Abidjan, Cote D’Ivoire

13-19 NOVEMBER 2010

On November 13, 2010, Operation Hernia embarked on its second mission in Abidjan, Cote D Ivoire. Once a French colony, Ivory Coast is situated on the southern border of West Africa.

Dr Elaine Chan and team members
Dr Elaine Chan and team members

Though the official capital is Yamoussoukro, Abidjan is the largest city with an estimated population of 3.5 million and the second largest francophone city in the world. Named after one of Ivory Coast s most prosperous rulers, we arrived in Felix Houphouet Boigny airport at approximately nine on a sweltering evening.

Led by Professor Kingsnorth, the mission party consisted of two colorectal consultants from Wales, Brian Stephenson and Gethin Williams and myself, a fourth year general surgical resident from the US. Immediately after landing, we greeted by the warm embrace of Dr Desire Trazo, an old friend of Professor Kingsnorth from a previous mission in Takoradi. His Ivorian background and gracious hospitality facilitated our acclimation to Abidjan.

Similar to the first mission in 2/09, Operation Hernia reestablished its presence at at Chirurgicale Yopougon-Attie (UCYA) Hospital with the help of its director, Dr. Max Thalmus. Nicknamed a gentle giant, his intimidating physical demeanor contrasted his soft-spoken, yet effective manners. Critical to the mission s success, Dr. Thalmus recruited not only patients, but also local surgeons who were eager to adopt the Lichenstein repair.

Preparing the mesh
Preparing the mesh
Hospital sign
Hospital sign

One main difference compared to last year s mission was the exciting introduction of mosi-mesh, imported from India. At a price of $0.01 per piece, our goal was to pave the way for a cost effective repair for all future hernias. Indeed, our first day included the trial and error measurements of the correct dimensions of the mesh in the autoclaving process. Once the initial wrinkles were ironed out, the rest of the operation was smooth sailing, even making headlines with the local newspaper and television network.

Our day-to-day itinerary commenced with an air-conditioned van ride to the hospital, offering a 15-minute glimpse into the indigents customs and habits. Amidst the chaotic traffic and ubiquitous potholes were beautifully clad women donning remarkably heavy items on their strong, slender necks. Their opulence and dignity mirrored that of the towering skyscrapers in the business district, products of Ivory Coast s pre-civil war financial prosperity.

Medical staff
Medical staff

With the corroboration of local anesthetists and nurses, we operated on 51 patients, repairing 54 hernias. The majority of the patients were male, ranging from 6 months to 82 years old. More than half of the patients suffered from their hernias for more than 5 years and were either irreducible or had a significant scrotal component. Over 90% of the cases were performed under local anesthesia with only a few requiring spinal or general anesthesia, mainly incisional and longstanding scrotal hernias. The mission concluded with the unexpected rare opportunity of following up patients on postoperative day 3-4. The fruits of our labor yielded beaming smiles in our grateful patients and their relatively painless hernia free strides.

On our last night, we celebrated the success of the mission and also Professor Kingsnorth's birthday with a lavish feast at a marvelous local restaurant. The highlights of the bittersweet festivities included speeches by both Dr. Thalmus (in French) and Prof. Kingsnorth. The highlight of the joyous occasion was receiving lovely African print clothing as tokens of their appreciation. From the bottom of our hearts, we thank everyone for their invaluable contribution to yet another successful Operation Hernia mission in Cote D Ivoire. It was an unbelievable and unforgettable experience and we look forward to the third mission soon (hopefully with French speaking volunteers!).

Elaine Chan