Carpenter March 2013

March 2013
Supplies in Magdi's garage
Supplies in Magdi's garage

This time preparation started a long time beforehand almost more than a year ago. The team scheduled to go at the beginning was completely different from the team who actually traveled. This is due to twelve of those who originally expressed  interest, apologizing at different times due to personal reasons and two withdrew due to separate skiing accidents one two months beforehand and one a week before the trip. We managed to recruit five surgeons, one anaesthetist, one anaesthetic practitioner, six theatre nurses, one ward nurse, two highly skilled helpers, and one medical secretary.

This year’s trip faced more difficulties than previous years. British Airways withdrew the charity support and we had to book the normal way, and pay for all extra luggage. Fund raising was difficult and many struggled to meet their own cost let alone the other expenses. It was extremely difficult to get everybody together to help packing our medical equipments and know what else we needed to buy before we go. We had to diversify our sources of buying medicines to find the cheapest possible antibiotics, pain killers, local anaesthetics, meshes… etc.

The team efforts that made this mission a success, were amazing. We managed to fill up 55 boxes and bags each 23 kgs as required by BA. We had to wait till Christmas time and bought the tickets during a sale to obtain the cheapest possible fares. We have repaired our equipments with the help of our hospital engineers free of charge, Eschmann, donated two more sterilizers and one diathermy machine. We bought all necessary plates, gowns, light sources, computer printer’s cartilage, papers and all the medicines required to treat 300 patients. We have successfully arranged transport for 15 boxes with Intercare to meet the team flying from London Heathrow in time for check in. Our biggest achievement was collecting all these boxes from Accra Airport and passing through customs. After searching a sample of boxes, they let us all go, British and Canadians with more than 200 pieces of luggage. We deposited the bags next to the truck and came back in the arrivals to collect more loaded trolleys, until all luggage were accounted for and loaded onto the truck.

Logistics
Logistics
Operation Hernia team with local support
Operation Hernia team with local support

One observation was the smooth gelling between those who came before with more experience in these missions, and the new recruits who were a little apprehensive. They did not feel outsiders, they were helped and joined in the efforts from day one and felt how important and valued their service is. The work this year was less tense, more organized, easy, calm and effective. We have achieved almost the same result as the mission last year but we were less exhausted. Practice makes perfect, add to that good preparation and commitment.

The other observation was the friendship that is getting stronger between all workers, either, Ghanaians, Canadians or British and (Antje from Germany). The interdependence is growing every year. We know each other by name and we are cared for by a designated physician who is approached by anybody who falls sick from both expatriate teams. One of our nurses had an accidental needle stick. She was tested and the patient consented and tested for HIV. She was started on prophylactic antiretroviral immediately and was cared for by this designated doctor and nurses. She never felt alone and this support brought her back to work after 48 hours.

All adult patients were tested for HIV, and cared for as other patients but with more measures of protection. We tested each child for malaria when listed for an operation and started them on treatment if positive. We did not know how long we should keep the children on anti-malarial before we can safely operate on them. Our paediatrician, Dr Ellison consulted local community nurse Ernestina and both agreed that three days of treatment would be enough. Dr Ellison was consulted as well on a three years old child with a hernia who our anaesthetist Dr Tony was not happy to put to sleep because of chest wheezes. She decided the child requires a year’s treatment to improve his asthma before he could be safely operated upon under general anaesthesia.

24hrs postop strangulated inguinal hernia repair
24hrs postop strangulated inguinal hernia repair

We have managed to provide not only the direct care which we are capable of delivering but created the same hospital atmosphere of internal interdisciplinary referrals and consultation that improved our safety net and supplied more confidence and satisfaction in our capabilities.

This atmosphere allowed us to tackle one of the biggest challenge we have ever faced in our missions to date. A 35 year old man arrived with a strangulated hernia, three days before our departure date. He had his hernia in that position for a little more than 24 hours. We asked him why he did not go to a nearby hospital? He said “I do not want to die, the doctors are on strike and if they were not, I was told that nobody within 100 miles has the experience to operate on such a condition.”

He was sweaty with rapid pulse, in pain and distressed. We made the decision we will operate on him, and started resuscitation with what was left of the IV fluids, antibiotics pain killers etc we catheterized him. Dr Tony the anaesthetist decided to give him spinal anaesthesia with sedation rather then to put him to sleep as we were not sure about his oral intake before the operation. When we opened the sac the black bowel emitted offensive gangrenous odour. We had to extend the incision laterally and superiorly and there were more gangrenous bowel in the abdomen caught between the two loops in the hernial sac. We proceeded to do resection of 60 cm of small bowel and caecum and primary sutured anastomosis. The problems were the postoperative care, the IV fluids, IV antibiotics, observations, dealing with any complications. The other problem of recurrence of the hernia -as we did not put a mesh or attempt any repair- was of secondary importance. What was amazing was that the nurses came out with intestinal clamps already sterilized that I did not know we had them. When I asked as to where they got them from, they said it was me who brought them.

I knew I had to care for the patient overnight as we had less nurses than surgeons. We could not afford loosing a nurse the next day as that would put one theatre out of action. Many nurses from the British and Canadian teams offered to help. I have only accepted the help of Chris Mann who helped me with the operation. He observed the patient till midnight and I took over after that.

The Canadian team kindly supplied all the fluids, antibiotics and analgesia required. We the surgeons were not prepared for such cases (a lesson well learned). The patient had a monitor recording and hourly observations for two days. We recorded his intake and output. He received seven and half liters of fluid in the first 24 hours. He had three liters of urine output and the rest was sweat. His tachycardia gradually settled, temperature back to normal, the urinary catheter and the drain were removed on the second postoperative day. Early morning on the third day he opened his bowel three times and he was allowed soup which he appreciated. The day we were traveling back we typed all the operative information and post operative care, and gave him a copy and the local nurse a copy to deliver to the care centre with instruction on the remaining two days needed for antibiotics administration and dressing changes. We left him with lots of gifts, and some money to support his family till he can get back to work as a farmer.

The whole team from all nationalities has supported us in delivering the best care to this patient. A force from up above helped us to succeed, and protected him from complications.

This story tells us we not only have the skills to cure ailments but we can also save lives. These skills carry responsibilities and we should be prepared for that. Together with these medical skills, preparation, communication, team work, respect and love, supporting each other in work and difficult decisions, re important attributes. These are talents we learn and implement in our missions and daily lives, because they work.

This man’s wife told us “without you I would have been burying my husband now, thank you for not making our children orphans and me a widow”.

Magdi Hanafy

Consultant Surgeon

Mid Cheshire Hospitals NHS foundation Trust

Volunteer for Operation Hernia.

 

On behalf of Team Carpenter 2013 (Ghana-Canada-UK-Germany)