REPORT OF THE EXPLORATORY MISSION BY CHRIS OPPONG
Rwanda was a very pleasant surprise. The country has recovered from the genocide that ravaged the country 20 years ago. The people are very welcoming. I felt I could easily make Kigali my second home in Africa, after Ghana.
The capital Kigali has been rebuilt. It is a very clean city. Commerce is booming. French used to be the lingua franca until after the genocide. English is now taught in schools. We were so embraced by the city I have already started planning a return in 2013.!!
A visit to the Genocide Memorial was both emotionally challenging and hugely instructive.
The surgical team comprised one Consultant Surgeon and a nurse. This was meant to be an exploratory visit. For that reason we planned to perform only 25 cases.
We travelled on Kenya Airlines and stopped over in Nairobi before connecting to Kigali, capital of Rwanda. We were met at the airport and transported to our accommodation.
We were very warmly welcome by the Medical Director Dr Alfred Rutagengwa ( Dr Alfred) and by the General Manager. They offered us the best hospitality they could offer from the resources they had. Our accommodation was in the hospital guest house. It was basic but included en-suite facilities. The team was grateful for the care and attention we received in the guest house. We were adequately fed, probably overfed!
Dr Alfred is very enthusiastic about establishing NYAMATA HOSPITAL as a Hernia Centre. Operation Hernia is keen to make this happen.
There were 2 trained nurses, one student nurse and 2 auxiliaries. We had 2 anaesthetist each day. They offered a superb service. One doctor was assigned to help us. The staff nurses were competent. The Anaesthetist were skilled in Spinal anaesthesia and committed to best patient care. Staff were helpful. The intensity of work we required was not the norm but they coped reasonably well. No cases were cancelled due to lack of theatre tome or staff. All our full days ended after 7pm.
Not all had had their pre-operative investigations. Some of them had not been fully registered. This delayed the start of surgery on 2 days. That will be improved for the 2013 visit.
2 Theatres, one Recovery room, one Minor surgery room, 2 Changing rooms, Doctors office equipped with a computer connected to the internet, Theatre Sister's office; Stock / Nurses room with a PC; Sterilisation Room with 2 autoclaves.
Each theatre had the following facilities:-
Theatre table: This was old but functional
Anaesthetic machine which was modern
Monitor which was also modern
Ceiling theatre Lamp. Functional in only one theatre.
Standing lamps which had poor focus.
Air conditioner worked in one theatre.
Diathermy machine: We provided and donated a refurbished Eschmann's diathermy machine complete with accessories- patient plates, diathermy pencils, foot pads. This was a donation from TORBAY HOSPITAL.
Surgical Instruments and supplies
They had enough instruments to perform 7 procedures a day. Most of these should be replaced. We can do with Travers / West/Weislander retractors, decent needle holders, scissors. These instruments would have been provided had our order arrived on time!! They coped with the rapid turnover. Theatre gowns and drapes were provided for all. Autoclaving of kit kept pace with the relative rapid turnover of patients. Some theatre gowns showed their age but did not affect sterility.
25 patients were originally booked for surgery. We operated on 29 patients and performed 33 procedures. This is a credit to the theatre staff for being willing to work hard on our full days to ensure that no patients were cancelled because of theatre time. All hernias were graded using Kingsnorth Grading. All operations were entered into Operation Hernia Database.
Apart from 2 patient excluded on clinical grounds, all hernia repairs were performed with Mesh. This was a complete novelty at Nyamata Hospital and was well received.
A major breakthrough was introduction of Hernia Repair under Local Anaesthetic infiltration. There was initial resistance from patients, anaesthetists and nursing staff. This has never been practiced. All hernias had hitherto been performed under spinal anaesthetic. Success of this "new " technique was welcomed enthusiastically by all staff. The advantages over spinal anaesthetic were swiftly recognised by the Chief anaesthetist:- safety, day case surgery, no family visits, less cost.
One of the local doctors assisted me and was trained to insert mesh in 3 patients. The need was expressed to train more local doctors in both mesh repair and local anaesthetic surgery.
1. Enthusiastic and hardworking staff
2. Skilled Anaesthetists
3. Keenness to learn new techniques.
1. 33 procedures performed in 4.5 working days
2. Introduction of Mesh Repair of Hernias - a more effective treatment.
3. Introduction of Hernia Repair performed with Safe Local Anaesthetic Infiltration
4. Training one surgeon in Mesh Repair.
Recommendation for future Visits
1. CME on theatre management
2. Workshop to train doctors - Mesh repair and LA infiltration
3. Require new surgical instruments
4. New Air conditioner
5. Possible New Theatre Table
6. Possible New Theatre Lamps