Operation Hernia Team in Ho

Operation Hernia Mission to Ho, Ghana – October 2016

Operation Hernia thanks the clinical and administrative staff at the Volta Regional Hospital in Ho, Ghana for an excellent week of hernia surgery this year. We also thank Mr Chances who graciously hosts us at his beautiful hotel.

Operation Hernia Team in Ho

Operation Hernia Team in Ho

Operation Hernia first travelled to Ho in 2011. Volunteers have returned every year since. This year’s team included Miriam Adebibe, Naami McAddy, David Defriend, Odd Mjaland and Kelly Shine. Each one of us has been on at least one prior trip to Ho. This is proof that Ho has a way of calling us back!

Surgical team working in the operating theatre

Surgical team working in the operating theatre

As a volunteer I find these trips restorative. We help patients every day at home. However the pace and the administrative frustrations can lead to burnout. Overseas, the privilege of helping others is so obvious. Despite a busy day, there is time to reflect on the joy of meaningful work. In the evenings all seriousness gives way to laughter, storytelling and dance!

If you are a surgeon, an anesthesiologist or a medical student reading this and contemplating your first international volunteer experience, I encourage you to reach out to Operation Hernia. Come and join us!

Kelly Shine

Missions

REPORT FROM HO MISSION NOVEMBER 14-21, 2015

This was the third Operation Hernia mission to Ho Hospital. The first mission was in 2012.

The team comprised the following members:

Coordinator: Miriam Adedibe Surgical Registrar;

Consultant Surgeons: David deFriend, Prof Guido Schuermann, Prof Odd Mjaland,

Surgical Registrars: Naami MCaddy and Sebastian Galler

Travel to Ho

Following arrival in Accra the team stayed overnight at the Baptist Guest House in Accra on November 14. All team members met with Chris Oppong for a briefing. The team travelled to Ho hospital the following day. They were met by Dr Geoff Nyamuameh, senior surgeon who took the team on tour of the hospital.

Accommodation and food

We enjoyed very good accommodation. We were hosted at Chances Hotel. This was specially arranged by Dr Ben Gbeve, a retired Plymouth Orthopaedic Surgeon whose nephew owns the hotel.

Theatre Sessions

We occupied three theatres for 4.5 days. One consultant and one junior were assigned to each – this allowed for maximum teaching. The 4th theatre was left for Ho Hospital to fulfil their emergency commitments.

It could not have been used as an extra theatre because it was impractical for us to do so due to:

1) A paucity of simple cases

2) Equipment/sterilised packs – Sister Lucy was struggling to equip the three theatres already running

3) Low staffing – again, Sister Lucy and the nursing staff pulled together and worked beyond their usual hours to complete this mission.

Outcomes

The total number of procedures performed was 80 and there were no early complications.

Post-operative patient reviews on the ward were performed by one of the visiting team when time allowed, otherwise the home team managed the patients.

Home Visit

As a first by the Operation Hernia team, 3 patients were visited over Friday afternoon and Saturday morning at their homes. The patients were happy to see the team and it was a wonderful opportunity for Operation Hernia to see the patients in their home environments.

This excellent idea had been suggested by Prof Guido Schuermann.

Debrief

1. Safety issues highlighted by team members included: sharps handling (scalpels should be handed over in a dish), swab count (not rigorously performed for each operation)

2. Worn-out needle holders

3. Diathermy: worn out accessories

This first section of the report was coordinated by Miriam Adedibe. Individual Team Members have provided their own additional comments and these are detailed below:

1. Prof Guido Schuermann

The Ho mission was a great success. The team was just perfect and it was very helpful that Naami and Miriam were with us. The hospital was well equipped and we could run three operating theatres for the whole week. We did more than 80 cases – most of them with huge hernias – without any major complication perioperatively.

The staff were excellent, highly motivated and very well trained. The hotel was the best I have ever seen in Ghana, all making it a very enjoyable and successful mission.

I thank the whole team for taking Sebastian and myself, for the friendly atmosphere and for the collegial and friendly exchange of ideas. It was just a great week!!

2. Miriam Adedibe

I fully echo Guido’s sentiment. The mission was a success in every way.

We completed the list of hernia repairs, totalling 81 cases, and most of these were relatively complex H3 cases. Many thanks for supporting me as the administrator/team leader. It was an unexpected opportunity from which I learned much. The team worked well together and were very helpful with suggestions on how to increase our efficiency in theatre. A special thanks to David (whose seniority and expertise was invaluable in many situations) and Naami (my co-pilot).

3. David deFriend

I can only say what a privilege it was to be part of such a great team and to have the chance to work with wonderful local staff and patients. Thanks to Miriam and Naami for organising us so well and for the report. I can’t think of anything to add except to say that I very much intend to go on another mission and would be honoured to work with all or any of you again. It went by so quickly that it almost feels like I never went away now that I’m back to the day job!

Chris, thanks again for the opportunity and it was great to see you.

4. Odd Mjaland

I am filled with great memories of a fun an interesting mission and happy to have made such nice friendships at my mature!!!! age. I felt young and revitalized when getting back to the frozen lakes and minus 7 in Norway. The cases were challenging but as I see it, the quality of our work could not have been much better. Working close with Naami was inspiring, the trailblazing energy of Miriam gave the group an energy boost that lasted long beyond the flight back home. I shall be back!! Miriam’s report covers our mission well and I would echo the comments about the problems with worn-out needle holders and diathermy equipment, areas for potential improvement.

Report of Operation Hernia’s Mission to Ho Volta Regional Hospital
November 2013

The Stats!

Location

Volta Regional Hospital in Ho, located in the Volta Region to the west of Ghana
Approximately 3 hours drive from the capital city, Accra

Personnel

From the UK: 3 consultant surgeons, 2 surgical registrars, one scrub nurse
Charge nurse Sister Josephine, who managed everything!
More than 10 theatre staff who rotated between recovery and theatre
Experienced anaesthetic nurses who could give spinals faster than we could scrub!

Patients

98 patients were recruited, 97 patients operated

Facilities

Initially three theatres, with the fourth emergency theatre being made available to us on the final 2 days.

Fixed operating lights and mobile lights
Sutures, gloves, instruments and mesh were brought by the team
2 diathermy machines present from previous trips, we brought a third
Unfortunately no air conditioning was available due to maintenance

Hospitality

We received 5-star treatment from hospital administration and theatre staff
Food and water between cases
Constant care and attention to our every need!

The Story

We congregate at the Baptist Guest house prior to departing to Ho. We meet Mr Oppong who has already arrived early, full of energy and knows everyone’s name. We all feel instantly special. We meet Bernard our hospital representative, who has already been coordinating things behind the scenes. A quick breakfast is followed by us loading up into our respective vehicles and the journey to Ho begins. It a beautiful 2.5hr trip, but one full of contrasts. The beautiful lush landscapes give way all too frequently to little townships, were the even from our vehicle we can see the poverty that so many live in. Grand buildings are side by side with mud huts, small mansions next to tin shacks. Our driver is enthusiastic, and often has to be reminded that we are not thrill seekers. The road is in relatively good condition with the usual perils of overloaded motorcycles, formula one-esque taxi drivers and the ubiquitous tro-tro (public minibus).

Our prayers are answered and we arrive safely at our accommodation. Our residence can only be described as beautiful. To say more would be to tempt you to join the mission for all the wrong reasons!

After a brief lunch we visited the Volta Regional Hospital. We meet the director of surgery, his administrator, head of finance and a senior surgical resident. We are welcomed into a conference room as if we were visiting dignitaries! After introductions and a heartfelt welcome it is time to see the rest of the hospital and staff. It’s a relatively new building, we are told as we walk around. All the buildings are bungalow style sprawling as far as eye can see. Fortunately the walks between the buildings are shaded. The first thing commented on however by our senior visiting surgeon was the ample parking available. I think this alone made his day!

On to the ward to see the patients preoperatively. They have been selected over a period of months, and are eagerly awaiting our arrival. As we enter the ward they have been patiently waiting for us and applaud spontaneously. After a warm welcome by the ward sister, complete with crushing hugs, we begin to see the patients. All the patients are admitted the night before surgery. We reviewed 21 patients, there was only one DNA. What impressed all of us was how organised the nursing and medical teams had been. From blood results to simple clinical notes, everything was in place, and we were able to review and assess all the patients in just over an hour. An impossible feat in the UK! We returned back to our accommodation in the evening, arms full of food that had also been gifted to us.

The week is made up of grueling 15 hours shift days where we operate, ward round, clinics and data collect tirelessly, whilst supported by the brilliant hospital staff, who do overtime to allow us to finish the cases. Our fatigue is quickly forgotten when we see the gratitude of the patients when their operation is completed. Most have travelled many miles to arrive, and wait patiently for their turn with no complaints.

We were pleased to finish all operations successfully on Friday with no complications. We were rewarded with our first social night out where we went for dinner and drinks, dressed in traditional wear that had been gifted to us by the Hospital staff. We left the following day, all of us promising to return the following year!

Special Thanks

To all the theatre staff at Volta Regional Hospital, Bernard, and Mr Chris Oppong.

Miriam Adedibe

Naami McAddy