The Opening

Operation Hernia Team Inaugurates Hernia Centre in Eruwa, Nigeria December 2012

The Opening

The Opening

We arrived at Eruwa on Saturday 1st December. There were seven members from Madrid hospitals (anaesthetists: Francisco Duran and Miguel Lopez Vizcayno, surgeons: JA Pascual Montero, Teresa Butrón, Patricia Maldonado (resident), internist: Iñigo Espert, nurse: Ana belen Abenoja) who were joined by an additional member from the UK the following day.

The site was the Awojobi Clinic, which started at grassroots level in the 1980’s and has been steadily growing ever since. The clinic was set up to serve the local rural population but the level of care has reached a standard that attracts patients from as far away as Lagos, a 3-4 hour journey by road.

Surgeons & Supporters

Surgeons & Supporters

At work

At work

Work started on the Sunday and continued during daylight hours for five days. The patients would arrive from 8am and the 8 team members formed two surgical teams. Surgery was performed in the purpose built ‘Hernia Centre’ which was opened during the visit. The operations were performed under spinal anaesthesia and operations were predominantly Lichtenstein repairs using locally sterilised mosquito mesh. Workload varied each day depending on the numbers of patients who presented.

There was strong training ethos to the mission. Dr Awojobi has a total of five registrars who initially watched and later performed Lichtenstein repairs under direct Consultant supervision. The hernia centre will remain open after the end of the mission with the registrars operating independently.

Registrars attending for instruction in Hernia surgery

Registrars attending for instruction in Hernia surgery

On a couple of the afternoons we had finished the operating before nightfall and had the opportunity to visit other departments in the clinic. The emphasis is on delivering the highest possible level of health care using available resources. The results are impressive, with most of the departments present that one would expect in a far larger hospital. We also had the opportunity to observe some of the differences in presentation and treatment between European and Nigerian patients. One evening team members assisted local staff with completion of a traumatic amputation in a teenage boy.

The people of Eruwa and were welcoming and friendly and we made a lot of new friends. Over the week we performed at total of 44 operations on 38 patients. They were predominantly inguinal hernia repairs, but we also repaired two femoral hernias, one epigastric hernia, explored one groin for lymphadenopathy and removed a large lipoma without immediate complication. We left Eruwa not only satisfied with the procedures which we had performed but also enthusiastic that the training element of the mission will add to the ‘hernia centre’ and lead to ongoing benefit to the local population once we have returned to our home countries.

Chris Grocock

Surgical Registrar

Spanish Team

Spanish Team Group 3, Eruwa, Nigeria 21-28 NOVEMBER 2009

This is the first Spanish Group to come to Nigeria. In spite of only a month´s notice, the preparations for the trip came along very well.

Spanish Team

Spanish Team

Within four weeks of knowing about the trip, the team of six (Teresa Butrón, Raquel Delestal, J.A. Pascual from 12 de Octubre University Hospital, Aleidis Caro, Carles Olona from Joan XXIII University Hospital Tarragona, Áurea Tartas from Getafe University Hospital Madrid) was assembled with financial aide and the necessary equipment. We want to thank Caja Madrid, the branch in 12 Octubre Hospital, Obra Social Caja Madrid, Ethicon, Smith and Nephew and Viajes Atlanta. We also want to thank the people in our hospitals, and Ethicon for collecting and handing over to us a good amount of materials.

The first time our team met was at the Madrid airport, hours before leaving. We brought 17 large bags of sanitary equipment. It took us a long time to wrap all of the materials in plastic wrap, and marked everything with red crosses. We want to thank Mano a Mano NGO for letting us each check one bag extra per person.

After a long flight, we arrived at the Lagos airport. Thankfully there were no problems with customs and we met Dr. Awojobi Yombo , who was very surprised to see 17 large bags. When we got outside, we weren´t sure if the bus would fit us, much less our bags, but there was no problem as the minibus was only for us.

The first night of our journey was spent in Lagos. The next morning, we awoke to loud music and singing. It turned out that a local Pentecostal church was having service with dancing and singing. What an experience! After this visit to the church and breakfast, we took a three hour bus ride to Eruwa.

On arrival we took a tour of the clinic we would be working at. When we arrived at the supply room, we found it was empty. Our first task was to stock an entire supply room. Fortunately with 17 large bags of medical material (two bags with toys and stationary for children), the room filled quickly and we had enough supplies. That night we had dinner in Dr. Awojobi´s house, and went back to the hotel to relax. We thought the next day would be a routine day in the operating room. But it was a learning experience that helped us to adapt quickly.

Spanish Team Operating

Spanish Team Operating

 

Spanish Team Operating

Spanish Team Operating

We started operating at sunrise because most of the light filtered through the windows. Our ´surgical light´ was four low-energy lightbulbs in an upside-down kitchen bowl, a felicitous local invention. The patients came to the clinic on foot, sometimes walking for miles to get there. There were two surgical tables in the operation room. From sunrise until well after sunset we operated on patient after patient. Finally, at 9pm, we finished our last operation for the day.

The following days became easier and easier as we adapted, and we began to finish earlier and earlier. From boys to old men, we worked on many different patterns. Some hernias were small, and others were quite large. After the spinal anaesthetic, they would stay for a day in our makeshift ward. We received quite competent help from the young doctors who have come from different places in the country to learn and practice new skills.

In our entire week of working with the patients, we never heard one complain or talk about their discomfort. They thanked us often and were heartily. By the end of the week, we were able to finish the surgeries quickly enough to walk around the community at the end of each day. We visited a school, where we distributed toys, pens and other writing materials. Another day, we visited different installations around the clinic. Dr Awojobi utilizes the local resources to function as autoclaves, a manual hematocrit centrifuge, patient trolleys, pedal suction pumps, water distiller, intravenous fluid and Histopathology service. The last day we visited the public General Hospital of Eruwa. We found that the installations needed updating. There was no water nor electricity in the whole hospital, and there was great lack of cleanliness everywhere except in the odontology section which the nurse in charge kept very clean, and we were told the lack of cleanliness was due to lack of official means or financial resources, but we also thought that in a great part this situation was due to carelessness on the part of the people in charge in the hospital.

The week was a very eye opening experience for us. We saw the difficult conditions that the Nigerian people live and work in, and we also saw the adaptability and ingenuity that can overcome many obstacles. We will never forget the people here, and thank everyone for their contribution in this great project.

We also give thanks to Peter John Acceturo whom we met at the airport and who helped us polish this English report.