Eruwa, Nigeria, June 2009

The Operation Hernia first "mission" to Nigeria has come and gone but the experience and the lessons learnt will always be remembered by all participants for the rest of our lives. I was a part of the Nigerian contingent that met with Professor Andrew Kingsnorth on his initial 'survey' visit to Eruwa. So I was very happy to jump at the opportunity to come and participate in the Operation Hernia project when the date was announced.
I arrived in Eruwa on Saturday 27th June, 2009 as part of a group of four residents (3 registrars & 1 senior registrar) from the department of surgery of the Olabisi Onabanjo University Teaching Hospital (O.O.U.T.H.),Sagamu, Ogun state. We initially made a stop-over at the General Hospital, Igboora to pay our homages to Dr A.C. Sagua,FRCS(Ed),FWACS, who is the consultant General surgeon there and the initial point of contact for the reality called Operation Hernia Nigeria.(It was he who met with Prof Kingsnorth in Ghana and suggested the idea of Operation Hernia Nigeria to him). We arrived Eruwa at about 4:30pm by road. We were warmly welcomed by Mrs Awojobi (Dr Awojobi's amiable wife). We were shown to the doctors' flat where we would reside for the duration of our stay in Eruwa and we settled in as quickly as we could.
Later that evening, we met with Dr Awojobi, Professor Kingsnorth & Dr deKoch (from South Africa). After preliminary introductions and pleasantries, we fixed a meeting for 9p.m. that night for a formal de-briefing about the schedule of activities for the following days. At the meeting we were given a pre-exercise questionnaire to fill and we were told about the daily time-table of the programme. We were expected to resume for work by 7:30a.m. the next morning.
The Operation Hernia started 'proper' on Sunday 28th June, 2009 and the venue was the AM eye clinic complex located within the premises of ACE(Awojobi Clinic Eruwa). It began at about 7:45a.m. with a lecture on the Lichtenstein tension-free mesh repair technique given by Prof. Kingsnorth. After this, we proceeded to examine the patients that were already present for surgery. A total of forty(40) patients had been booked for the expedition. There we learnt hands-on classification of hernia types to determine the duration of the surgery and type of anaesthesia to be used. We then proceeded to the operation theatre where we had a series of photo sessions to commemorate the epoch making event of the first mission of Operation Hernia to Nigeria. There were two operating tables so that two surgeries could be going on simultaneously. Three doctors scrubbed for each patient; the surgeon, assistant surgeon and 'scrub doctor', I mean 'nurse'. This was so because there was only one nurse available who served as a running nurse for both operating tables, hence a doctor had to scrub in as the scrub nurse. However, as the day progressed the surgeon decided to be picking up the instruments himself from the sterile tray hence the duties of a scrub nurse was no longer required.
We were taught how to effectively administer the local anaesthetic(LA) agent to achieve optimal neural blockade in the inguino-scrotal region. I must say here that though Prof. Kingsnorth and Dr deKoch used different methods to administer the LA, both methods were equally highly effective. The local anaesthetic used was 0.25- 0.5 % xylocaine with adrenaline.
We took turns at assisting Prof Kingsnorth and Dr deKoch initially then later they assisted the younger doctors. Emphasis was spent on outlining the anatomy of the inguinal region, the hernia sac and appropriate technique of mesh repair. I also learnt a principle of hernia surgery from Prof Kingsnorth when he said that "treat the hernia and not the age of the patient". Hence, herniotomy can be done for an adolescent or middle aged male will a tiny hernia and strong posterior wall.
We took a lunch break and we went to buy food at the restaurant within the hospital premises. At the end of the first day we did a total of ten surgeries comprising herniotomies and mesh hernioplasties. Other doctors arrived that day ,athough most went back home that same day too.We finally closed for the day at about 6p.m. Later at about 7p.m, we had a meeting to assess the days' work. In attendance were Prof Kingsnorth, Drs Awojobi,Sagua, Villalonga(Spain), Adekoya(OOUTH),Adebanjo(OOUTH),Obe(OOUTH),myself, a doctor from Korede clinic, Abeokuta and two residents from the family medicine department of the University college Hospital, Ibadan.After the meeting we were taken on a night tour of ACE by Dr Awojobi to showcase his innovations to generate and supply light at night with a locally manufactured inverter and lamps. We then retired to our flat.
We resumed work at 7:30a.m. on the second day of the expedition i.e Monday 29th June, 2009. I assisted Dr deKoch at an hydrocelectomy in the morning session.He took time to explain to me as well as assist me in every step of the surgery(I must say I did almost everything!) while every other person was busy either doing, assisting or listening to the teaching sessions during the surgeries. Dr Sagua then took all the residents on tieing of surgical knots which was a hands-on exercise,each doctor had a nylon suture to practice with. A new set of doctors joined us that day from Gboko, Benue state which is in the middle belt of Nigeria.
We took a lunch break and filled a post-exercise questionnaire to assess the program and profer suggestions. We then took our leave home in order to enable another batch of residents from OOUTH to come and resume at theprogram.
For all that it was worth, I will say that it was a very educative and fulfilling experience. The patiens benefited from the exercise not only because they had access to highly skilled manpower but received a modern repair technique at an affordable price of N6,000.00(six thousand naira) as compared to the regular cost of a hernia repair which is about N10,00.00 to N20,000.00(ten to twenty thousand naira).
THANK YOU VERY MUCH OPERATION HERNIA NIGERIA.


DR OGIDIAGBA, E.L
MBBS(Ib.)
Registrar in Surgery,
Olabisi Onabanjo University Teaching Hospital, Sagamu Ogun state, Nigeria



Takoradi, Ghana, November 2010 REPORT OF MESH REPAIR TRAINING
We will start by saying Operation Hernia Repair for 2010 was a complete success and it will forever change the image of hernia repair at Komfo Anokye Teaching Hospital.
The whole trip had initial setbacks when the hospital administration refused to sponsor trainees for the trip, but after persistent diplomatic efforts they succumbed. We got to Takoradi a day before the commencement of the programme and we immediately familiarise ourselves with the Operation Hernia Team.
On the first day of the programme we had a brief orientation and quickly moved to our first station which was Axim district hospital; there we were taken through kingsnorth classification of inguinal hernia by a consultant. We then reassessed the patients and those with other medical problems that the surgery was going to affect were either rescheduled or the surgery totally cancelled. We also had a quick refreshment of the anatomy of the groin and a theory of the mesh repair.
We were ushered into the theatre by a fantastic local team at Axim and they were of tremendous help to the Operation Hernia team. We assisted with the first two cases of mesh repair and we were carefully taken through hernia repair using mesh. Subsequently we were assisted by the consultant to do the mesh repair ourselves alternately. We then did the cases amongst ourselves interchangeably with the consultant supervising us.
I must emphasize again that Operation Hernia was a very huge success for both the patients and we the trainees. A few suggestions which we have itemised if considered can make Operation Hernia better for all Ghanaians and the trainees. They are;
• The trainees should be rotated amongst the other consultants so that they can learn from the other consultants.
• Medical officers from other district hospitals should also be invited as trainees.
• More patients should be incorporated into the programme so that more experience can be acquired.
• Operation Hernia should be held at other regions so that more Ghanaians can benefit.
• Finally ethical clearance should be sought so that mosquito nets will be the sole ingredient for Operation Hernia in Ghana.
We are sure that the knowledge gained from mesh repair will change the image of hernia repair at Komfo Anokye Teaching Hospital. We say thank you all. The team was fantastic and it was a big family to us. We say long live Operation Hernia team and together we shall all make an effort to reduce hernia recurrence to the minimum by also training our colleagues here at Komfo Anokye.
Thank you and God bless you all. Happy new year.
Dr. Boateng Nimako
Dr. Abeeku A. Hammond