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.

Mission to Nalerigu Baptist Medical Centre
October 2013

Ghana was a very beautiful country. The people were very welcoming, we really felt like at home. The capital Accra is a big nice city. Almost all of the people speak English.

The surgical team comprised two consultant surgeons (Prof Guido Schuermann, Germany and Mr Chris Oppong –Lead, UK), two registrars (Ahmed Elmeghrawi, Germany and Miriam Adedibe, UK) and a nurse Kristina Horvath from Switzerland. Prof Guido was accompanied by his wife. Dr Zainab Alhassan, a surgical trainee from Komfo Anokye Teaching Hospital, in Kumasi Ghana, was sponsored under a new Operation Hernia Ghana Fellowship scheme to join the team for training.

Travel:

Most of us travelled on Portugal Airlines PTA and stopped over in Lisbon before connecting to Accra, Capital of Ghana. Mr. Chris Oppong and Miriam had arrived few days earlier.

We were met at the airport by Mr. Oppong and stayed overnight at the Baptist Guest House. The next morning we flew to Tamale in Northern Ghana and from there went by hospital 4-wheel drive to Nalerigu a journey of a couple of hours. Most roads were mostly tarred but one had a bumpy segment that was not tarred.

Hospitality:

We were warmly welcomed by the Manager of the Guest House in Accra. The accommodation was basic but comfortable. All our needs were met.

In Nalerigu Baptist Medical Centre we were housed on the hospital grounds in comfortable houses set in a picturesque setting of trees. The houses were well furnished. It was a pleasant surprise. The food was delicious, available at three times daily, breakfast (serve yourself), lunch & dinner.
Theatre staff:

There were at least 4 trained nurses and 2 auxiliaries. We had 2-3 anesthetists each day. They offered a good service. All the staff were competent. The anesthetists were skilled in spinal anaesthesia and were committed to quality patient care. The staff were very cooperative and helpful. The intensity of work we asked for was demanding, but they tried to cope. Most of our days ended after 4 pm. Perhaps the scene was set for such cooperation by an engaging speech made by Mr Chris Oppong and Prof Guido when we met the all theatre staff at the beginning of the mission.

Facilities:

2 theatres, one minor surgery room, one changing room, the sister’s office, a stock room, a sterilization room with one autoclave. One of the theatres was very large and was split into two theatres when required, e.g. when they had a Caesarean section. Each theatre had the following facilities:

Theatre table: old but functioning.
Anaesthesia machine: we didn’t use it, because of lack of oxygen cylinder.
Monitor: which was modern.
Ceiling theatre lamp: in only one theatre.
Standing lamps which had poor focus.
Air conditioner worked in both theatres.
Diathermy machine: in both theatres.
Surgical instruments & supplies: were adequately provided.

All theatre gowns, surgical drapes and gloves were provided by the hospital.

Outcome:

We operated on 44 patients and performed 46 procedures. This is a credit to the theatre staff for being willing to work hard to ensure that no patients were cancelled because of theatre time. All hernias were graded using Kingsnorth Grading and all operations were entered into Operation Hernia Database.

All hernia repairs were performed with affordable mesh, and all patients received perioperative antibiotic-prophylaxis (one single shot at induction), then regularly for 5-7 days. Most of the operations were done under spinal anaesthesia (apart from two inguinal hernias in which the repair was done under local anaesthesia).

Training:

For the first time Operation Hernia sponsored a local surgical trainee on a new scheme called the Operation Hernia Ghana Fellowship. The purpose of the scheme is to fund Ghanaian doctors to join Operation Hernia missions to gain more experience in Mesh Repair. The scheme was pump primed by a generous donation from Prof Guido Schuermann and was very successful. Operation Hernia is grateful to Prof Schuermann.

Social:

We could find time to visit Tamale’s famous traditional market, we all bought worthy beautiful gifts, souvenirs, etc.

On the last day in capital Accra some visited the national museum, where we were informed about the dark history of slavery in Africa.

We spent some time on the Atlantic Ocean beach, where we experienced riding horses. We also tried out some of the delicious dishes e.g. chili Fufu in one of the Ghanaian restaurants

Achievements:

44 operations performed in 5 working days.
Mesh-repair of hernias (more effective treatment) under antibiotics cover.
Training one local surgeon in mesh-repair.

Thanks

We would like to thank Dr Lisa Morhman the American surgeon, who delayed her departure to the US in order to supervise the mission. Our thanks also go to Mr Edward Addai, the hospital administrator for his hospitality.

The great success was mainly possible because of the incredible teamwork. Every team member participated fully in all the activities. There was an early start in the morning for post-operative ward rounds, followed by assessing the new cases and then operating all day long and into the evening.

We will be back………….

For operation hernia Nalerigu 2013

Dr.Ahmed Elmeghrawi.