Report by Zoe Sun

This was my first time Africa and first time with the mission, led by mission veterans Mr Shina Fawole (Team Leader and Consultant Surgeon) and Melanie Precious (Advanced ODP and Surgery Team Leader), along with my fellow colleagues Miss Rupa Sarkar (Consultant Surgeon), Rajiv Dave (Registrar) and Claire Casey (ODP). The mission was in June, the rainy season, rather than its usual time in November. We carried with us medical supplies for the duration of the mission including medications, local anaesthetic, mesh, syringes, needles, sutures, gloves, gowns and hats. With all these, we met at the airport ready for our mission led by our team leaders.

We arrived in Accra, Ghana on the evening of 6th June and stayed overnight in Accra. The next day, the taxi driver took us on a 4 hour journey to Takoradi. We stayed in a house owned by the local government and used specifically for teams on the mission. Lillian and her team of helpers stayed with us and looked after us during the mission. They did all the hosting, cooking and general maintenance. We visited one of the hospital sites in Dixcove and greeted the local team of nurses and doctors. Next to Dixcove was a tranquil, unspoilt beach where we shared a few drinks and a group photo and Mr Fawole taught us the suture-sparing mesh repair technique for hernias! The same night, Dr Bernard Boateng, Medical Director of GPHA (Ghana Port and Health Authority) Hospital, greeted us at the house. He and his team had assessed the patients locally and planned their operations and their respective hospital sites for their operations. We decided on the order of week and how to split the team along with Dr Boateng.

Monday was the start of the testing week. We based ourselves in two hospitals in Takoradi, Takradi Hernia Centre and GPHA into teams of three. Introduced to the local friendly and very outspoken team of nurses and ODPs, we started on our operations. The caseload consisted of primary and recurrent inguinal hernias, hydroceles, umbilical hernias and children with groin hernias. On average, there would be 8-10 cases per day. Most hernias were operated on under a local anaesthetic; recurrent and larger hernias had spinal anaesthesia, which the local anaesthetic nurses specialised in.

The challenge initially was with the size of the hernias and their chronicity. The rule was not to open the hernia sac if possible, but only Miss Sarkar stuck by this rule, we later found. After the first day, we divided ourselves in teams of two for each of the three sites, with those at Dixcove travelling an extra 2 hours return journey on a daily basis. We were faced with additional challenges, with power cuts and during a longer power cut, we learnt to operate under a torch light. We were also faced with shortage of running water, for which we were provided with water from a tank for scrubbing. At Dixcove, the same theatre was shared between elective and acute cases. Whilst we were carrying out our operation on children, two emergency Caesarean sections came through back to back. The operating tables adjacent to each other, we would be placed in the in stifling conditions when our local colleagues performed the emergency Caesarean sections.

The children were extremely compliant as were the adult patients. The nurses were outgoing and outspoken. Lilian and her helpers were extremely responsive to our needs back at the house. The people in general were very friendly and helpful. One young man, a patient, thanked us profusely as he could now find a wife now that he no longer has a deformity (his hernia). On the last day, we ended the day, altogether at the Hernia Centre with Dr Boateng, and had a group photograph to mark our time there. Many of the staff, were desperate for our return on following missions and explained how much they enjoyed our times together. We were greeted later in the house by politicians who were grateful for our work and wanted to improve the host’s programme for later groups and to include organised sight-seeing. We thanked Lillian and her team for their hospitality before embarking on a return journey to Accra the following day.

I was extremely grateful for this experience, learning not just about operating, but about people and cultures. I learnt that some aspects were not a good mix for my team members…Mel and cockroaches, Mr Fawole and Raj sharing a room, Miss Sarkar and ‘vegetable free’ foods, Claire and any Ghanaian foods. However, the team was fantastic, the experience invaluable. I have learnt a lot about myself, others and the skills I will carry forward in my future training and life thanks to Operation Hernia and my team leaders.

Zoe Sun

November 2013
Mission to Takoradi

The team arrived in Accra on the evening of Saturday 2nd November 2013. As a registrar in General Surgery this was my first trip with Operation Hernia, but I was travelling with experienced Operation Hernia member Melanie Precious and fellow first-timer Nicola Perrin, both Operating Department Practitioners, along with a large supply of surgical and anaesthetic equipment. The rest of our group comprised of Chris Macklin (Consultant Surgeon), Jurij Gorjanc (Consultant Surgeon from Austria and President of the Slovenian Hernia Society), Khaled Ismail (Consultant Anaesthetist), Beverley Parker (Registrar in Anaesthesia), Rafay Siddiqui (Registrar in General Surgery), and our team leader Shina Fawole (Consultant Surgeon), on his seventh Operation Hernia mission to Takoradi.

After a late-night dinner and an initiation to the unconventional practices of Ghanaian taxi drivers (including rolling backwards down the hill to start the engine, and opening the passenger side door to get the radio to work!), we spent our first night in the comforts of the Baptist Guest House. After a minor drama with an early-morning altercation between Melanie and a cockroach (“don’t you dare come any closer to me…!!) we set off on the three and a half hour minibus journey to Takoradi. We received a very warm welcome from our host Lillian and her helpers at the villa in Takoradi, and they even arranged a solar eclipse to mark our arrival! After unpacking our medical supplies we spent a relaxing and enjoyable afternoon at the Busua Beach Resort. In the evening we were visited by Dr Bernard Boateng, Chief Medical Officer of the Ghana Ports and Harbour Authority (GPHA) Hospital, and the plan for the week was set out.

On Monday morning the hard work really began. Each day a team of between two and four of us travelled to Dixcove Hospital, GPHA Hospital and the Takoradi Hernia Centre. The patients had been assessed and selected by Dr Boateng beforehand, and after a brief ward round to review all of the patients for the day, and decide on the most appropriate anaesthesia, the list started. We were warmly welcomed at all three hospitals, and worked alongside the local theatre teams and nurse anaesthetists, who were particularly skilled at spinal anaesthesia. Between the teams we operated on 105 hernias and 7 hydroceles in 107 patients, including 19 paediatric patients and 6 patients with recurrent hernias. Fifty-seven patients were operated on under spinal anaesthesia, 24 had a local anaesthetic and 26 had a general anaesthetic.

The days were long and intensive, but it was undoubtedly worth all the hard work to be able to achieve so much in just 5 days of operating. The impact that we were having on the patients was clearly apparent; I particularly remember one elderly gentleman who had travelled for nearly twelve hours to have his hernia repaired. The children were amazingly brave and compliant, not a word of objection or a tear from even the youngest ones. On one of the days at Dixcove Hospital, a local surgeon attended our list, and we were able to show him how we use the hernia meshes to reduce the recurrence rate for inguinal hernias. As a team we were fortunate enough to have both a Consultant Anaesthetist and a very skilled Anaesthetic Registrar with us, and as well as enabling us to operate on more children by means of general anaesthesia, it was also clear that the local nurse anaesthetists benefited from the training and advice they provided. Likewise, our experienced Operating Department Practitioners, Melanie and Nicola, were able to work alongside, and pass on their expertise to, the local theatre staff.

But it was not just the patients and the local theatre staff who benefited from our mission. All of the Operation Hernia team members gained invaluable experiences from the trip, which provided us with insights into our own practices in the UK and an appreciation of our own privileged situations, as well as improving our ability to adapt to challenging situations and make the best possible use of the minimal resources available. We are all especially proud of Melanie, for mastering the art of the scrotal bandage, after what was, it has to be admitted, a rocky start! As a group we are very thankful to Shina for his guidance, support and unwavering encouragement, unperturbed by any obstacle, apart from those baby lizards! Despite problems with an intermittent water supply, Lillian and her team ensured that we were comfortable, well fed and well looked after for the whole week, and we all appreciate her efforts.

From a personal perspective I feel very privileged to have been given the opportunity to be a part of such a fantastic, life-changing organisation. I am grateful to the other members of the team who were all wonderful colleagues and companions, and who provided much friendship, support and laughter. As a trainee surgeon I am particularly grateful to Chris, Shina and Jurij, whose patience and skill in training enabled me to operate on more challenging hernias than I have ever encountered before. I hope that I will continue to be involved in future missions with Operation Hernia.

Hannah Welbourn, ST8 General Surgery