NOVEMBER 9-16, 2013
Mission to Keta Hospital

Operation Hernia activity in Ghana continues to expand. In 2012 a team led by Chris Oppong made a very successful visit to Ho Hospital in the Volta Region of Ghana for the first time. This year, another team made a premier visit to Keta Hospital, also in the Volta Region of Ghana. This brings to nine, the number of Operation Hernia centres in Ghana. The centres are: Bole Hospital, Nalerigu Hospital and Carpenter in Northern Ghana; Takoradi Hospital, GHPA Hospital and Dixcove Hospital in the Western Region; CapeCoast Hospital in the Central Region; Ho and Keta Hospitals in the Volta Region.

Planning: The success of the mission was due to the hard work put into local organisation by the Hospital Administrator, Mr Serene Akpenya, supported by the Medical Director. They deserve very high commendation. Patient recruitment was so efficient, they had over 200 patient registered for the mission. This was as a result of very effective publicity. Half of the patients were reserved for the next mission from Holland in January 2014. All the patients were screened by local doctors, and registered with known mobile telephone numbers. This allowed the hospital to change appointments without difficulty. This will hopefully facilitate follow-up which has been a major issue. Our accommodation was in a local hotel. Transportation was efficiently organised. We had a breakdown on our way from Accra but a replacement vehicle was soon arranged. At the end of our mission, the team were congratulated by the Regional Medical Director.

Team: The team was made up of three Consultant surgeons (Terry Irwin, Roger Watkins and Chris Oppong, the Leader) one Anaesthetist (Stephen Millen), two nurses (Jenny Irwin, Caroline Lee) and a medical representative (Jess Peace). The team stayed overnight at the Baptist Guest House in Accra and were picked up the following day for the trip to Keta. All the surgeons were experienced Operation Hernia Surgeons. The team spirit generated was tremendous.

Theatres: Patients were reviewed by surgeons and their hernias graded and theatre list prepared. All patients had a pre-operative oral antibiotic and an analgesic. We had at our disposal two regular theatres and one theatre that was a converted recovery ward. This latter theatre was used for local anaesthetic cases. All theatres were equipped with diathermy machines. One had to be repaired by local engineers. The theatre and ward staff were all excellent.

Outcome: A total of 101 procedures were performed of which 87 were inguinal hernia repairs, 1 incisional hernia and 2 paraumbilical hernia repairs. 11 hydrocoeles were repaired as well. 5 of the hernia patients were under 12 years old (respectively aged 2, 2, 3, 11 and 12 years). 44% of the hernias were scrotal (Kingsnorth H3, H4). Only 5 procedures were carried out under general anaesthetic. All the other operations were performed under either local anaesthetic or under spinal anaesthetic. GA was administered by the team anaesthetist. Spinal anaesthetic was provided by a competent local nurse anaesthetist and the team anaesthetist. Recovery after GA took considerable amount of anaesthetic time. Teams should equip themselves with portable pulse oximeter. This proved invaluable. Only one immediate complication was recorded: a scrotal haematoma that had to be evacuated in theatre.

To conclude, the premier Keta mission was hugely successful in every department. I will recommend the centre to future volunteers.

Chris Oppong

November 2013