The Cheshire team, Leighton Hospital, Crewe, UK - Visit to Takoradi, Ghana.

29 NOVEMBER - 10 DECEMBER 2008

Team Members: Magdi Hanafy (Consultant Surgeon), Selvachandran (Consultant Surgeon), Neil Brooks ( Consultant Anaesthetist), Virginia Long ( Theatre Manager), Janet Burrows (Theatre Sister), Emma Reay ( Theatre Nurse and ODA), John Kerslake ( Local GP), Rachel Kerslake ( Writer).

The first step was to create a team of professionals, willing to give their own time and money for this purpose without pressures from work or families. They should know each other, work as a team, good communicators and aim to achieve common goals. These goals are, to treat as many patients as possible (and teach local doctors and nurses), and return safely back home. (May be visit schools and distribute stationary to children). A welcome addition to our team was our Local General Practitioner John Kerslake and his daughter Rachel Kerslake who works in the Local news agency. We managed to get articles published in local newspapers, and radios. Donations poured from patients, relatives, consultants colleagues, local GPs, practices, Rotary clubs, personal friends..Etc. Further collections achieved by members of the team (mainly Janet Burrows) through raffles, bag packing at supermarkets, duck races, ..Etc. The above team worked hard over six months before the trip. All in all we managed to collect £4,300.00 . We have spent £6,700.00.

The hospital managed to donate almost everything we needed for the operations from redundant equipments, sutures, dressings..etc. (nothing out of date). The hospital paid for all the anaesthetics, antibiotics, analgesics. We had to buy syringes, needles, venflons, and disposable scrubs. (Not a good idea in hot countries). In June 2008 we had a visit from The Presidents and council of the Royal College of Surgeons of England. Mr. B. Ribeiro (who is Ghanaian himself) praised our efforts and suggested to add footballs and sports equipment for the children as well. The hospital paid for our vaccinations, anti-malarial, and anti-retroviral prophylactic medications. They have paid for shipment of 39 boxes to a container in Plymouth heading to Takoradi. All these boxes were there when we arrived. British Airways waived fees for extra 12 luggages. The British High Commission in Accra offered support if needed. Bard supplied us with a box full of meshes (worth £9,000), other companies supplied us with boxes of gloves, gowns, drapes.. Etc.

Communications with Professor Kingsnorth, Chris Oppong, and Brian Dixon, answered all the questions. We planned to travel to Heathrow by a mini bus, and a van, kindly lent by Go Green cars, and driven by one of the team s husband and son (Janet Burrows). We arrived safely and had a nice luggage check in. 29 bags checked in. BA was as usual very efficient. We noticed their strict rules regarding bags number and weight and time. Plane was late taking off (55 minutes). Runway was too busy. Smooth flight, seven hours but plenty of entertainment. Arrived in Ghana, 10:00 pm. Warm weather. I started sweating once we got out of the plane. We cleared the immigration and customs very easily with all the boxes and bags. Pushing two full trolleys, one in each hand, down slope was not easy.

Once outside the airport, we had to deal with ten men appearing from nowhere trying to help. We could not differentiate between them and the two drivers sent to us with their minivan and truck. All cleared and on the way to Takoradi. 11:00 pm. Three hours drive arrived to the villa 02:00. Transferred 29 luggage safely inside, all counted for, luggage and personnel. We were met by Brian Dixon (our man in Ghana).

Brian and the girls (Kate, Lillian & Grace) gave us a warm welcome and explanations about how things are going. We resided in a local government villa with seven rooms, each one with en-suite and a large bed and air-conditioning. Everybody phoned home to reassure their relatives. Each one went to a room, and fell asleep. I could not believe the day passed without any problems. The next day Brian took us to visit a local village. Almost 80% of the children were staring at us with their tummies exposed showing an umbilical hernia. They are really nice full of smiles, surprise and interest. We went to the Turtle beach had a relaxing day and swam in the ocean, dangerous waters with strong currents.

First day at work. 
Woke up early, 5:00 am. Had breakfast and we started to empty boxes and redistribute drugs, stitches, drapes and gowns between two teams as we were going to work in two different hospitals. We saw children going to school passing by our villa, we went out and distributed some stationary. Dr Boateng came at 7:30 and took us to the Hospital. We went up to theatre, were introduced to all theatre staff, then shown around the department. We than began to open our 57 boxes which have arrived (with us and the container), and collected medicine and equipment needed immediately for the cases. We examined the patients, decided the procedures they required, and marked the sites. We were introduced to the Nurse anaesthetist, and we started working. Hernias, recurrent hernias, Hydrocoeles primary and recurrent, varicocoeles. Adult and children, Males and females. Electricity went off four times during one of the procedures, I had to have a torch light directed into the wound, and my reading glasses put on for me, my protective mask removed, to be able to safely continue the operation. A hand torch and headlamps would be handy. After our first day of operating, we all relaxed meeting up at Africa Beach bar for a beer! This is to be our after work meeting place for the rest of the week.

Further days at work 
Woke up all together around 7:00 am and had Breakfast, the driver came and took us to the hospitals. Ginny collected some more stuff from the boxes, and off she went with Selva to the other hospital. No more electric failure. All the cases for today were presented to us, previously clerked in and screened for diseases like HpB and HIV, and consented. We only had to mark them and decide which type of anaesthesia we needed. We made sure they had prophylactic oral antibiotics. We continued until 2:00 pm when Selva and Ginny had their share of mega hernias (shown below) but finished early and came over to join us. Selva did our fifth case while I had lunch, met with the hospital Director, and marked my last patient. Each team did one patient until we finished.

We went with Brian to the Africa club for a beer and a swim, then back to the villa for dinner. We had to make arrangements for visiting schools, the next days. The responsibilities lied with Emma and Neil and the Kerslakes, for distribution, taking photos and video shots. We opened the bags, distributed contents in the four cases, hoping to visit four schools at least, one every day. The first school was for deaf children. It became apparent that distributing stuff individually to huge number of children was not a good idea. Also giving a football to a group of young children to play with meant that older kids will take it from them. We preferred to give the donations (Footballs, clothes, school stationary, chalks and board erasers) to the school principal, who will make sure donations will go to those who need them, and create some discipline and order. We went to other schools later on in the week, and followed the above advice.

We met some high ranking Ghanaian officials as well. Brian Dixon, Operations Director for Operation Hernia, has invited us and them to a dinner in a Chinese restaurant. We met Dr Bernard Boateng-Duah and The Honourable Edwin Phillips the Presiding Member of the Municipal Assembly for Takoradi and Sekondi the equivalent to the Leader of a local authority and extremely well respected in the area. They warmly thanked us and Brian and Operation Hernia . We responded by praising their hospitality and kindness.

Over five days of work we managed to perform 74 procedures, a respectable number, we are proud of, but it left us and the Takoradi team completely exhausted. Things that we take for granted like electricity and running water were not routine commodities there, we had to scrub by asking somebody to pour water from a bucket onto our hands. Without the air conditioning in theatre we could not have achieved half the above numbers. The diathermy kept disconnecting because the plate has been used on many patients beforehand and was not sticking and connecting properly. The diathermy stick was disinfected in fluid and would not work unless dry.

Further advice published on the site and written by Brian Dixon are first hand, important and worth considering. Unfortunately Brian Dixon is due to retire by the end of 2008. We were the last team he took care of and he did this job perfectly well. I am sure the local teams will do an impeccable job, but replacing Brian s position will be a hard act to follow. I hope the girls (Kate, Lillian & Grace) will continue serving the coming teams as well as they did with us.

Conclusion 
Back safely we think we have achieved these goals:
1. Getting Leighton Hospital involved within the community of the European Hernia Society for its charitable Operation Hernia exercise.
2. Creating a successful team willing to give their time and money for this cause.
3. Collecting funds securely and professionally.
4. Getting as much advertisement as possible to help collecting the funds and to improve our hospital profile in the community.
5. Collecting and transporting as much as we can from donations, etc. that is not needed anymore by our hospitals, but is essential for our purpose.
6. Providing all possible protection to our team from vaccination and prophylactic medication.
7. Creating a charitable, happy atmosphere within the team and colleagues in the hospital.
8. Reducing expenditure to as little as possible. (Ex. Airline tickets, transports. etc..)
9. Achieving contacts to ease passing through customs in Ghana.
10. Safe arrival of all medical and school equipment (61 boxes and bags) to their intended destination. (Takoradi Hospital)
11. Achieving a respectable number of procedures (74) by two surgical teams and an anaesthetic team in five days, without immediate complications.
12. Leaving a good impression within the local and international Operation Hernia team .
13. Arriving back home safely, without accidents, incidents, or illnesses. Only extremely tired.

Thank you
On behalf of the Ghana Team
Magdi Hanafy