Land of the Blue Sky

Fourth Year for Operation Hernia in Mongolia September 2013

Land of the Blue Sky

Land of the Blue Sky

Mongolia 8-20 September, International Team

Country

Mongolia is a country on the central part of Asian plateau situated between China and Russia. In Europe Mongolia is known as a low-income country, where the healthcare system has poor infrastructure and old equipment – in my opinion it is not truth in 100%. Mongolian people are also known as a very proud and brave nation – and this is absolutely true. The best chance to see all wonders of The Land of Blue Sky is to travel by car (better to take 4×4). What a traveller can see, meet and taste are beautiful and breathtaking landscapes, hospitable herdsmen who own totally 40 million horses, goats and sheep (the goats and sheep were very important for the team). The taste of a mutton stew, horse meat, tea with goat’s milk and especially khoomis is something what cannot be forgotten. Let’s say something about Operation Hernia in Mongolia – because it was the main goal of this trip for all of us.

Team

It was a pleasure to work with this truly International Team comprising Andrew Kingsnorth (UK); Maciej Śmietański Poland), Kamil Bury (Poland), Teresa Butron (Spain), Giorgio Giorgobiani (Georgia) and Martin Kriz (Sweden). We received huge support from every surgeon that we met on our route but especially we are grateful to Dr. Naraa and Dr. Sanchın and Enkhee

A herdsboy

A herdsboy

Performance at the National Theatre

Performance at the National Theatre

Journey

We landed at the airport of Chinggis Khan – Ulan Baatar (UB) on Sunday morning – as it turned out we all flew from Moscow on the same flight so there was no problem with the gathering. After breakfast we set off on a journey through the wilderness of Mongolia.

During the two-day trip we drove nearly 400km, we spent one night in the middle of nowhere and during the same night we took part in a Mongolian wedding. A lot of drinks and strange meals – but it was a marvellous experience. On the way back to UB at the special invitation of one of the surgeons we were able to take part in a horse race – a lasting impression and experience that we will never forget. After returning to UB we were divided into two teams. The team I was operating at the University Hospital and the other at the prison hospital. Operations performed at prison hospital resulted in three interviews for Mongolian TV and an invitation to dinner by the Head of the prison hospital. During our stay in UB, thanks to the hospitality Dr Naraa, we admired a fabulous performance in the National Theatre. The performance presented the culture and history of Mongolia in a magnificent way.

Teaching

Teaching

Operation Hernia

We operated on 78 cases, which included 20 children, 16 prisoners and 4 reconstructions including Ramirez and one cholecystectomy. We had a mixture of incisional and inguinal cases. The operating lists were tightly-organized but thanks to very good organization of work in the operating theatres we had no problems with performing all procedures. So we were able to do cases ourselves or assist and teach the Mongolians surgeons as appropriate. Andrew, Teresa and Martin gave lectures to the local surgeons. In the opinion of Mongolian surgeons the topics were well chosen and the knowledge gained will be very helpful in normal everyday work.

In a nutshell– the work was the same as on every Operation Hernia mission – early start in the morning for a post-operative ward round, followed by assessing into the new cases, then operating all day long and in the evening… night life in UB.

The great success of that mission was mainly possible because of the distinguished capacity for teamwork of every participant. All team-members expressed their wish to participate on the next humanitarian mission under the auspices of Operation Hernia.

We will be back…

For Operation Hernia from Ulaan Baatar

Kamil Bury

Trainers and Ukrainian surgeons

Between 13 and 19 May 2012 surgeons from The Department of General and Vascular Surgery at Ceynowa Hospital in Wejherowo, Poland took part in a humanitarian mission and travelled to Mikulov in Ukraine to teach modern techniques of Hernia Surgery. The Polish team was represented by Maciej Śmietański, Andrzeej Lehmann and Grzegorz Zając (responsible for the mission logistics). Due to the poor economic conditions in Ukraine and lack of adequate universal healthcare systems (procedures are not reimbursed, patient are required to pay all procedural costs directly to the hospital; including meshes, sutures etc.) we concentrated our activities on teaching. The possibilities of learning and observing advanced techniques in Ukraine is not widely available, and the supply of prosthetic meshes and laparoscopic equipment is very limited.

Our hosts decided not only to provide the opportunity operate on their patients, but also to open this activity to the community of surgeons using a live transmission and also preparing a lecture room for surgeons to attend and take part in discussions. Preparation of this event (as we have mentioned) was difficult, but ultimately extraordinarily excellent. The team from the hospital in Mikulov have done a perfect job preparing the facility and eventually to be ready for 20 operations in two days. Over 120 surgeons from Ukraine, Georgia and Moldova attended the workshop. We also had the pleasure of having the expert assistance of Professor Yaroslav Feleshtinsky (from Kiev) and Professor Tamaz Gvetenadze (from Tbilisi, Georgia) in conducting the lectures and working in operating theatre.

It must be mentioned that the mission was possible due to extraordinary activity of Dr Orest Lerchuk from Lviv and the local J&J representative Roman Salamakcha – our close friends. We know that the partnership and cooperation will be continue in the future. As a result of the mission we have established a grant to host two Ukrainian surgeons a year in Poland for one month of training. (funded by donations from the surgeons working in our hospital).

We look forward for future activities .

Maciej Smietanski

Cote D’Ivoire 6-13 FEBRUARY 2009

Following some logistical problems with visa application Maciej Smietanski and I arrived to a VIP welcome at the Felix Houphouet-Boigny airport on a humid afternoon with grey tropical rainclouds circling the Ebrie lagoon. To an Anglophone the capital city Abidjan is a big surpise. It has a population of 3.5 million and it is the second largest French speaking city in the world. It is also a cultural hub for a multiethnic population and has a large French community. Although the recent civil war has impacted seriously on economic activity, the business district stands out from all sectors of the city with its gleaming skyscrapers, boutiques and outdoor cafes.

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We were provided with a car and chauffeur and hotel accommodation paid for and organised by the protocol of the First Lady. Hotel Ivoire was positioned on the edge of the Ebrie lagoon overlooking several converging peninsulas and islands connected by bridges. Here we enjoyed African style comfort in readiness for the hard work ahead.

The Unite Chirurgicale Yopougon-Attie (UCYA) Hospital was situated approximately 30 minutes drive from the hotel and we travelled there to meet Dr Max Thalmus Director of the Hospital. After a tour of the clinic we attended to preoperative assessment of our first 13 challenging inguino-scrotal hernias. The conditions were basic but softened by the presence of air-conditioning. Cleanliness and surgical protocol were perfect and we worked with a cohesive team of Nurses and anaesthetists who provided many spinal anaesthetists for the patients with larger hernias. Our French was a little rough but our surgical vocabulary increased remarkably during the week. Our schedule included three infant hernias, two incisional hernias and one orchidectomy, for a total of 52 patients with 57 hernias. There were no immediate postoperative complications.

We enjoyed immense hospitality including two late night dinners by the lagoon watching fisherman cast their nets into the murky waters ready for the next days table. Desire Trazo, an old friend from Takoradi and an Ivorian citizen dined us out at a Lebanese restaurant and Jean-Didier Guigrey, the instigator of this mission who is the CEO of EOG Healthcare Limited entertained us at his relatives house in the old Colonial Capital of Bingerville with a traditional repaste. We visited some of the architectural wonders of this exotic city including the dramatic St Paul s Cathedral designed by Aldo Spiritom and the Business district.

The highlight however was a meeting with the First Lady coordinated by Jean-Didier and Dr Eugene Djedje, technical advisor to the First Lady. At this meeting the First Lady confirmed that she would give continuing support to all Operation Hernia missions in Abidjan.

It is hoped that in 2009 two to three further teams will attend. I am asking for French-speaking volunteers.

Andrew Kingsnorth
February 2009

23 FEBRUARY – 8 MARCH 2008
Only two surgeons (Maciej Śmietański and resident Kamil Bury) can enjoy the mission according to difficulties in financial support offered by local medical companies in Poland. Finally we would like to thank Covidien Poland, Gore and J&J for the meshes and sutures, Hartmann for surgical drapes and gloves and the authority of the Medical University of Gdansk Hospital (Marek Labon). All other expenses (flights, accommodation, fuel) were paid by us.

In 9 days of work in the hospital we have done 67 procedures in 58 patients. Not only inguinal hernias were treated, also umbilical and middle line hernias and hydrocoele cases were present in the treated group. We found the hospital facility convenient for hernia surgery, in fact very similar to conditions in Poland some 10- 15 years ago. Also to work with not full equipped operation room was nothing new for us, so it was not making any difficulties in our activity. All the people we met were very friendly and helpful, offering a lot of time and heart to the patients and us.
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We had the possibility to check the patients one week after the surgery. In this short follow-up only one haematoma occurred in the patient operated for bilateral scrotal hernia. This patient needed conservative treatment and we advised him to come back to the hospital during the next two weeks for a control visit.

According to the local culture many patients promised to pray for us for many days, so I believe that never in my life did so many people pray for me at one time. Also one of the patients, the judge from the court in the town of Axim invited us for a trip and meal. It happened that he organized the trip to the historic places connected with first president of Ghana Kwame Nkrumah (his home, his mother s home, the river next to the house) and finished with meeting with all his living relatives dressed in traditional clothing. To express our pleasure a post card originally signed by first Polish president Lech Walesa will be sent to these people.

Enormous help was also offered for us from Brian Dixon and Bernard Boateng-Duah. Without this help the whole mission would have been impossible.

During our stay I meet also the Executive Director of the Teaching Hospital in Kumasi (one of two Medical Universities in Ghana) speaking about the problems of introducing mesh repairs in Ghana. The lecture about standards of groin hernia repair in Europe and USA was given during the meeting of the local doctors association. I had to answer a lot of questions and had to explain all the mesh methods to the audience.

What we advise to all the following participants of the hernia project is to stay in the country for a few days extra to enjoy the seaside and make some trips to other towns. We spent 5 days visiting Kumasi, the water village of Nzalazu, Tarkwa gold mine and dancing with a village party on the Saturday night (live drum music and gospel singers). Missing the direct contact (and local gin) will be a mistake on the way to meet and understand the people of Ghana.

Our participation in next year’s mission is decided.

Maciej Śmietański