Leighton, UK Magdi Hanafy, Paul Sutton, Janet Burrows, Jackie, Sara Watson
Northampton, Rob Hicks, Sue Johnson
Canada Lawrence Turner, Ira Bloom, Teresa Buckley
Inverness Morag Hogg
Germany- Antje Haupt
Southampton Sarah Hasted
Operation Hernia to Carpenter, Northern Ghana. November 2011
One of my most rewarding experiences -this trip should be recommended to everyone. As a Consultant Surgeon, I joined the Operation Hernia Team for the trip to Carpenter in Northern Ghana. The trip is organised to coincide with the visit of a Canadian Team , called Ghana Health Team and together we spent two weeks away. We operated for 10 days and during our time in Ghana; together with the Ghana Health team we screened 10,000 patients, treated 5000 patients and repaired 290 hernias.
The Operation Hernia team comprised of 5 surgeons, 1 anaesthetist, an anaesthetists assistant, 4 nurses and Sarah our non-medic. Magdi Hanafy, a Consultant Surgeon from Leighton was our Leader. This is his 5th trip to Carpenter, and on this occasion Magdi and Andrew Kingsnorth had recruited a team from far and wide. Lawrence Turner from Vancouver, Paul from Manchester, Morag from Inverness, Sarah from Southampton, Sara, Jackie and Janet from Leighton, Antje from Germany and Sue and myself from Northampton.
There is a lot of planning required fro a successful trip. Behind the scenes, Magdi had been busy chasing sponsors, begging, borrowing and collecting equipment and supplies, which we would need. Prior to leaving all the required equipment was checked and packed into boxes, each weighing 23kgs. In addition there were all sorts of fundraising activities to help support this and future Operation Hernia trips.
It was with some trepidation that I headed to Heathrow with Sue to meet the team. I had no real idea of what was in store. We all met on Saturday morning in Terminal 5 Heathrow and after a hearty lunch took off for Accra. The plan was to stay the night in Accra and then take a 12-hour drive north to Carpenter. There was great excitement as all of our kit was loaded onto a lorry for the journey north. The 60 Canadian hockey bags all filled with essential medical supplies overshadowed our 24 cardboard boxes.
Carpenter is a small village in Northern Ghana. The village comprises of a few houses (mud huts with thatched roofs), a water pump, a primary school, and the church. We were staying on a compound run by the NEA – Northern Empowerment Association. This is an organization whose aims are to improve health, nutrition and water supply, improve education, reduce local conflict and improve farming techniques (grid-nea.org/). It is led by Dr David Mensah and his wife Brenda, who organize the local aspects of our visit. The logistics of 60 healthcare professionals from Canada and the UK, coming to work for 2 weeks, not to mentions the organization of seeing 10000 patients cannot be underestimated. For anyone concerned we were looked after extremely well and a considerable amount of effort had been put into ensuring that our accommodation and food would enable us to maintain the hard work over the 2 week period.
We arrived on Sunday evening and our first hernia patients were scheduled for surgery on Monday morning. These were patients whom had been listed for surgery the previous year by last years Operation Hernia Team. The morning was spent unpacking. This year we had 3 operating theatres to use, David’s theatre, Brenda’s theatre and a newly prepared room called Moses theatre, named in memory of David’s father who died of a strangulated hernia when David was a boy. Each theatre was of basic design. Two theatres had an operating table, the third an operating trolley. The windows were sealed with polythene sheets and each room had a very much needed air conditioning unit. By the end of Monday each theatre had a table full of the necessary equipment and the shelves of the storeroom were full to bursting.
We quickly got into our routine of a busy hernia factory. The patients came from all over Northern Ghana and a few from neighboring Burkino Faso. They stayed at the local school until called for surgery. Each morning we were greeted by the wonderful site of the day’s admissions sitting under the shade of a large tree in the central courtyard of our “Surgical Block”. A typical day was 11 or 12 procedures. Most of the hernias were inguinal, many large and some enormous. Other cases included many hydroceles, epigastric hernias, umbilical and para -umbilical hernias, and lipomas. 90% of cases were done under local, the very large or children being done under General or local and sedation. As each day went by, I found myself adjusting my scale of size as my confidence to do large hernia under local anaesthetic increased.
The work was hard; the days were hot and long. With a small team it was a real challenge to run three theatres all of the time. There were 4 scrub nurses and so for many days there was no relief. After the first day there were only 2 diathermy machines. There was a limited supply of essential equipment and this had to be managed. Despite all of this there was the requirement for good practice. All patients had antibiotics and analgesia and a name band prior to surgery. A brief WHO check was performed to ensure ‘right patient – right operation – right side’. All children were screened for malaria prior to surgery and surgery delayed for a few days if positive until treated. Patients were screened for HIV at a pre-assessment to ensure that the whole team was aware of the patient’s status prior to the procedure. Between cases instruments needed to be washed and sterilized in a mobile sterilizing unit in each theatre. We were supported in our work by a team of local men, employed by the NEA, who acted as interpreters, theatre porters, Chaperones, admissions clerks and discharge coordinators! They were a very efficient team.
The Ghanaian people are wonderful. They were very kind, appeared very happy and so grateful for the work we were doing. The best time to see this was during the visit to the villages with the Canadian Ghana Health team. Each day of the first week the GHT headed to different local villages, organized by David Mensah and his team. One of the surgeons accompanied the offering a surgical opinion when required and listing new patients for next year’s trip. I had the opportunity to accompany them to the village of Yaara. The organisation of the team was impressive. I arrived to a sea of colour and noise. Yellow and white awning provided shade for waiting patients. Different areas had been allocated to Health Screening, Paediatrics, Dentists, General Practice, Dentists, Ophthalmology, Diagnostics and Pharmacy. This was the first opportunity that many of these people had of ever seeing a doctor. It was a big event for the village. Each day in the village started with a welcome from the Chief and the village elders and the Canadians often came home with gifts of goats and Yams, given in thanks.
I came away with lasting memories and new friendships and would thoroughly recommend this trip to anyone who is considering going. I enjoyed the surgical challenges and the environmental challenges. This takes you away from the comfort of your normal theatre, your favorite scrub nurse, your particular light and your must have suture! The days are long and tiring but very rewarding. I really enjoyed the opportunity to work alongside the Canadian team, led by Dr Jennifer Wilson. I will always remember the gratitude expressed by some of the patients and the inspirational leadership of Dr David Mensah.
Northampton General Hospital