Team UK - Estonia

December 2012
Welcome to Operation Hernia
Welcome to Operation Hernia

Following a really successful trip to Farafenni in January 2011 an enlarged team comprised of the original group from Estonia led once again by Surgeon Juri Teras and a new team from the UK lead by Surgical Registrar Michelle Tipping ventured once again into the depths of Africa to build on the valiant efforts of the Estonians earlier in the year.

Having linked up with the Estonian team via e-mail before departure our UK contingent was large: 1 consultant anaesthetist - Scott Farmery, 2 consultant surgeons - Mr Andrew Wan (UGI) & Mr Andy Ramwell (Colorectal), 1 senior scrub nurse Adrian Kasparian, 2 surgical trainees Hannah Wright (FY2) and myself (ST4), and two general volunteers Christopher Mason and Helen Durance.

We arrived a day after the Estonians which was lucky as they were able to organise transport for us to the hospital, even then, the amount of supplies we had managed to secure seemed to take our hosts by surprise! 100kg of drapes, a surgical operating table, 1 portable ultrasound machine, 8 volunteers, 10 bulging bags and a huge box of donated vacuum packed teddy bears. One small hospital ambulance and half the length of the country along a pot-holed African road later, we all knew each other much better than when we set off! The adventure had officially started.

We found the hospital and the breath-taking hospitality exactly as described by the Estonian team. Baboucarr Saine, Mr Bondi and Sainey Dibba once again went out of their way to make us feel at home and we stayed in the same accommodation they had used previously.

As the Estonian team had made a head-start we were already almost up & running on arrival. The plan was to get three theatre teams working so we could maximise the work we could do. We managed to get enough resources together to get two theatres running simultaneously and got started with the first patients. The UK team had discussed our long-term mission prior to arrival as well as our immediate objectives. We left the UK with aspirations to help train local people to start doing their own hernia repairs. Once we started we realised that the needs of the hospital were a lot more basic. It became apparent very quickly that basic theatre practice & education was desperately needed. Basic knowledge regarding concepts of sterility and instrument handling were just unknown. So, we started at the beginning. Luckily due to the size of our team we could educate and develop practice as we went along and by the end of our time things were much improved although it will take time and effort to train surgical nurse practitioners to the standards required to complete their own repairs.

Another basic concept which needed addressing was the organisation of supplies in the hospital. As we explored we found lots of locked rooms containing boxes & boxes of donated supplies but no-one seemed to know what was in them! This was where our extra non-clinical volunteers made a huge impact. Using a lot of elbow grease and any of the surgical team not currently operating they re-organised the whole of the hospital surgical supplies into 2 labelled rooms so that everyone knew what was there and how to find everything. This also came in extremely handy when we were asked to see other surgical problems that didn’t involve hernias but needed treatment! Safe to say the hospital does not need any more urinary catheters or neonatal ITU equipment!!!

This was a great hospital to visit and the enthusiasm they have as hosts clearly shows they appreciate the efforts of the volunteers who give up their time to go. It is a place where people are keen to improve and develop to offer the best possible for their patients. We see a long-term future for Operation Hernia in this hospital although the two things I would recommend as vital for future teams (apart from all your surgical kit) . CO2 monitors for the anaesthetist to assist with childrens hernias and head torches; some-things never change!

Inguinal hernia repair under local anaesthesia
Inguinal hernia repair under local anaesthesia
The local market
The local market
Rural Gambia
Rural Gambia