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September 2012
Hernia Tutorial
Hernia Tutorial

Report on Operation Hernia visit to Thyolo District Hospital, Malawi 8th -15th September 2012

This was my 2nd visit to Thyolo as part of Operation Hernia following a successful trip last year. On this occasion I went on my own but I had the assistance of Francis, one of the clinical officers who was on the course last year. Eight new clinical officers from Thyolo and adjacent District Hospitals attended the course. They already had basic surgical skills and were providing the obstetric service under the supervision of the Senior Clinical Officer Steady Vinkhumbo. I am grateful to Professor Kingsnorth for supplying me with enough mosquito mesh to repair the hernias and enough for many years in the future! I am also grateful to St Anthony’s Hospital in Cheam for assisting with sterilization I took enough mesh, suture material and other supplies to cover the course and subsequent repairs as from last years experience they have very little stock. I would also like to thank my Trust (Epsom and St Helier) for giving me professional leave and Ruthie Markus of AMECA, a charity working in Malawi, for assistance with accommodation.
The trip was coordinated well in advance with the assistance of the District and Local Medical Officer. Francis planned for 8 patients a day in advance but we could have done more this year as I had access to two theatres for much of the time usual NHS story of competing with obstetric emergencies. There was a clinical officer who provided a spinal anaesthetic in the majority of patients. This is an advantage after last years experience when we repaired most of the hernias under LA or regional blocks. African hernias are more difficult than we see in this country and the surgery is definitely easier for the larger inguino-scrotal and recurrent hernias some had had previous darn repairs or herniotomies at the Central hospital!
Each day I attended routine rounds starting at 0800 followed by a teaching session for all staff shame we cannot replicate this at home. Apart from the Medical Officer and a visiting MSF doctor there are no qualified doctors in Thyolo. I would then do a teaching session on hernia surgery that was reinforced on each day of the course. The principle of the course was ‘see one, do one and teach one’ along the lines of Training the Trainers course in UK. I was amazed how quickly the trainees picked up the mesh technique. Each candidate was able to do 2 supervised hernias by the end of the course and we performed some simple herniotomies in children.
It was an intense week and I would strongly recommend providing the course if the opportunity arises. I think it is important to structure it as a teaching course and go back to the same place to provide consistency and encourage sustainability. I was very impressed that Francis was so good at teaching his colleagues within the course environment. It is my intention to return to Thyolo next year.
I also had the opportunity to visit Queens in Blantyre and I hope to run a Thyroid course along similar lines next year. I would be happy to advise anyone who is considering reproducing the course at other sites. Once again many thanks to Andrew Kingsnorth for giving me the opportunity to work with Operation Hernia.

Paul Thomas

Hands on Teaching
Hands on Teaching