Frank McDermott's Second Mission
OH Mission to Volta Regional Hospital, Ho. (3rd – 10th November, 2012)
This was my second mission with Operation Hernia having returned from an amazing experience in Mongolia in 2011. I flew with a registrar colleague and friend, Mr Surajit Sinha, and we arrived into Accra to be greeted by Godwin, a hospital administrator from Volta Regional Hospital. Godwin was very welcoming and demonstrated throughout the week what a useful asset he is to the Hospital. Unfortunately one of my bags had not made the journey with me on the airplane which made for a challenging 48 hours in a hot and humid country!
We spent the first night in the Baptist Guest House in Accra before travelling to the Volta Regional Hospital. On Sunday morning I met the rest of the team. Mr Chris Oppong I already knew as I had just completed a surgical rotation with him as a Colorectal Registrar in Derriford Hospital, Plymouth. He co-founded the charity with Professor Kingsnorth and as a Ghanaian was the perfect guide for my first adventure in this fascinating country. Joining us on the mission was an American team headed up by Dr Pedro Cordero, an Attending Surgeon based in New York. Pedro runs his own charity that has provided surgical care to Haiti and Philippines and we shared many interesting stories about providing surgical care in the developing world. The rest of his team comprised Aida St John and Carol Turner (American Theatre nurses), Peter Dixon (surgical trainee) and Alyssia McEwan (medical student). We all jumped on the hospital bus and began the 3 hour drive to the Volta Regional Hospital in Ho. You learn so much from driving through a new place. It gave the team the opportunity to gel and also see the captivating scenery fly by. We passed many small towns and witnessed the hustle and bustle of Ghanaian life with many street vendors selling some staple produce such as cassava, plantain and Tilapia freshwater fish interspersed with electronic stores selling sim cards for your mobile phone! Crossing the toll bridge over the Volta River gave stunning views of the region. I was not sure what to expect having never been to Ghana before but the hills were lush albeit the victims of deforestation over many years.
We arrived in Ho in the afternoon; it is the fifth most populous town in Ghana with a population of around 100,000. We drove to the hospital for a formal introductory ceremony with management from the hospital, the lead surgeon Geoff and a representative from the Ghanaian Royal Family, Mamma Tratto. This was all filmed by Ghanaian TV! The introductions all done we went to the ward to meet our patients and assess them prior to starting the real work the next day. Professor Kingsnorth has developed a scoring system for hernias grading them between H1 and H4. H1 being a small hernia that reduced on lying supine and H4 a recurrent or irreducible inguinoscrotal hernia. This scoring system is very useful for planning the list from a point of view of resources, type of anaesthesia proposed and for on-going data collection and audit. We assessed all the patients, checked blood pressure, Haemoglobin and sickle cell status and then planned the lists for the next day.
Monday - Friday
We were allocated three theatres in the surgical block for the 5 day mission. The theatre staff were very welcoming and we quickly developed a good rapport. We all stuck our first names on a label which broke down any barriers and emphasised that we wanted to work as a team to maximise the work we could do in this short time. We set a goal of operating on 100 hernias. We donated a diathermy machine to the hospital as well as 6 suitcases full of equipment that Pedro had brought. I operated with Sinha in Theatre 3 alternating cases. Our theatre team included ‘Old Sam’ an anaesthetic practitioner who was an expert at spinal anaesthesia, Eunice and Felica our theatre nurses and Gloria a circulator. The conditions were sweltering and even the Ghanaian staff said it was hot. On that first day I had to change my scrub top 7 times! As well as the heat we had some serious hernias to contend with. A lot of the hernias had been neglected for many years and were very large and stuck to cord structures. This made a big difference to the small hernias I’m used to operating on in the UK. We worked from 7:30 am when we were picked up from our hotel until the last case was done which was usually anywhere from 8-10pm. All patients had an operation note completed by the operating team and were sent home with a 5 day course of oral antibiotics and analgesia. We kept a prospective database of all the patients that we operated on. One of the main aims of OH is frugal innovation. Surgery is expensive but potentially lifesaving as Mr Oppong found out when two of the patients that were due to come in electively turned up with strangulated hernias. OH uses sterilised mosquito net as alternative to the expensive alternatives although we still rely on industry support for their kind donations. As mosquito net is very cheap it allows the local surgeons to perform an economical tension free mesh repair with consequent low recurrence rates.
Patient safety is the most important factor when we operate and something that has been in the spotlight over the last few years. We used a simple ‘timeout’ on the theatre whiteboard with patient details, operation proposed and who the team was for each day. This is something that the local staff found useful and was beneficial to us as Surgeons in a different environment. Aida and Carol also spent the week acting as scrub nurses but also sharing the benefit of their experience from working in the USA with the local theatre team. Some small changes could lead to a great improvement in patient safety. This was brought into focus when we met the local Governor whose brother had died following hernia surgery when a surgical glove had been left inside the abdomen.
Adapted ‘time out’
Over the 5 days we made many friends in theatre. We worked 13 hour days from Monday – Friday but were well looked after with beautiful local dishes. Sister Josephine, the theatre matron, deserves special mention. There was a stern side to her and she ran a tight ship but as the days went on we all developed a fondness and respect for her management and people skills. We managed to perform 99 procedures including 80 inguinal hernias, 50% of which were inguinoscrotal. 21 cases were performed under local anaesthetic, 2 under general anaesthetic and the rest were spinal. On the last day we shared a bottle of champagne with all of the theatre staff. There was an amazing feeling of accomplishment but also an immersive sensation of friendship and team work. I looked around at the American team, my friends from the UK and the Ghanian staff and found it utterly bizarre that I had only met a lot of them 6 days before. This is what OH does, it brings likeminded hard working and resourceful individuals together who want to make a difference and I hope this is what we’ve done.