The Leighton & Derriford team

Leighton & Derriford Hospital Team, Carpenter 1-14 NOVEMBER 2009

Magdi Hanafy, reporting.

The Leighton & Derriford team

The Leighton & Derriford team

On the last day of October 2009 the Leighton Hospital team arrived at 7:00 am to my house in two mini-buses. I opened my garage and we shifted all 22 boxes and bags filled with our and medical equipments to one of the buses, and headed off to Manchester Airport. We took turn, transporting our luggage, upstairs to departures, where BA opened a check-in counter especially for us. 22 luggage counted and checked- in without problems. We flew to Heathrow, terminal 5. Janet and I noticed people walking around wearing a T shirt with GHANA written on it. She went and talked to some of the ladies and we discovered they were the Canadian team who have just arrived from Toronto on their way to Accra and then Carpenter. We introduced ourselves and met with Dr. Jennifer Wilson their team Leader. She explained to us the way they were introduced to Carpenter through Mrs Mensah, who is originally from Canada. The Canadian group have met Prof Kingsnorth two years ago when they were travelling to Ghana, and a new destination for Operation Hernia was born. We had a potential problem with Ginny s ticket as it was a free ticket donated by British Airways. We were told that if the plane was full she would have to wait for the next available place which could be the next day. That could cause a problem as we had to travel by land to Carpenter the next day. I could not have left her to travel alone the day after. Luckily there were enough spaces on the plane and we boarded together to Accra.

In Accra airport we made a long queue (at least two hundred meters) extending from customs and excise to the trucks and buses waiting for us outside the terminal. People with their trolleys loaded with boxes, hockey bags full of medicines etc… (Total of 102 pieces of luggage). We went to the hotel in Accra where we spent the night after meeting with the Plymouth team and Prof Kingsnorth who arrived on Ghana Airlines two hours beforehand.

The next morning we were waken up at six a.m. had a breakfast and off we started our journey to Carpenter. That took 12 hours, including three stops. We arrived in a big compound next to the village. Mr and Mrs Mensah have prepared our accommodation AND OUR DINNER. We were accommodated in a large compound with security and all facilities in constant supply, electricity, water, transport.etc. We were told about the project they are running and the efforts they are doing in sustaining this community. We went to our rooms. Each room had from one to three beds, each with mosquito net and a washing bag. Rooms and toilets are clean. The area is calm. It rained twice on that day.

The next day we woke up early in the morning, warm weather. We went early to operating theatres (which were empty rooms) and started opening the boxes and distributing the equipment on both theatres, knowing what is available and what is not. Craig, Ali, Helen, Dee, Janet, Ginny worked hard mobilising heavy equipment into both theatres with the help of the local boys. We gave Brenda, three bags of children school equipment we brought as a gift to the community. By the middle of the day it became very hot, and we became tired. We started screening patients for HIV and listing them for an appropriate operation, i.e. local or general. We did not have enough nurses, but a surplus of surgeons. We had to sit down in the night and arrange a rotating list between us to see who is doing what, when. We all had lunch together. The Canadians started work already, screening people from the compound. We started operating at three o clock, finished two operations in each theatre, and had to stop when night fell down, due to inability to work with only headlight, and insect s invasion. We had dinner and Prof started to organise our list for the next day. With that number of surgeons and staff the work had to be organised so that nobody would be left out, and others would not feel tired. We listed ten patients per theatre for the whole day, a big task. We had to go early to bed as we decided to start at first light, to reduce the likelihood of working in the dark, at the end of the day.

One of many operations performed each day

One of many operations performed each day

 

Patient care

Patient care

Tuesday 03 November 2009

Woke up early at six a.m. Perry Board before me. A quick shower before everybody else and off we went to theatre. Patients were there waiting for us. A quick ward round, yesterday’s patients were seen and discharged, new patients were allocated to their rooms, Ali started to excel, in organising the local helpers and the flow of patients. Theatres were prepared by Craig, Ginny, Dee and Janet, and we started one after the other. We performed 20 patients with 26 procedures. We finished late after sunset. When all the insects concentrate where light is shining (i.e. the wound). The air-conditioners started to fail. We started screening for the next day and allocated lists for both theatres. I was asked to go to the community with the Canadian team. I had dinner and went to bed early.

Wednesday 04 November 2009

Off with the Canadian team to the nearest village one hour away. A big organised place was set up for us. Chiefs waiting to great us, and each medical, nursing and pharmacy group was allocated a room. The Canadian team was prepared for the invasion by all the local population with and without any illnesses. But many of them have already been triaged by David Mensah, so those with genuine complaints were allowed to be examined. The day started very busy, and we had lots of surgical referrals until things started to calm down by 2:00 pm and I managed to see medical conditions as well, bringing me back to the old days in medical school. I have diagnosed malaria, yaws, and chest problems. I was very happy with the experience. At the end of the day, we gathered to be greeted by the chiefs who offered us gifts of vegetables and a ram as a token of gratitude. We went on to our vehicles for the long trip home which we had to reach before sunset.

Thursday 05 November 2009

Raj’s day out in the villages today. I have had a whole list on my own and managed to finish five cases in the morning. Prof did many cases as well, in the afternoon Richard managed a list on his own while we were seeing new cases and making the lists for tomorrow. Ginny did not feel well and had to retire. Many of us have been falling for slight diarrhoea, and exhaustion from heat. Especially when the air conditioners in Brenda operating room packed up and the room turned into a sauna. We had dinner together that was followed by a speech of thank you for Prof Kingsnorth, Jane and Ginny before their leaving home on the next day. They were thanked and praised.

Friday 06 November 2009

I started a GA list after Breakfast. Prof Kingsnorth and Ginny said their Good byes and left for Accra. Richard was out in the villages today. Raj went on to do the local anaesthetics list in Brenda s theatre when the A/C packed up again. But he continued operating. The last patient on my list was Kunako Koene a 120 years old man. We do not know whether this is true or not but he was very old. He had bilateral inguinal hernias. He was booked for general anaesthetic. He weighed 32 kgs. Walked with a light stick. We helped him up to the table, Perry started his anaesthesia and I performed the two operations. We decided to wake him up and recover him in theatre where the A/C is still working. When he woke up he asked the interpreter to tell us. I pray to God for all those people who came from far away, leaving their families, and jobs and countries to treat us for free, may God may bless you all. May God reward you and give you all the money that you need and more, not only you, but your children as well during and after a long life. Most of us started crying as we were very touched. He continued praising us while we all stood surrounding the operating table looking at him. The interpreter was quick and flawless. We were amazed at his way of thinking and talking, the way he realises all what is happening to him, the confidence that he had, the strength to go through such an operation at such an age, the wisdom and presence of mind. We helped him down from the table, gave him water to drink, and walked him to his room. The same evening at dinner David asked me to say what happened. In the middle of the talk I was so emotional I had to stop.

Saturday 07 November 2009

Raj was exhausted yesterday and took the morning off. I started the GA list and Richard the LA list. We went to see all the Patients and the old man Kunako Koene was doing very well. We kept both lists light, but still finished at 8:00 o clock. We managed to see all the patients for Monday s lists. At the evening we had dinner together and went to Brenda and David s house for tea and had a lovely evening with Craig s magic and a nice game. We went to sleep late.

Sunday 08 November 2009. Our Day off.

After a late breakfast we went to the buses heading for the church. While driving we found Richard s (one of our theatre helper staff) motor bike on the road with him standing with a piece of cloth against his head, full of blood. He had a fall while driving to Church. He sustained a small laceration to the scalp and a deep wound to the left knee that was bleeding profusely. I decided to take him back to the theatre in the compound and Janet offered to come with me. We cleaned his wounds, infiltrated them with Local anaesthetics and prepared our instruments. All the wounds were debrided, edges freshened, foreign bodies removed. The scalp wound was easily closed with sutures. The knee injury was deep reaching the patella. The quadriceps tendon was torn in two. I had to suture the tendon with interrupted number 1 ethilon. Then subcutaneous tissue than skin, with silk. We bandaged the wound for the day and provided antibiotics, pain killers etc.

In the afternoon David took us in a tour around the compound. Not known to us, there were fish farm and an ostrich farm as well. Nice big trees surrounding the farm from its fruits the ladies extract oil that is sent to Body Shops around the UK.

Bernard came to visit us on his way to Takoradi from the North. During the evening meal Chris Oppong arrived as well. We had dinner together. And sat down to chat over a cup of tea, discussed the next morning list before retiring.

Part of the Leighton & Derriford team

Part of the Leighton & Derriford team

Tuesday 10 November 2009

We woke up early and did a ward round, changed the dressings, and prepared the rooms to accommodate today s patients. I went for breakfast and followed the Canadian team to the school in Carpenter. On that day there was a queue of patients with only hernias. I examined and listed 61 hernia patients and examined 16 non hernia patients.

I operated on a patient under local anaesthetic and evacuated two abscesses from her neck and her pubis. A man came back two days after a hydrocoele operation, with melena and fainting attacks, I examined him and found no problem with the scrotal wound. I decided to resuscitate him on the floor in the clinic, with fluids first. Followed by transfer to the compound. He felt much better after the fluid load and proton pump inhibitors he was given. There was some confusion about whether to send him to a nearby hospital or to continue treating him in the compound. I heard that Raj is not feeling well and decided to come back around 3:30 to the compound and theatres. I managed to help with two cases on Brenda s list. Finished at 9:00 o clock pm and went for dinner. Than a shower and sleep.

Wednesday 11th November 2009

I had a whole day list. Started by a large irreducible indirect inguinal hernia under GA that did not have any contents in the thickened hernia sac. But there were a large prolapsed diverticulum of the bladder sliding with the sac that I could not identify. I injured the bladder and corrected the whole with two layers of viryl. I finished the repair and inserted a urinary catheter. The patient did very well. I operated on two children afterwards followed by adults. We finished the day at 8:00 pm, having hit more than 140 patients.

We had a nice dinner together, had a nice chat and were congratulated by the team on the achievement. By that time 146 patients and 186 procedures.

Thursday 12th November 2009

I woke early as usual went and packed two boxes full of sutures and gloves and the remaining medicines. After Breakfast we had a meeting down in the garden, when the old man Kunako Koene came with David to give us a speech, thanking all of us on the care that he had received and giving us praise and praying for us. Brought few more tears down. Jennifer controlled her tears while giving a speech. The Canadian team gave the man a small gift, and we thanked him for his kind words.

I felt tired and left theatre to have a quick siesta. Janet, Craig, Perry, Helen, Sarah and Ali all were in theatre logging numbers of meshes left (95), packing the instruments, theatre furniture and equipment in one room and closing the doors for next year.

We still had to operated on some facial lumps, clean wounds, change dressings and evacuate abscesses. The final count was 191 procedures on 151 patients. The next day we said Good bye and travelled home on a long trip of 11 hours inland drive, six hours overnight flight and one hour internal flight to arrive home 28 hours afterwards on Saturday 14th November 2009. Still much quicker than our Canadians colleagues.

Conclusions: This mission was exceptional, our achievements were as follows
– 191 surgical procedures in 151 patients in 8 ½ days.
– Collection, packing and transportation of 16 bags of medical equipment.
– Listing patients with hernias for next year. (60 pts/day)
– Helping support the Canadian Medical Team. Canadian team supporting us with medications, bandages, dressings etc.
– All in all, a Life Changing Experience!

Leighton Team: Mr Magdi Hanafy (Surgeon), Dr Perry Board ( Anaesthetist), Dr John Kerslake (General Practitioner), Dr Helen Simpson (Trainee surgeon), Sister Virginia Long (Theatre Manager) Sister Janet Burrows (Theatre Sister).

Plymouth Team: Professor Andrew Kingsnorth (Surgeon), Dr Jane Kingsnorth (General Practitioner), Mr Raj Dhumale (Surgeon), Mr Richard Dalton (Surgeon), Mr Craig Brown (Theatre Manager) Sister Dee Richards (Theatre Sister), Miss Sarah Hasted (Volunteer), Sister Alison Stout (Ward Sister), Dr Stephen Lewis ( Consultant Gastro-enterologist).

The Cheshire team, Leighton Hospital, Crewe, UK – Visit to Takoradi, Ghana. 29 NOVEMBER – 10 DECEMBER 2008

Team Members: Magdi Hanafy (Consultant Surgeon), Selvachandran (Consultant Surgeon), Neil Brooks ( Consultant Anaesthetist), Virginia Long ( Theatre Manager), Janet Burrows (Theatre Sister), Emma Reay ( Theatre Nurse and ODA), John Kerslake ( Local GP), Rachel Kerslake ( Writer).

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The first step was to create a team of professionals, willing to give their own time and money for this purpose without pressures from work or families. They should know each other, work as a team, good communicators and aim to achieve common goals. These goals are, to treat as many patients as possible (and teach local doctors and nurses), and return safely back home. (May be visit schools and distribute stationary to children). A welcome addition to our team was our Local General Practitioner John Kerslake and his daughter Rachel Kerslake who works in the Local news agency. We managed to get articles published in local newspapers, and radios. Donations poured from patients, relatives, consultants colleagues, local GPs, practices, Rotary clubs, personal friends..Etc. Further collections achieved by members of the team (mainly Janet Burrows) through raffles, bag packing at supermarkets, duck races, ..Etc. The above team worked hard over six months before the trip. All in all we managed to collect £4,300.00 . We have spent £6,700.00.

The hospital managed to donate almost everything we needed for the operations from redundant equipment, sutures, dressings..etc. (nothing out of date). The hospital paid for all the anaesthetics, antibiotics, analgesics. We had to buy syringes, needles, venflons, and disposable scrubs. (Not a good idea in hot countries). In June 2008 we had a visit from The Presidents and council of the Royal College of Surgeons of England. Mr. B. Ribeiro (who is Ghanaian himself) praised our efforts and suggested to add footballs and sports equipment for the children as well. The hospital paid for our vaccinations, anti-malarial, and anti-retroviral prophylactic medications. They have paid for shipment of 39 boxes to a container in Plymouth heading to Takoradi. All these boxes were there when we arrived. British Airways waived fees for extra 12 luggages. The British High Commission in Accra offered support if needed. Bard supplied us with a box full of meshes (worth £9,000), other companies supplied us with boxes of gloves, gowns, drapes.. Etc.

Communications with Professor Kingsnorth, Chris Oppong, and Brian Dixon, answered all the questions. We planned to travel to Heathrow by a mini bus, and a van, kindly lent by Go Green cars, and driven by one of the team s husband and son (Janet Burrows). We arrived safely and had a nice luggage check in. 29 bags checked in. BA was as usual very efficient. We noticed their strict rules regarding bags number and weight and time. Plane was late taking off (55 minutes). Runway was too busy. Smooth flight, seven hours but plenty of entertainment. Arrived in Ghana, 10:00 pm. Warm weather. I started sweating once we got out of the plane. We cleared the immigration and customs very easily with all the boxes and bags. Pushing two full trolleys, one in each hand, down slope was not easy.

Once outside the airport, we had to deal with ten men appearing from nowhere trying to help. We could not differentiate between them and the two drivers sent to us with their minivan and truck. All cleared and on the way to Takoradi. 11:00 pm. Three hours drive arrived to the villa 02:00. Transferred 29 luggage safely inside, all counted for, luggage and personnel. We were met by Brian Dixon (our man in Ghana).

Brian and the girls (Kate, Lillian & Grace) gave us a warm welcome and explanations about how things are going. We resided in a local government villa with seven rooms, each one with en-suite and a large bed and air-conditioning. Everybody phoned home to reassure their relatives. Each one went to a room, and fell asleep. I could not believe the day passed without any problems. The next day Brian took us to visit a local village. Almost 80% of the children were staring at us with their tummies exposed showing an umbilical hernia. They are really nice full of smiles, surprise and interest. We went to the Turtle beach had a relaxing day and swam in the ocean, dangerous waters with strong currents.

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First day at work.
Woke up early, 5:00 am. Had breakfast and we started to empty boxes and redistribute drugs, stitches, drapes and gowns between two teams as we were going to work in two different hospitals. We saw children going to school passing by our villa, we went out and distributed some stationary. Dr Boateng came at 7:30 and took us to the Hospital. We went up to theatre, were introduced to all theatre staff, then shown around the department. We than began to open our 57 boxes which have arrived (with us and the container), and collected medicine and equipment needed immediately for the cases. We examined the patients, decided the procedures they required, and marked the sites. We were introduced to the Nurse anaesthetist, and we started working. Hernias, recurrent hernias, Hydrocoeles primary and recurrent, varicocoeles. Adult and children, Males and females. Electricity went off four times during one of the procedures, I had to have a torch light directed into the wound, and my reading glasses put on for me, my protective mask removed, to be able to safely continue the operation. A hand torch and headlamps would be handy. After our first day of operating, we all relaxed meeting up at Africa Beach bar for a beer! This is to be our after work meeting place for the rest of the week.

Further days at work
Woke up all together around 7:00 am and had Breakfast, the driver came and took us to the hospitals. Ginny collected some more stuff from the boxes, and off she went with Selva to the other hospital. No more electric failure. All the cases for today were presented to us, previously clerked in and screened for diseases like HpB and HIV, and consented. We only had to mark them and decide which type of anaesthesia we needed. We made sure they had prophylactic oral antibiotics. We continued until 2:00 pm when Selva and Ginny had their share of mega hernias (shown below) but finished early and came over to join us. Selva did our fifth case while I had lunch, met with the hospital Director, and marked my last patient. Each team did one patient until we finished.

We went with Brian to the Africa club for a beer and a swim, then back to the villa for dinner. We had to make arrangements for visiting schools, the next days. The responsibilities lied with Emma and Neil and the Kerslakes, for distribution, taking photos and video shots. We opened the bags, distributed contents in the four cases, hoping to visit four schools at least, one every day. The first school was for deaf children. It became apparent that distributing stuff individually to huge number of children was not a good idea. Also giving a football to a group of young children to play with meant that older kids will take it from them. We preferred to give the donations (Footballs, clothes, school stationary, chalks and board erasers) to the school principal, who will make sure donations will go to those who need them, and create some discipline and order. We went to other schools later on in the week, and followed the above advice.

We met some high ranking Ghanaian officials as well. Brian Dixon, Operations Director for Operation Hernia, has invited us and them to a dinner in a Chinese restaurant. We met Dr Bernard Boateng-Duah and The Honourable Edwin Phillips the Presiding Member of the Municipal Assembly for Takoradi and Sekondi the equivalent to the Leader of a local authority and extremely well respected in the area. They warmly thanked us and Brian and Operation Hernia . We responded by praising their hospitality and kindness.

Over five days of work we managed to perform 74 procedures, a respectable number, we are proud of, but it left us and the Takoradi team completely exhausted. Things that we take for granted like electricity and running water were not routine commodities there, we had to scrub by asking somebody to pour water from a bucket onto our hands. Without the air conditioning in theatre we could not have achieved half the above numbers. The diathermy kept disconnecting because the plate has been used on many patients beforehand and was not sticking and connecting properly. The diathermy stick was disinfected in fluid and would not work unless dry.

Further advice published on the site and written by Brian Dixon are first hand, important and worth considering. Unfortunately Brian Dixon is due to retire by the end of 2008. We were the last team he took care of and he did this job perfectly well. I am sure the local teams will do an impeccable job, but replacing Brian s position will be a hard act to follow. I hope the girls (Kate, Lillian & Grace) will continue serving the coming teams as well as they did with us.

Conclusion
Back safely we think we have achieved these goals:
1. Getting Leighton Hospital involved within the community of the European Hernia Society for its charitable Operation Hernia exercise.
2. Creating a successful team willing to give their time and money for this cause.
3. Collecting funds securely and professionally.
4. Getting as much advertisement as possible to help collecting the funds and to improve our hospital profile in the community.
5. Collecting and transporting as much as we can from donations, etc. that is not needed anymore by our hospitals, but is essential for our purpose.
6. Providing all possible protection to our team from vaccination and prophylactic medication.
7. Creating a charitable, happy atmosphere within the team and colleagues in the hospital.
8. Reducing expenditure to as little as possible. (Ex. Airline tickets, transports. etc..)
9. Achieving contacts to ease passing through customs in Ghana.
10. Safe arrival of all medical and school equipment (61 boxes and bags) to their intended destination. (Takoradi Hospital)
11. Achieving a respectable number of procedures (74) by two surgical teams and an anaesthetic team in five days, without immediate complications.
12. Leaving a good impression within the local and international Operation Hernia team .
13. Arriving back home safely, without accidents, incidents, or illnesses. Only extremely tired.

Thank you
On behalf of the Ghana Team
Magdi Hanafy