Hernia Training Workshop at Cape Coast Teaching Hospital, Ghana, 17-21 October 2016

Prof Akoh, Dr Debra and the hospital staff
Prof Akoh, Dr Debra and the hospital staff

Itinerary

I arrived Accra on 15 October, spent the night at the Baptist Guest House and was driven to Cape Coast on 16 October. I was housed at the Samrit Hotel about 1.5 km from the hospital for the duration of my stay and had breakfast and dinner  there every day. Lunch was usually provided in the operating theatre. I returned to Accra airport on 21 October and to the UK thereafter.

Activity

Day

Patients

Hernias

Comments

Monday

Lectures AM

 

 

 

JA  3

SD 2

 

 

 

 

3 (1 incisional)

3

Academic morning opened by Dean of Medical School, Professor Fer. Lectures delivered as per program by Dr Martin Morna (MM),  Prof Sam Debra (SD) and Prof Jacob Akoh (JA)

Tuesday

JA  4

SD 2

5 (1 incisional)

2

SD and MM examining in Medical School

Wednesday

JA  5

SD 5

6

6

 

Thursday

JA  2

SD 2

MM 2

2 (1 incisional)

2

2

 

Friday

Academic morning

 

Additional lectures on ventral hernias, incisional hernias and non-mesh repair by JA

 

Prior to our arrival, 25 patients were organised for surgery. Attempts to recruit more patients during the week were only partially successful. The majority of the procedures were performed under local anaesthesia, with a few under spinal and two incisional hernias under general anaesthesia.

Trainee being  supervised administering local anaesthesia prior to hernia repair
Trainee being supervised administering local anaesthesia prior to hernia repair

Training

1.     The lectures were well attended by trainees, senior hospital doctors and medical students. The academic morning on Friday was well appreciated and turned out to be an effective use of the “surplus” day due to our clearing the surgical list by Thursday afternoon.

2.     The theatre facilities were excellent with a team that was well motivated and hard-working. Theatre efficiency could be improved by developing standard operating pathways involving ward preparation, theatre reception and recovery of both inpatient and day case patients.

3.     There were approximately ten trainees (including one who travelled ten hours to attend the workshop) who were divided into two groups. Though they were all very keen and they took turns to assist, perform in part and or do the whole procedure, one felt that the opportunities could have been better to allow concentrated training of each candidate as we have done elsewhere.

4.     This was very much a joint effort between Operation Hernia and Cape Coast Teaching Hospital (CCTH) as Prof Debra and Dr Morna actively took part in the programme.

5.     It is praiseworthy that CCTH surgeons cancelled their elective cases during that week to allow the theatres to be devoted to hernia training.

 

Prof Akoh with the trainee surgeons
Prof Akoh with the trainee surgeons

Recommendations

1.       Formally establish CCTH as a centre for Operation Hernia training in Mesh Repair. It may be necessary to involve both the Ghana College of Surgeons and the West African College of Surgeons in this venture.

2.       Encourage CCTH to research the effectiveness of prophylactic antibiotics for mesh repair of abdominal wall hernias.

3.       Formalise arrangement with Plymouth Hospitals NHS Trust for sterilising “Affordable Mesh” in order to ensure a steady supply to low income countries.

 

Participant Evaluation

Dr Morna is collating these and will produce a mini-report in due course.

 

Thank you for the opportunity to contribute in this deeply satisfying way. We owe a depth of gratitude to Dr Mona and Prof Debra and their teams for making the program a great success.

Jacob A Akoh, Consultant Surgeon