November 2015 “Operation Hernia” Mission to Bole, Ghana

Visiting Team

John Budd – Team Leader – Vascular and general surgeon

Anna Budd – Theatre nurse

Graham Howell – Urologist and previously a general surgeon

Rosemarie Howell – Theatre nurse

Travel Itinerary

Direct BA flight London Heathrow to Accra arriving 21.30 on 14th November

Overnight stay in Accra at the Baptist Mission Guest House. Meet, greet and brief with Chris Oppong and teams heading for other destinations.

Nissan 4×4 road transfer to Bole: depart Accra 06.00 and arrival at 16.00

Return to Accra by road on 21st November with wash up at the Guest House and return flight to London departing 22.00


The Cocoa Research Institute Guest House ½ mile from the hospital in Bole provided comfortable and clean accommodation with full board and air conditioning if required. Morning pick up was at 07.30 and return at 19.30.

Surgical Achievements

The team carried out 112 elective procedures in 97 patients as follows:

Adult Inguinal hernias 61 Inguinal Herniotomies (children) 15

Femoral hernia 1 Umbilical hernia 1

Hydroceles 18 Epigastric hernia 2

Lumps and bumps 8 Minor ano-rectal surgey 1

Four Emergency procedures were also performed:

Laparotomy and splenectomy for trauma

Appendicectomy for gangrenous appendix

Laparotomy and repair of perforated distal ileum for blunt injury

Caesarean section and tubule ligation


Basic surgical training and some surgical skills were imparted to Dr Asiz and Dr Gerald, two newly qualified general doctors.

Nurse training included theatre skills for the nurses and concept of swab count for laparotomies.

This was a return trip to Ghana for John and Anna and a first visit for Graham and Rosemarie – deferred by the West African Ebola epidemic the previous year. The plan had been to visit Keta on the coast but there was a greater surgical need in Bole despite another teams endeavours the previous week, and we headed up country in the Bole Hospital Nissan pick-up truck on metalled roads. The 50 miles of potholes and craters on first leaving Accra had fortunately been resurfaced since John and Anna’s previous visit 3 years ago. The 10 hour journey was remarkable by its near misses and our passing 19 overturned lorries en route.

We had very comfortable and clean accommodation in the Cocoa research institute guest house and the food was a very pleasing combination of local and European fare.

We were warmly welcomed by the hospital director and the theatre and ward staff. Our surgical day began on the ward each day soon after 7.30 with a pre-operative examination of the day’s patients with surgical marking and a review ward round for those who stayed overnight on day 2 onwards. We used both operating theatres available. Each is now equipped with effective air condition units which made the operating environment quite comfortable. We were most impressed by the ability and humbled by the enthusiasm of all the theatre team.

There were two very capable and experienced nurse anaesthetists – Vitus and Michael. The strategy was to use spinal anaesthesia for the adult patients with very large, irreducible hernia or large bilateral problems whilst the children were given IV Ketamine. There was a modern anaesthetic machine in the main theatre and pulse oximetry and Valley Lab/Eschman diathermy units in both theatres. The laparotomies were done under GA and the Caesarean section under spinal anaesthetic.

John had brought a substantial supply of disposables including mesh, syringes, needles, local anaesthetic, sutures and diathermy pads/pencils. The BMI Bath Clinic had kindly supplied the bulk. It would have been difficult to have managed without the imported supplies and the hospitals own resources were preserved as a result.

We were assisted for some of the operations by Dr’s Asiz and Gerald who were recently qualified doctors with an interest in surgery and there was some time to help them with surgical skills . Dr Joe, the Hospital’s resident doctor, was very supportive and we were fascinated to hear of his WHO secondments to Liberia as part of the Ebola effort and to Ethiopia with the Polio eradication programme.

Some of the hernia repairs were challenging and very worthy of our visit. The diathermy finger switch devices tended to degrade with recycling and we encountered a diathermy pad burn for reasons which weren’t immediately obvious. We had no returns to theatre but disappointingly our splenectomy patient failed to regain renal function post-operatively and died of multi-organ failure within 36 hours. It was a busy week of operating made light by the enthusiasm and hard work of the Bole staff. There was a very positive ambience in theatre and laughter reminding us of the surgical careers of our youth.

Anna and Rosemarie visited the local market on Friday morning kindly escorted by Agatha, one of the theatre nurses, to help with the robust matter of negotiating prices!

We spent our evenings in the guest house discussing how best to resolve the world’s problems but failing somehow to reach a solution. Our final evening in Bole involved a great send off by the theatre team in a down town hostelry and our introduction to BBQ’d chicken gizzards. We were honoured to receive traditional headman’s robes. We renewed and made friendships and look forward keenly to a return visit.

Graham Howell 29/11/2015

The Team, Bole

MARCH 2012
The team had initially been set up to travel to the Republic of Cameroon but because of delays in obtaining official letters of invitation needed to obtain visas a late change in destination was enforced. Cameroon will now be visited later on in this year I understand.

The Team, Bole

The Team, Bole

The English (John, Roger and Anna) and German (Guido, Thomas, Lilianna and Cordula) contingents having tentatively approached each other at gate 37 terminal 5 at Heathrow made their introductions and boarded BA81 bound for Accra. The initial omens were not good when take off was delayed by over an hour whilst the ground crew replaced a loose panel in the engine housing and then the in flight entertainment system failed. Things got worse when due to a mix up with communications we were left stranded at the airport for nearly two hours as nobody was waiting to meet us. Fortunately everyone remained very positive and in good humour and we were well looked after by a very attentive security guard and his mate (who were handsomely rewarded!). After a few phone calls by Chris Oppong we were eventually warmly greeted by Adams and Cosmos and transported to the Unique Palace hotel for the night. During the transfer a wrong turn resulted in an unplanned excursion through one of the seedier districts of Accra that has probably remained undiscovered by most tourists to Ghana. At one point we thought that we might never see our German friends again as they disappeared down a side street and we lost phone contact. We did however all manage to meet up at the hotel around 1.30am for a well-earned slumber in air-conditioned rooms.

Rising a little later than initially planned we breakfasted and set off for Bole at around 8.00am. The journey through the capital was relatively pleasant but on reaching the outskirts the main road seemed to vanish and became a mixture of dirt track and large potholes for about 30 miles! These 90 minutes of “entertainment” would have aptly graced any amusement park as a ride called “The Boneshaker”. At the end of this stretch the road turned into a virtually unblemished “motorway” for the next 7 hours giving us a relatively smooth birds-eye view of a typical Sunday in Ghana. The only obstacles on the road were the numerous broken down lorries and the free roaming sheep and cattle that took some avoiding. We arrived at our accommodation at the Cocoa Research Institute of Ghana in good time to meet Dr Joe our medical host and discussed the plan for the week over a very welcome cold Star beer. Compared to the other accommodation in Bole the Guest House was like a 5 star hotel but it was still somewhat basic by European standards. We were however extremely well looked after and the food was very tasty.

Monday started with a brief introduction to the hospital staff and we then unloaded the large amount of equipment and disposables that we had all managed to obtain from various sources in the UK and Germany. It would be very helpful if some shelves could be put up in the “storeroom” to make it easier to find things once they had been stored. We then visited the wards to check “some” patients and after an hour had seen nearly 40 patients (enough for 2 days operating!) with a mixture of hernias and hydrocoeles. Dr Joe had very efficiently recruited all the patients for the week via radio, television, local newspapers and leaflets and we all commend him for his sterling work. The hospital has 2 functioning operating rooms and we therefore divided in to two teams of 2 surgeons mixing the pairings on some days. One of the first patients was a 4-year-old boy who had his hernia operation carried out under ketamine that worked extremely well. During the course of the mission a number of children of similar age were operated on in a similar fashion and there were also a handful of patients who required spinal anaesthetics rather than local anaesthetic. All of these anaesthetics were carried out by Raymond a very proficient Cuban anaesthetist on secondment to Bole for 3 years. He had been accompanied to Bole by his wife (a physician) who was unfortunately struck down for the third time in a year with malaria. She was really quite unwell and this certainly reinforced the fact that we needed to take our anti-malarial medication religiously. The first day saw a total of 18 patients operated on between the two theatre teams and we finished about 7.00pm. What struck us all was the very muscular physique of all the patients especially the males and during the week we did not see one patient who would be classed as even a little overweight. We were also impressed by the sheer size of the hernias and hydrocoeles the likes of which we rarely see in the UK or Germany.

Village, Bole

Village, Bole

Operating, Bole

Operating, Bole

Tuesday started with breakfast at 7.00am which was the first meal so far that didn’t contain cold baked beans! It was then off to the hospital to start what turned out to be a rather gynaecological day. Lilianna (Thomas’s partner) a consultant gyaenocologist was presented with a 24-year-old woman with a grade 3 prolapse caused by a previous very prolonged labour. Her husband would not have intercourse with her and the only treatment normally available to her would entail a hysterectomy. Because of her age this would cause her husband to divorce her, as she would not be able to bear any more children. Lilianna successfully carried out a sacrohysteropexy to the patient’s great delight. Our lists were then interrupted by two emergency Caesarean sections performed by Tamara, a very excitable Cuban gynaecologist, assisted by Lilianna. Again we finished at about 7.00pm.

Wednesday saw nothing out of the ordinary apart from the fact that we became a little more adventurous with our evening meal choosing beef as opposed to the chicken that we had had for every lunch and evening meal up until then.

On Thursday as well as continuing the sterling work in the operating theatre we had the opportunity to visit some of the patients we had operated on in their villages. We did this in two groups to enable work to proceed as normal in the 2 operating theatres. The visits proved to be fascinating not only to see how quickly the patients got back to normal activities but also to experience first hand what life in a Ghanaian village community entailed. We had the chance to talk to the village people and also had the opportunity to visit the local school in Kiape to chat to the teachers and pupils (the latter ranging from age 4 to 14). We also visited Bole senior school where a significant number of pupils are boarders. Cordula the only non-medical member of the team took the opportunity during the rest of the week to explore the town and converse with the local people bringing back many fascinating tales.

Our final day of operating proceeded in a similar fashion to the rest of the week and at about 4pm we actually ran out of patients. We even managed to fit in a number of patients in the afternoon with various lumps and bumps. In total over the week we carried 94 procedures on men, women and children the vast majority under local anaesthetic. We had the opportunity to use sterilised mosquito net meshes that worked extremely well. Unfortunately we were not able to teach any of the Ghanaian doctors since Dr Joe is the only physician in the region and he was kept busy with all the other patients. We operated on 2 local Chiefs during the week and as an indication of their importance we noticed that they were always placed at the front of the queue when they arrived. We also had the opportunity to visit the town’s bustling market on Friday where we were made to feel very welcome with absolutely no hassling. We all commented on how lovely and friendly all the Ghanaians we met were and how they all seemed to be wearing continuous broad smiles and spouting “wicked” laughs (especially Adams!).

As a special treat after we finished on Friday Matron had kindly organised a send off party with drinks, food and even a bit of dancing. It gave the Bole hospital staff chance to thank all of us but more importantly it gave me the chance to thank all of them for making us feel so welcome. The four male surgeons were presented with Chief’s shirts and the females with material celebrating the 50th anniversary of the Ghana Nursing Association to make garments of their choice.

We left early on Saturday morning not looking forward to our 11-hour road journey back to Accra but with extremely fond memories of all of the people we came in to contact with in Bole. Anna would not recommend the goat fufu however!

We would all like to reiterate our thanks to Dr Joe and the staff at Bole hospital. Finally we would also like to thank the Ghana Government for facilitating our mission. We will be visiting again.

John Budd
Team leader