UK Team, Takoradi, Ghana

1-5 NOVEMBER 2010

Our team consisted of 3 Consultant Surgeons, 2 Senior Registrars and 5 experienced Theatre Nurses. There were 4 first timers in the group (Catriona, Lizzie, Mary and I Andrea) but the others were a wealth of experience and guided us through all we needed to know!

Team members

Chris Oppong , Surgeon ( Lead) / Jayne Buckley, Theatre Nurse/ Christine Tinsley, Theatre Nurse / Lizzie Stone, Theatre Nurse / Andrea Warwick, Senior Registrar (Derriford, Plymouth)

Terry Irwin, Surgeon (Lead NI) / Jenny Irwin, Theatre Nurse / Mary Kennedy Nolan, Theatre Nurse / Catriona Semple, Senior Registrar (Belfast, N Ireland)

Shina Fawole, Surgeon (Dewsbury, West Yorkshire)

The week started with a day trip to Green Turtle Beach: gorgeous sunshine; white beach; volleyball (expert level ha!) and plenty of beer was this the hard work I d been hearing so much about?!

Reality hit the next day. The hernia centre is a fast paced machine. No sooner have you written your operation note than the next patient is on the table. The lists in the hernia centre were long and we generally worked until about 7pm, with an easier time in GPHA and Dixcove. Saying that Dixcove was so hot (air conditioner not really working) that even though the day was half as long, it was hard (and sweaty!) work!

At the end of the day on Wednesday Chris Oppong/ Shina Fawole operated on a young gentleman who had presented emergently with a huge strangulated hernia. He had become acutely unwell and they spent until late at night repairing his hernia. Thankfully the patient survived. He developed a minor wound infection.

Most hernias were operated on under Local Anaesthetic as in previous campaigns. There was no Consultant anaesthetist in the team this year. General and Spinal Anaesthetic was administered by the local nurse anaesthetists. There were a couple of anaesthetic near misses which were thankfully rectified without post op complication. One patient had a low saturation due to poor monitoring. The other was a large lady having a huge incisional hernia repair, converted from spinal to GA in less than controlled circumstances.

The recovery of children/ patients following GAs was also less than ideal. The hospitals need a dedicated recovery area. In 2011 we hope to recruit a Consultant Anaesthetist and a specialist recovery nurse to provide appropriate training to the local medical and nursing staff.

There was plenty of equipment when we were there, although we had of course taken plenty with us. On the last day Jayne and Christine went through all the cupboards making an inventory of the stock at the hernia centre. Hopefully this should help the subsequent teams to know what quantities of supplies to take.

So our stats we did 108 procedures on 100 patients. The vast majority were performed primarily by trainees under supervision (including 2 Ghanaian trainees who spent the week learning mesh repair with Chris Oppong). We operated on 10 children (9 inguinal hernia repairs, an umbilical hernia , and a 3 year old angel with an enormous lateral abdominal wall hernia). Most were primary inguinal hernia repairs but there were 8 recurrent hernias, and a handful of hydrocoeles/ epididymal cysts/ ventral hernias. Approximately half the patients had their procedures done under local anaesthetic , with 12 GAs and the rest under spinal anaesthesia (very quick and good results from the nurse anaesthetists).

We were extremely well looked after by the girls in the villa and by Bernard.
It was a very enjoyable and rewarding week for all involved and we are all looking forward to next year!

Andrea Warwick (Registrar)