November 2015 “Operation Hernia” Mission to Bole, Ghana
John Budd - Team Leader - Vascular and general surgeon
Anna Budd - Theatre nurse
Graham Howell – Urologist and previously a general surgeon
Rosemarie Howell – Theatre nurse
Direct BA flight London Heathrow to Accra arriving 21.30 on 14th November
Overnight stay in Accra at the Baptist Mission Guest House. Meet, greet and brief with Chris Oppong and teams heading for other destinations.
Nissan 4x4 road transfer to Bole: depart Accra 06.00 and arrival at 16.00
Return to Accra by road on 21st November with wash up at the Guest House and return flight to London departing 22.00
The Cocoa Research Institute Guest House ½ mile from the hospital in Bole provided comfortable and clean accommodation with full board and air conditioning if required. Morning pick up was at 07.30 and return at 19.30.
The team carried out 112 elective procedures in 97 patients as follows:
Adult Inguinal hernias 61 Inguinal Herniotomies (children) 15
Femoral hernia 1 Umbilical hernia 1
Hydroceles 18 Epigastric hernia 2
Lumps and bumps 8 Minor ano-rectal surgey 1
Four Emergency procedures were also performed:
Laparotomy and splenectomy for trauma
Appendicectomy for gangrenous appendix
Laparotomy and repair of perforated distal ileum for blunt injury
Caesarean section and tubule ligation
Basic surgical training and some surgical skills were imparted to Dr Asiz and Dr Gerald, two newly qualified general doctors.
Nurse training included theatre skills for the nurses and concept of swab count for laparotomies.
This was a return trip to Ghana for John and Anna and a first visit for Graham and Rosemarie - deferred by the West African Ebola epidemic the previous year. The plan had been to visit Keta on the coast but there was a greater surgical need in Bole despite another teams endeavours the previous week, and we headed up country in the Bole Hospital Nissan pick-up truck on metalled roads. The 50 miles of potholes and craters on first leaving Accra had fortunately been resurfaced since John and Anna’s previous visit 3 years ago. The 10 hour journey was remarkable by its near misses and our passing 19 overturned lorries en route.
We had very comfortable and clean accommodation in the Cocoa research institute guest house and the food was a very pleasing combination of local and European fare.
We were warmly welcomed by the hospital director and the theatre and ward staff. Our surgical day began on the ward each day soon after 7.30 with a pre-operative examination of the day’s patients with surgical marking and a review ward round for those who stayed overnight on day 2 onwards. We used both operating theatres available. Each is now equipped with effective air condition units which made the operating environment quite comfortable. We were most impressed by the ability and humbled by the enthusiasm of all the theatre team.
There were two very capable and experienced nurse anaesthetists - Vitus and Michael. The strategy was to use spinal anaesthesia for the adult patients with very large, irreducible hernia or large bilateral problems whilst the children were given IV Ketamine. There was a modern anaesthetic machine in the main theatre and pulse oximetry and Valley Lab/Eschman diathermy units in both theatres. The laparotomies were done under GA and the Caesarean section under spinal anaesthetic.
John had brought a substantial supply of disposables including mesh, syringes, needles, local anaesthetic, sutures and diathermy pads/pencils. The BMI Bath Clinic had kindly supplied the bulk. It would have been difficult to have managed without the imported supplies and the hospitals own resources were preserved as a result.
We were assisted for some of the operations by Dr’s Asiz and Gerald who were recently qualified doctors with an interest in surgery and there was some time to help them with surgical skills . Dr Joe, the Hospital’s resident doctor, was very supportive and we were fascinated to hear of his WHO secondments to Liberia as part of the Ebola effort and to Ethiopia with the Polio eradication programme.
Some of the hernia repairs were challenging and very worthy of our visit. The diathermy finger switch devices tended to degrade with recycling and we encountered a diathermy pad burn for reasons which weren’t immediately obvious. We had no returns to theatre but disappointingly our splenectomy patient failed to regain renal function post-operatively and died of multi-organ failure within 36 hours. It was a busy week of operating made light by the enthusiasm and hard work of the Bole staff. There was a very positive ambience in theatre and laughter reminding us of the surgical careers of our youth.
Anna and Rosemarie visited the local market on Friday morning kindly escorted by Agatha, one of the theatre nurses, to help with the robust matter of negotiating prices!
We spent our evenings in the guest house discussing how best to resolve the world’s problems but failing somehow to reach a solution. Our final evening in Bole involved a great send off by the theatre team in a down town hostelry and our introduction to BBQ’d chicken gizzards. We were honoured to receive traditional headman’s robes. We renewed and made friendships and look forward keenly to a return visit.
Graham Howell 29/11/2015