Dutch Team, Takoradi, Ghana

10-19 JANUARY 2009

The Dutch team consisting of Maarten Simons (consultant), Frank Garssen (experienced tropical doctor and surgical resident) and Astrid Huiberts (surgical resident) operated at in Takoradi from January 10-19.

Grace, Lilian, Kate and Brian.
Grace, Lilian, Kate and Brian.

We had a wonderful time thoroughly enjoying performing the operations, meeting Ghanaians and visiting parts of the country. After arrival we drove to Takoradi arriving there at 2 a.m. being welcomed at the guest house by Brian Dixon and our hosts for the week Kate, Lilian and Grace. We are very grateful for all the effort that was put into making our trip a success. Brian was closing down his office but this did not stop him from worrying about our wellbeing 24 hours a day. On our final day when we were traveling back to Accra he called us 23 times informing whether the drive was OK, if we had found Rebecca our guide, if the lunch was OK and if enough salt was added to Frank's sandwich. The girls were a delight. Cooking wonderful meals and joining us for trips to the market and the beach. We will not forget their singing on the way from the beach back to Takoradi. Beautiful songs and beautiful voices. We were sad the car drive was over. We hope that the girls will continue being part of Operation Hernia and certainly that Brian will stay involved. It is hard to imagine the stay without his help.

Sunday we met Bernhard Boateng and discussed the week. He thought we were with two teams and had planned 40 patients; 25 in the hernia wing and 15 in the Ghana Ports and Harbour Authority hospital. We agreed to try to help all the patients by spreading them over the week and working in two teams on the last day. In 5 days we managed to perform 40 operations in 38 patients. We had taken material for 40, so our suitcases were empty at the end of the week. Everything went very well. The Hernia Wing and GPHA are well equipped. The nursing staff are well trained and fun to work with. They work very hard without complaining and put the wellbeing of their patients first. We operated on five children, two women, two bilateral, two recurrences and almost all hernias were scrotal. Very educating for the two residents! We performed one orchidectomy for an ectopic testis and scrotal hernia and for a huge hydrocele a hemiscrotectomy in an old man. With Bernard the residents performed drainage and excision of an infected mesh with a fistula of two months. The patient had come quite late with this complication. This is of course the nightmare of operating with mesh and everything must be done to keep the complication rate at an acceptable low percentage. We gave prophylactic antibiotics and Bernard had chosen to give all a 5 day cure of Stafoxil. Sterility in the OR is good. Rules are abided by although lack of enough drapes and running water can be a disadvantage. We used large meshes that before the first patient were cut into 8 smaller meshes and kept them under a sterile drape during the day. Dr Frank and Dr Bernhard deserved and received our deep respect for their work in Takoradi. Running a hospital and being a generalist physician who treats all patients (children and adult) with all diseases (as surgeon, obstetrician etc) with relatively little is an immense responsibility. They deserve as much support as we can give.
We truly hope to hear if there are complications of our work. The infected mesh that we had to remove in a young adult was hopefully an exception and infrequent complication. It would be a good idea to have all patients put into a databank so that results can be monitored more closely. We spoke about this with Bernhard and he would come with a proposal for some research in this area.

We performed a small study into the EHS classification system. All hernias were independently by the three of us scored for type of hernia preoperatively (H classification) and peroperatively (EHS). We hope to publish the results in 2009-10.

The second weekend we stayed at Axim beach. Very relaxing. We played soccer with the local kids, swam in the wonderful sea and enjoyed the sunshine. Sunday we were picked up by Brian and the crew that sang us back to Takoradi. Monday we visited the rain forest, Hans Cottage and Elmina. Finally on Monday evening we were on our way home. We will be back.

Maarten Simons
Frank Garssen
Astrid Huiberts