 km/hr. The smiles on the faces of the people were unlike smiles that I have ever seen in the United States – these were smiles portraying honest happiness. I kept asking myself “what do these people look forward to?” “what do these people worry about?” – the answer, I imagine comes down to the basic needs of human beings – food, shelter, water, family – the things that actually matter in this world. How different than what so much of the world thinks of.

I found our welcome to Ho Hospital unexpected. An impressive number of regional officials and hospital administrators joined in to welcome our team. There was a lot of this during our stay, lots of introductions to important people and making connections. Though, in my mind, none of these people were as important as the people who we met later that day, our patients.

We entered the doors of the ward that evening to see the patients who we would be operating on the following day. I had seen a handful of hernias over the past year but I had never imagined hernias like this. Basketball-sized masses extending into the scrotums of these men – one after the next. Its difficult to imagine how they managed for the many years that most of these men were carrying these burdens. How they could work and provide for their families is a mystery to me. These men were unlike any pre-op patients that I had ever come across. There was no air of nervousness or being frightened or any requests or questions. They were stoic and ready – ready for surgery and ready for their new lives.

The following day was day 1 in the operating theatres. We met the theatre staff who we would grow to love by the end of the week. Pedro had the brilliant idea of labeling everyone with makeshift tape nametags so that we could get to know the people who we would spend the week working with. In my mind, this was probably one of the most influential decisions of the entire mission. Being able to call each other by name is something that I believe contributed to the bond that we all formed. Nothing is sweeter to our ears than the sound of our own name, and being in an environment of strangers where we can begin to know each other by calling each other by name was very powerful. We learned that the person in charge of the theatres (and quite possibly in charge of the world) was Sister. Though she seemed very “all-business” in the beginning, by the end of the week the soft humanistic side of her was clearly shining through.

The kindness, generosity and politeness of Ghanaians is really beautiful. I felt so welcomed into the community and the hospital. The saying that is repeated over and over by Ghanaians is “you are welcome” – when you walk into a room, when you meet someone. The thing about this, is that it is honest – they were really welcoming us. It wasn’t just something to say to be polite, they really meant it. As much as the members of our team gained from going on this mission, I can say that the people who we worked with gained also. On the last day, one of the scrub techs who we worked with, Senyo, said to me in the most heartfelt and honest way “It has been so wonderful having you all here. It has really brought a lot to us and we will really miss you. I don’t even know how to say how I feel about the way that you have interacted with us and made us all feel. We really wish that you will come back.” It sent goose bumps up my arms when he said this because it became clear at that moment that every single person involved in this mission benefited – the international team, the local nurses and staff, the local surgeons, the hospital administrators and officials, and of course the patients and their families.

Bonded

Bonded

As a medical student, I was able to first assist during the cases. I spent time assisting Pedro, Chris and Sinha. Assisting with approximately 30 inguinal hernia repairs over the course of 5 days offered a unique opportunity for me. For the first time, it gave me the chance to really truly understand what was happening in the operating theatre. During the third year of medical school, we are briefly exposed to a variety of specialties. The rotations in each of these specialties last 1-2 months and by the end of the year we are expected to have made a decision about which specialty we would like do commit to for the rest of our lives. During my surgery rotation, I realized that I loved surgery but the problem that I had was that I could not understand how I could ever be a great surgeon. During my medicine, pediatrics, emergency medicine, and psychiatry rotations it was simple to understand that after 3-4 years of specialized training one could obtain the skills necessary to do those jobs. As a student, I was doing more or less the same things that I would do as a physician – interviewing patients, suturing, making decisions about antibiotics, counseling patients about smoking cessation, etc. But in surgery, I was never really holding the scalpel, understanding why decisions were being made, seeing the big picture, knowing what to do next or even truly understanding what I was looking at. I was retracting tissue and trying to ensure that the surgeon had good visualization, I wasn’t acting as a surgeon by any means. By assisting with the SAME procedure 30 times in a row in 5 days on this mission, I began to understand what was happening and what to do next. For the first time, I believed that I could become a surgeon – I could recognize the difference between a nerve, an artery and the vas deferens. I understood the anatomy of the inguinal canal and what went into the actual repair of a hernia, and why. I could actually for the first time visualize myself being on the other side of the table and knowing what to do next. This was a HUGE realization for me.

In order to feel this way, it wouldn’t have been enough to have simply observed and assisted in the operations. I was fortunate to be in the company of surgeons who love to teach, Pedro and Chris. During one case, I asked Chris a question about the anatomy (a question which he had probably already answered 5 times) and he realized that I was still confused. He removed all of the retractors from the deep tissue and skin and held the skin closed. Then he started at the beginning and slowly retracted each layer explaining and quizzing me on what we were looking at and what had been done. It was important to him that I understood, and somehow this man has been gifted with a seemingly endless amount of patience. At the end of that day, I expressed to Pedro that I felt much more comfortable with the anatomy but wished that I had packed my anatomy books so that I could review before tomorrows cases and understand even more. Pedro has been a surgeon for probably close to 30 years and thus naturally has an extensive and impressive knowledge of anatomy. He instinctively grabbed a piece of paper and drew out in exquisite detail the anatomy of the entire inguinal region – explaining every structure to me and confirming that I understood. By the next day, I was even more comfortable and was able to soak in even more from the cases.

Whatever the rationale that these two gifted and seasoned surgeons had for taking the time and putting the effort into teaching me I cannot say for certain. But what I know is that their efforts resulted in me leaving Africa with the confidence and belief that I could become a surgeon. I have always been interested in international medicine and global health and knew that no matter what specialty I chose, I would incorporate international work into my career. I see, however, through the Operation Hernia that simple surgeries such as hernia repairs can have an enormous impact on communities worldwide. Surgeries to correct hernias, cataracts, and cleft palates are simple yet absolutely life (and community) changing. Without this experience, I would not have believed that I could become a surgeon or have been able to see the results of correcting surgical disease in the developing world. I hope to be involved with future Operation Hernia missions in the future. I am very impressed with the mission of this organization – they are interested in sustainable and innovative improvements. Using mosquito net in place of brand mesh is just one example of the forward-thinking ideas that are born through leaders of this organization. This trip has changed the course of my life and I am forever grateful for the opportunity to have been a member of the 2012 Operation Hernia team.

Alyssia McEwan, BA, MS

4th year medical student

Touro College of Osteopathic Medicine – New York, NY, USA