English/German Team, Bole, Northern Ghana

MARCH 2012

The team had initially been set up to travel to the Republic of Cameroon but because of delays in obtaining official letters of invitation needed to obtain visas a late change in destination was enforced. Cameroon will now be visited later on in this year I understand.

The team, Bole
The team, Bole

The English (John, Roger and Anna) and German (Guido, Thomas, Lilianna and Cordula) contingents having tentatively approached each other at gate 37 terminal 5 at Heathrow made their introductions and boarded BA81 bound for Accra. The initial omens were not good when take off was delayed by over an hour whilst the ground crew replaced a loose panel in the engine housing and then the in flight entertainment system failed. Things got worse when due to a mix up with communications we were left stranded at the airport for nearly two hours as nobody was waiting to meet us. Fortunately everyone remained very positive and in good humour and we were well looked after by a very attentive security guard and his mate (who were handsomely rewarded!). After a few phone calls by Chris Oppong we were eventually warmly greeted by Adams and Cosmos and transported to the Unique Palace hotel for the night. During the transfer a wrong turn resulted in an unplanned excursion through one of the seedier districts of Accra that has probably remained undiscovered by most tourists to Ghana. At one point we thought that we might never see our German friends again as they disappeared down a side street and we lost phone contact. We did however all manage to meet up at the hotel around 1.30am for a well-earned slumber in air-conditioned rooms.

Rising a little later than initially planned we breakfasted and set off for Bole at around 8.00am. The journey through the capital was relatively pleasant but on reaching the outskirts the main road seemed to vanish and became a mixture of dirt track and large potholes for about 30 miles! These 90 minutes of "entertainment" would have aptly graced any amusement park as a ride called "The Boneshaker". At the end of this stretch the road turned into a virtually unblemished "motorway" for the next 7 hours giving us a relatively smooth birds-eye view of a typical Sunday in Ghana. The only obstacles on the road were the numerous broken down lorries and the free roaming sheep and cattle that took some avoiding. We arrived at our accommodation at the Cocoa Research Institute of Ghana in good time to meet Dr Joe our medical host and discussed the plan for the week over a very welcome cold Star beer. Compared to the other accommodation in Bole the Guest House was like a 5 star hotel but it was still somewhat basic by European standards. We were however extremely well looked after and the food was very tasty.

Monday started with a brief introduction to the hospital staff and we then unloaded the large amount of equipment and disposables that we had all managed to obtain from various sources in the UK and Germany. It would be very helpful if some shelves could be put up in the "storeroom" to make it easier to find things once they had been stored. We then visited the wards to check "some" patients and after an hour had seen nearly 40 patients (enough for 2 days operating!) with a mixture of hernias and hydrocoeles. Dr Joe had very efficiently recruited all the patients for the week via radio, television, local newspapers and leaflets and we all commend him for his sterling work. The hospital has 2 functioning operating rooms and we therefore divided in to two teams of 2 surgeons mixing the pairings on some days. One of the first patients was a 4-year-old boy who had his hernia operation carried out under ketamine that worked extremely well. During the course of the mission a number of children of similar age were operated on in a similar fashion and there were also a handful of patients who required spinal anaesthetics rather than local anaesthetic. All of these anaesthetics were carried out by Raymond a very proficient Cuban anaesthetist on secondment to Bole for 3 years. He had been accompanied to Bole by his wife (a physician) who was unfortunately struck down for the third time in a year with malaria. She was really quite unwell and this certainly reinforced the fact that we needed to take our anti-malarial medication religiously. The first day saw a total of 18 patients operated on between the two theatre teams and we finished about 7.00pm. What struck us all was the very muscular physique of all the patients especially the males and during the week we did not see one patient who would be classed as even a little overweight. We were also impressed by the sheer size of the hernias and hydrocoeles the likes of which we rarely see in the UK or Germany.

Village, Bole
Village, Bole
Operating, Bole
Operating, Bole

Tuesday started with breakfast at 7.00am which was the first meal so far that didn't contain cold baked beans! It was then off to the hospital to start what turned out to be a rather gynaecological day. Lilianna (Thomas's partner) a consultant gyaenocologist was presented with a 24-year-old woman with a grade 3 prolapse caused by a previous very prolonged labour. Her husband would not have intercourse with her and the only treatment normally available to her would entail a hysterectomy. Because of her age this would cause her husband to divorce her, as she would not be able to bear any more children. Lilianna successfully carried out a sacrohysteropexy to the patient’s great delight. Our lists were then interrupted by two emergency Caesarean sections performed by Tamara, a very excitable Cuban gynaecologist, assisted by Lilianna. Again we finished at about 7.00pm.

Wednesday saw nothing out of the ordinary apart from the fact that we became a little more adventurous with our evening meal choosing beef as opposed to the chicken that we had had for every lunch and evening meal up until then.

On Thursday as well as continuing the sterling work in the operating theatre we had the opportunity to visit some of the patients we had operated on in their villages. We did this in two groups to enable work to proceed as normal in the 2 operating theatres. The visits proved to be fascinating not only to see how quickly the patients got back to normal activities but also to experience first hand what life in a Ghanaian village community entailed. We had the chance to talk to the village people and also had the opportunity to visit the local school in Kiape to chat to the teachers and pupils (the latter ranging from age 4 to 14). We also visited Bole senior school where a significant number of pupils are boarders. Cordula the only non-medical member of the team took the opportunity during the rest of the week to explore the town and converse with the local people bringing back many fascinating tales.

Our final day of operating proceeded in a similar fashion to the rest of the week and at about 4pm we actually ran out of patients. We even managed to fit in a number of patients in the afternoon with various lumps and bumps. In total over the week we carried 94 procedures on men, women and children the vast majority under local anaesthetic. We had the opportunity to use sterilised mosquito net meshes that worked extremely well. Unfortunately we were not able to teach any of the Ghanaian doctors since Dr Joe is the only physician in the region and he was kept busy with all the other patients. We operated on 2 local Chiefs during the week and as an indication of their importance we noticed that they were always placed at the front of the queue when they arrived. We also had the opportunity to visit the town's bustling market on Friday where we were made to feel very welcome with absolutely no hassling. We all commented on how lovely and friendly all the Ghanaians we met were and how they all seemed to be wearing continuous broad smiles and spouting "wicked" laughs (especially Adams!).

As a special treat after we finished on Friday Matron had kindly organised a send off party with drinks, food and even a bit of dancing. It gave the Bole hospital staff chance to thank all of us but more importantly it gave me the chance to thank all of them for making us feel so welcome. The four male surgeons were presented with Chief's shirts and the females with material celebrating the 50th anniversary of the Ghana Nursing Association to make garments of their choice.

We left early on Saturday morning not looking forward to our 11-hour road journey back to Accra but with extremely fond memories of all of the people we came in to contact with in Bole. Anna would not recommend the goat fufu however!

We would all like to reiterate our thanks to Dr Joe and the staff at Bole hospital. Finally we would also like to thank the Ghana Government for facilitating our mission. We will be visiting again.

John Budd
Team leader