OPERATION HERNIA MISSION TO RWANDA - FEBRUARY 2014 REPORT BY CHRIS OPPONG, CHAIRMAN OF OPERATION HERNIA

Operationn Hernia team in Rwanda
Operationn Hernia team in Rwanda
  1. INTRODUCTION

The OPERATION HERNIA/LEGACY OF HOPE MEDICAL MISSION to Rwanda 2014 was the largest this year.  It was led by Chris Oppong, a UK Consultant Surgeon who is the Medical Director of Operation Hernia.  A UK medical team of four teamed up with a team of 13 from Germany, led by Ralph Lorenz. We were attracted back to Rwanda by the burden of need but also by the legendary warm welcome which awaits volunteers and visitors.

We linked up with LEGACY OF HOPE for the RWANDA Project.  Legacy of Hope is a church-based registered UK Charity.  They operate from Plymouth which is also the base of Operation Hernia.  Operation hernia provided the UK and Germany teams. This year we had a solo Plastic Surgeon who works in the UK.  Ralph Lorenz, a Consultant Surgeon, is the Operation Hernia Ambassador in Germany.

The aim of OPERATION HERNIA/LEGACY OF HOPE MEDICAL MISSION is to deliver sustainable, high quality medical care to relieve suffering from burden of disease in Rwanda and to train local doctors, nurses and other healthcare workers.

  1. BURDEN OF HERNIA DISEASE IN RWANDA

Hernias are more common in Rwanda than is commonly thought.  In fact the estimated burden (prevalence) of hernias in Rwanda is 5.78%3.  This compares with 5.36% in Tanzania1 and 3.15% in Ghana in West Africa.2   Repair of Hernias with polypropylene mesh (Lichtenstein technique) has become the standard in high income countries.  In low resourced countries high tension, sutured repair is standard because of cost of branded mesh and lack of skill. Resultant high recurrence rates increase the total cost of treatment of hernias.  Mesh repair of hernias averts significant number of disability adjusted life years (DALY)4.

  1. HOSPITALS

Last year, OPERATION HERNIA/LEGACY OF HOPE MEDICAL teams worked in two mission hospitals: Nyamata and Remera-Rukoma hospitals. This year we worked in two additional mission hospitals: Kirindi and Gahini hospitals.  The new Hospitals were represented by the Medical Director of the Association of Presbyterian Hospitals, Dr Esperance.  Nyamata, Kirindi and Gahini hospitals hosted Hernia surgery.  Remera-Rukoma hospital hosted hernia surgery and plastic surgery. The latter is an expansion of the medical programme of LEGACY OF HOPE.  Training of local doctor was a high priority and this was provided in Kirindi and Gahini hospitals.

  1. PATIENT RECRUITMENT

This year’s recruitment was a massive success.  The publicity for the programme was mounted by the Rwandan Ministry of Health for all the four hospitals involved in the project.  This is because of the vital link established between the project and the Rwandan Ministry of Health. This link was negotiated by LEGACY OF HOPE (LOH), led by Pastor Osee Ntavuka.  Legacy of Hope is officially recognised by the Rwandan government and OPERATION HERNIA (OH) is a partner of LOH.

The success of recruitment was in part due to the involvement of Dr Esperance, the Medical Director of the Presbyterian Hospitals.

A young boy with an inguinal hernia being assessed prior to surgery
A young boy with an inguinal hernia being assessed prior to surgery
  1. TRAVEL AND CUSTOMS

All equipment brought by the teams were cleared for customs by the Ministry of Health because of the official recognition given to LOH.

  1. MEDICAL REGISTRATION

The OPERATION HERNIA/LEGACY OF HOPE MEDICAL team is in a unique position in Rwanda regarding registration of the medical team by the Rwanda Medical Council (RMC).  We are grateful to Pastor Osee through whose efforts, all the doctors on the project have been given a 5-year registration by the RMC.  This includes registration as Continuing Professional Development (CPD) providers. This is an invaluable platform on which to expand the work of OPERATION HERNIA/LEGACY OF HOPE MEDICAL team in Rwanda.

  1. ACCOMMODATION

The teams stayed overnight in Kigali, the capital.  Accommodation in Kigali was in a hotel.  During the week, all volunteers were accommodated by the hospitals who also provided subsistence.  Volunteers paid for their hotel accommodation in Kigali.

  1. TRAINING OF DOCTORS

This training programme was registered by the Rwandan Medical Council for CPD points.  A total of 13 local doctors received training in two hospitals. All but one of the doctors had skills in hernia surgery. The training programme included formal teaching on anatomy and the essentials of mesh hernia repair. This was delivered by PowerPoint. Trainees then had hands-on training –

  1. Assisting OH surgeons
  2. Assisted to insert mesh in at least two cases.
  3. A few had opportunity to do more cases.

At Gahini hospital, trainees were presented with certificates to recognise their attendance at the training sessions.  Five doctors adjudged to be competent at the end of the 5 days were given mesh to use in their hospitals.  All the cases they perform will be documented for review when the team visits in 2015.

Chris Oppong presenting a certificate of attendance at a training session to one of the local doctors
Chris Oppong presenting a certificate of attendance at a training session to one of the local doctors
  1. CLINICAL OUTCOME

A grand total of 166 operations were performed in all 4 hospitals.

A total of 132 cases of hernias and hydrocoeles were performed in all centres.  33 plastic surgery operations were performed at Remera Hospital.

 

HOSPITAL

NO of CASES

No of CHILDREN <12YRS

% of CHILDREN <12 YRS

Gahini

43

9

21%

REMERA

43

10

23%

NYAMATA

35

10

29&

KIRINDI

45

10

22%

TOTAL

166

39

23.5%

 

  10. COMPLICATIONS

There were 3 complications recorded.

 

COMPLICATION

HOSPITAL

TREATMENT

OUTCOME

1.Bronchospasm

Remera

Transfer to King Faisal Hospital

Discharged

from Hospital

 

 

 

 

2.Bronchospasm

Gahini

Treated successfully

Discharged. Well

 

 

 

 

3.Vascular Injury

Gahini

Successful control

Transfer to Kigali Teaching Hospital

Discharged. Well

 

Change of policy.

Because of the complication in the 5 year old, it was decided at Gahini hospital to postpone surgery in all children under 9 until 2015 when hopefully a consultant anaesthetist would be part of the team.

  1. MEDICAL EQUPIMENT DONATED

OH/LOH provided and donated a large amount of medical equipment to the various hospitals.

The total estimated cost of medical equipment was £39,000.

       12. ACKNOWLEDGEMENTS

12.1 Ministry of Health

Our prime thanks go to God who is the provider of all goodness.

We would like to register our profound gratitude to the Minister of Health for the tremendous support the team has received.  Our thanks also go to François Habiyaremye and all the other officials.

12.2 Medical Teams

It is appropriate to acknowledge and congratulate the effort of all the medical team for volunteering significant financial resources, annual leave and other resources to provide the people of Rwanda with such excellent medical care.  All team members are motivated by a passion to care by employing their clinical skills to provide relief of suffering and transfer of their skills to the local healthcare stakeholders.

12.3 The Medical Team would like to express sincere thanks to the following stakeholders.

  1. Minister of Health
  2. Ministry of Health officials
  3. Rwanda Medical Council
  4. All Medical Directors
  5. Staff of all hospitals
  6. The Head of the Presbyterian Church
  7. Dr Esperance, Medical Director of Association of Presbyterian Hospitals

  13. FUTURE PLANS

The OPERATION HERNIA/LEGACY OF HOPE MEDICAL MISSION will continue to cooperate with the RWANDA MINISTRY OF HEALTH to expand the coverage of our care.  This will be clearly detailed in our Plan of Action for 2015.      

CHRIS OPPONG, CHAIRMAN OPERATION HERNIA

                                                                                                                

14. REFERENCES

1. Beard JHOresanya LBAkoko LMwanga ADicker RAHarris HW

An estimation of inguinal hernia epidemiology adjusted for population age structure in Tanzania.

Hernia 2014: 18: 289-95

 

2. Beard JHOresanya LBOhene-Yeboah MDicker RAHarris HW

Characterizing the global burden of surgical disease: a method to estimate inguinal hernia epidemiology in Ghana.

World J Surg 2013; 37: 498-503

 

3. Beard JH, Oppong FC

 Epidemiology of Inguinal Hernias in Rwanda.

(To be published)

 

4Shillcutt SDClarke MGKingsnorth AN

 Cost-effectiveness of groin hernia surgery in the Western Region of Ghana.

 Arch Surg 2010; 145: 954-61