Spanish Team at Phnom Penh airport

Hebron International Hospital, Phnom Penh, Cambodia, Nov 24-30, 2013

Spanish Team at Phnom Penh airport

Spanish Team at Phnom Penh airport

Team members: Enrique Navarrete; Francesc Marsal, Pilar Concejo, Cristina Gonçalves, David Pares, Antonio Curado, Marina Infantes (surgeons) and Mar Felipe (anaesthetist).

On 23rd. November 2013 a group of seven surgeons and an anesthetist from different cities in Spain arrived at Barcelona Airport to fly to Phnom Penh the capital of Cambodia with Qatar Airways on an Operation Hernia Mission. Thanks to the efforts of our agent we were allowed a baggage weight of 23 kg. Without having to pay any additional fees . On November 24th. we arrived at Phnom Penh where we were met by Stephen Kim the coordinator of the Hebron Hospital who saw to our safety and comfort for the rest of the week. On the advice of Prof. A. Kingsnorth and the previous group we had booked accommodation near the Hebron Hospital at the 9 Dragon Hotel. This allowed us to reduce the daily travel time to our workplace since the traffic in the city was very difficult.

The Spanish Team & staff Hebron hospital

The Spanish Team & staff Hebron hospital

The patients before surgery

The patients before surgery

We used the Sunday afternoon to sort out our surgical material in the operating area. Construction on the Hebron Hospital was begun in 2007 and currently there are three operating theatres and 70 in-patient beds.

On Monday 25th. November we attended a religious ceremony together with members of the hospital before starting our work in the operating theatre. We carried out 4 days of surgical activity , as on November 29th. there were no patients ready to be operated on and during the web we performed 55 procedures on 48 patients of all ages. The fact that we had an anesthetist in the group meant that we were also able to operate on young children.

Once we had finished our cooperation at the end of the week, we travelled to Siem Riap to visit the temples of the Angkor Wat World Heritage Site and then made a quick visit to the Batambang Prefecture to meet the Spanish Bishop there, Kike Figaredo. Hundreds of young people injured by landmines are cared for here and helped to recover.

Teaching surgery

Teaching surgery

The Spanish group have wonderful memories of Cambodia and its people and hope that new missions will be going to Hebron Hospital in the future in cooperation with Operation Hernia

Francesc Marsal

Report of Operation Hernia’s Mission to Ho Volta Regional Hospital
November 2013

The Stats!

Location

Volta Regional Hospital in Ho, located in the Volta Region to the west of Ghana
Approximately 3 hours drive from the capital city, Accra

Personnel

From the UK: 3 consultant surgeons, 2 surgical registrars, one scrub nurse
Charge nurse Sister Josephine, who managed everything!
More than 10 theatre staff who rotated between recovery and theatre
Experienced anaesthetic nurses who could give spinals faster than we could scrub!

Patients

98 patients were recruited, 97 patients operated

Facilities

Initially three theatres, with the fourth emergency theatre being made available to us on the final 2 days.

Fixed operating lights and mobile lights
Sutures, gloves, instruments and mesh were brought by the team
2 diathermy machines present from previous trips, we brought a third
Unfortunately no air conditioning was available due to maintenance

Hospitality

We received 5-star treatment from hospital administration and theatre staff
Food and water between cases
Constant care and attention to our every need!

The Story

We congregate at the Baptist Guest house prior to departing to Ho. We meet Mr Oppong who has already arrived early, full of energy and knows everyone’s name. We all feel instantly special. We meet Bernard our hospital representative, who has already been coordinating things behind the scenes. A quick breakfast is followed by us loading up into our respective vehicles and the journey to Ho begins. It a beautiful 2.5hr trip, but one full of contrasts. The beautiful lush landscapes give way all too frequently to little townships, were the even from our vehicle we can see the poverty that so many live in. Grand buildings are side by side with mud huts, small mansions next to tin shacks. Our driver is enthusiastic, and often has to be reminded that we are not thrill seekers. The road is in relatively good condition with the usual perils of overloaded motorcycles, formula one-esque taxi drivers and the ubiquitous tro-tro (public minibus).

Our prayers are answered and we arrive safely at our accommodation. Our residence can only be described as beautiful. To say more would be to tempt you to join the mission for all the wrong reasons!

After a brief lunch we visited the Volta Regional Hospital. We meet the director of surgery, his administrator, head of finance and a senior surgical resident. We are welcomed into a conference room as if we were visiting dignitaries! After introductions and a heartfelt welcome it is time to see the rest of the hospital and staff. It’s a relatively new building, we are told as we walk around. All the buildings are bungalow style sprawling as far as eye can see. Fortunately the walks between the buildings are shaded. The first thing commented on however by our senior visiting surgeon was the ample parking available. I think this alone made his day!

On to the ward to see the patients preoperatively. They have been selected over a period of months, and are eagerly awaiting our arrival. As we enter the ward they have been patiently waiting for us and applaud spontaneously. After a warm welcome by the ward sister, complete with crushing hugs, we begin to see the patients. All the patients are admitted the night before surgery. We reviewed 21 patients, there was only one DNA. What impressed all of us was how organised the nursing and medical teams had been. From blood results to simple clinical notes, everything was in place, and we were able to review and assess all the patients in just over an hour. An impossible feat in the UK! We returned back to our accommodation in the evening, arms full of food that had also been gifted to us.

The week is made up of grueling 15 hours shift days where we operate, ward round, clinics and data collect tirelessly, whilst supported by the brilliant hospital staff, who do overtime to allow us to finish the cases. Our fatigue is quickly forgotten when we see the gratitude of the patients when their operation is completed. Most have travelled many miles to arrive, and wait patiently for their turn with no complaints.

We were pleased to finish all operations successfully on Friday with no complications. We were rewarded with our first social night out where we went for dinner and drinks, dressed in traditional wear that had been gifted to us by the Hospital staff. We left the following day, all of us promising to return the following year!

Special Thanks

To all the theatre staff at Volta Regional Hospital, Bernard, and Mr Chris Oppong.

Miriam Adedibe

Naami McAddy

Missions
November 2013

Itinerary

We met up in Accra and were driven in the Bole Hospital vehicle to Bole on 3 November – about 10 hours journey. We were housed at the Cocoa and Shea Research Institute Guest House for the duration of our stay. We were served breakfast and dinner every day. Lunch was usually provided in theatre. We returned to Accra on 9 November and to our respective homes thereafter.

Activity

Work started with team briefing usually about 07.45 and finished with team debriefing at about 18.30-19.00 hours most days. Prior to our arrival, patients were invited through radio broadcasts to register for surgery. We understand that a total of 205 patients turned up during the week. Of these, 101 patients underwent a total of 126 procedures during the five-day working week. The vast majority of the procedures were performed under local anaesthesia, with a few under spinal and five children and one adult lady under GA. The procedures performed were:

HERNIAS 85

HYDROCOELES 39

EPIDIDYMAL CYST 1

EXCISION OF TUMOUR 1

TOTAL 126

Miscellaneous

The local hospital doctor joined Mohan most days and obtained experience in performing some of the procedures.
The theatre team was well motivated, hard-working and very efficient.
The operating light in theatre one was very dim making visibility difficult.
There were two episodes of power outages on the first day with operations being completed with the use of torch lights.
There were no critical incidents.
One patient who underwent repair of bilateral inguinoscrotal hernias under spinal developed scrotal haematoma and was still an inpatient at the end of the mission.
The hospital donated traditional attires to visiting surgeons as sign of appreciation.

Recommendations

Arrange activity to coincide with times when demand for farming is less, for example, November and February. The heavy turnout during this trip might have been due to the diminished demand for farming at this time.
Mission activity should be extended to a period of two weeks to ensure maximum coverage at peak periods. The two week period might be covered by two separate teams if necessary.
Bole District Hospital would appreciate the donation of any medical equipment including a functioning theatre light.
Local doctors in the Northern Region of Ghana could be invited to participate and learn how to repair hernias during missions.

Missions
November 2013
Mission to Takoradi

The team arrived in Accra on the evening of Saturday 2nd November 2013. As a registrar in General Surgery this was my first trip with Operation Hernia, but I was travelling with experienced Operation Hernia member Melanie Precious and fellow first-timer Nicola Perrin, both Operating Department Practitioners, along with a large supply of surgical and anaesthetic equipment. The rest of our group comprised of Chris Macklin (Consultant Surgeon), Jurij Gorjanc (Consultant Surgeon from Austria and President of the Slovenian Hernia Society), Khaled Ismail (Consultant Anaesthetist), Beverley Parker (Registrar in Anaesthesia), Rafay Siddiqui (Registrar in General Surgery), and our team leader Shina Fawole (Consultant Surgeon), on his seventh Operation Hernia mission to Takoradi.

After a late-night dinner and an initiation to the unconventional practices of Ghanaian taxi drivers (including rolling backwards down the hill to start the engine, and opening the passenger side door to get the radio to work!), we spent our first night in the comforts of the Baptist Guest House. After a minor drama with an early-morning altercation between Melanie and a cockroach (“don’t you dare come any closer to me…!!) we set off on the three and a half hour minibus journey to Takoradi. We received a very warm welcome from our host Lillian and her helpers at the villa in Takoradi, and they even arranged a solar eclipse to mark our arrival! After unpacking our medical supplies we spent a relaxing and enjoyable afternoon at the Busua Beach Resort. In the evening we were visited by Dr Bernard Boateng, Chief Medical Officer of the Ghana Ports and Harbour Authority (GPHA) Hospital, and the plan for the week was set out.

On Monday morning the hard work really began. Each day a team of between two and four of us travelled to Dixcove Hospital, GPHA Hospital and the Takoradi Hernia Centre. The patients had been assessed and selected by Dr Boateng beforehand, and after a brief ward round to review all of the patients for the day, and decide on the most appropriate anaesthesia, the list started. We were warmly welcomed at all three hospitals, and worked alongside the local theatre teams and nurse anaesthetists, who were particularly skilled at spinal anaesthesia. Between the teams we operated on 105 hernias and 7 hydroceles in 107 patients, including 19 paediatric patients and 6 patients with recurrent hernias. Fifty-seven patients were operated on under spinal anaesthesia, 24 had a local anaesthetic and 26 had a general anaesthetic.

The days were long and intensive, but it was undoubtedly worth all the hard work to be able to achieve so much in just 5 days of operating. The impact that we were having on the patients was clearly apparent; I particularly remember one elderly gentleman who had travelled for nearly twelve hours to have his hernia repaired. The children were amazingly brave and compliant, not a word of objection or a tear from even the youngest ones. On one of the days at Dixcove Hospital, a local surgeon attended our list, and we were able to show him how we use the hernia meshes to reduce the recurrence rate for inguinal hernias. As a team we were fortunate enough to have both a Consultant Anaesthetist and a very skilled Anaesthetic Registrar with us, and as well as enabling us to operate on more children by means of general anaesthesia, it was also clear that the local nurse anaesthetists benefited from the training and advice they provided. Likewise, our experienced Operating Department Practitioners, Melanie and Nicola, were able to work alongside, and pass on their expertise to, the local theatre staff.

But it was not just the patients and the local theatre staff who benefited from our mission. All of the Operation Hernia team members gained invaluable experiences from the trip, which provided us with insights into our own practices in the UK and an appreciation of our own privileged situations, as well as improving our ability to adapt to challenging situations and make the best possible use of the minimal resources available. We are all especially proud of Melanie, for mastering the art of the scrotal bandage, after what was, it has to be admitted, a rocky start! As a group we are very thankful to Shina for his guidance, support and unwavering encouragement, unperturbed by any obstacle, apart from those baby lizards! Despite problems with an intermittent water supply, Lillian and her team ensured that we were comfortable, well fed and well looked after for the whole week, and we all appreciate her efforts.

From a personal perspective I feel very privileged to have been given the opportunity to be a part of such a fantastic, life-changing organisation. I am grateful to the other members of the team who were all wonderful colleagues and companions, and who provided much friendship, support and laughter. As a trainee surgeon I am particularly grateful to Chris, Shina and Jurij, whose patience and skill in training enabled me to operate on more challenging hernias than I have ever encountered before. I hope that I will continue to be involved in future missions with Operation Hernia.

Hannah Welbourn, ST8 General Surgery

Teaching mesh repair of inguinal hernia

First mission in Tanzania Team Report from Korogwe District Hospital, Tanzania. Oct-Nov 2013 From Karl Moser.

Teaching mesh repair of inguinal hernia

Teaching mesh repair of inguinal hernia

We arrived on the 25th October in Dar Es Salaam International Airport. In order to work as a doctor in Tanzania it is mandatory to have a temporary medical licence. This licence was issued from the Regional Office of the Ministry of Health of Korogwe District for free, with the enormous help of Rashid. Usually the temporary medical licence would cost 300 USD per physician! With this document one has only to apply for a tourist visa at home or at the airport. As the custom officers in Tanzania are very strict, it is also advisable to send Rashid a list of all medical items and drugs which you plan to take with you. Rashid will then ask the customs for clearance in advance. With a letter of the Regional Ministry of Health in his hands, it was no problem to pass the customs with 250 kg of medical equipment within a minute. As we arrived late we stayed one night in Dar Es Salaam. As the travel distance to Korogwe from Dar Es Salaam is equal to the distance from the Kilimanjaro Airport it seem to me more advisable to fly to the latter. There is a direct flight from Amsterdam to Kilimanjaro Airport whereas to Dar Es Salaam one is usually forced to stop over in Nairobi.

On the 26th October we arrived in Korogwe Hospital after 4 hours’ drive over an acceptable road in two Landrovers. We were welcomed by the Hospital Staff. We were guided to the office of the head of the Hospital. There the Surgeon Sister Dr. Temba had prepared a speech were she told us that she performed 125 hernia surgeries last year with a recurrence rate of 25%. At this moment we already suspected a possible systematic mistake. Then all 65 patients who were scheduled to be operated the following week were presented to us. The hospital staff had already grouped the patients according to their day of operation. While one part of our team examined all patients, the other group set up the OR.

In the Korogwe District Hospital there are two very well maintained operating rooms with a functioning air condition, emergency generator, cautery in each room (Erbe) and 1 brand new anaesthesia machine. For our materials a metal rack was prepared, where we could store our items safely. In summary I had never experienced such an excellent organisation in Africa before! On the 27th October we started operating. The patients were excellently prepared. The correct side was marked, every patient had an infusion running and 2 infusion bottles next to him. Due to this fact the turn over time for each operation room was incredibly low – around 10-15 minutes. Our anaesthetist was supported very professionally from Dr. Muya .

Dr. Temba showed very much interest to learn the newest techniques in hernia surgery. We taught her the Shouldice technique and the correct Lichtenstein technique with mosquito meshes. The meshes we brought along, were sponsored by Prof. Dr. Kingsnorth. After a very short learning phase Dr. Temba did very well and was able to perform these operation on her own safely. When we operated the first recurrent hernia we found out, that the hernia sac was only reduced to the inguinal canal and the external ring was then closed with non-absorbable sutures. This resulted in a very heavy scarring around the external ring and caused – of course- the high recurrence rate. As the recurrence rates were equal in the whole Korogwe District Dr. Temba informed the other surgeons in her district and invited one colleague to learn the correct technique from us.

The hospital staff under supervision of Mrs. Shangwe supported us every lunch time with an excellent meal and during the day there was never a shortage of water, coffee and tea or nuts – even better than at home. As nobody was hungry or thirsty, we managed to operate – due to this excellent organisation – 64 patients -including 12 children- in 5 days in a very comfortable, warm atmosphere. The night we spend in The White Parrot Motel, which was very clean, had good food and bar. The best rooms are however on the ground floor, where the water-pressure for the morning and evening showers is acceptable. All rooms are equipped with a TV, air-condition and mosquito net.

During my stay I was lucky to have my birthday. I celebrated with the hospital staff and my team (38 people in total) a real African Birthday! This was marvellous and an extraordinary experience!! Therefore I highly recommend that more teams should go to Korogwe district Hospital!!! I hope that all administrative barriers are now taken. The Medical Officer of the Korogwe District said following clear words, when we addressed the issue of the fee for the temporary medical licence:

“We think that we have gained more from you, than you from us.”

The teams

The teams

PREMIER OPERATION HERNIA MISSION TO KETA HOSPITAL, VOLTA REGION, GHANA
NOVEMBER 9-16, 2013
Mission to Keta Hospital

Operation Hernia activity in Ghana continues to expand. In 2012 a team led by Chris Oppong made a very successful visit to Ho Hospital in the Volta Region of Ghana for the first time. This year, another team made a premier visit to Keta Hospital, also in the Volta Region of Ghana. This brings to nine, the number of Operation Hernia centres in Ghana. The centres are: Bole Hospital, Nalerigu Hospital and Carpenter in Northern Ghana; Takoradi Hospital, GHPA Hospital and Dixcove Hospital in the Western Region; CapeCoast Hospital in the Central Region; Ho and Keta Hospitals in the Volta Region.

Planning: The success of the mission was due to the hard work put into local organisation by the Hospital Administrator, Mr Serene Akpenya, supported by the Medical Director. They deserve very high commendation. Patient recruitment was so efficient, they had over 200 patient registered for the mission. This was as a result of very effective publicity. Half of the patients were reserved for the next mission from Holland in January 2014. All the patients were screened by local doctors, and registered with known mobile telephone numbers. This allowed the hospital to change appointments without difficulty. This will hopefully facilitate follow-up which has been a major issue. Our accommodation was in a local hotel. Transportation was efficiently organised. We had a breakdown on our way from Accra but a replacement vehicle was soon arranged. At the end of our mission, the team were congratulated by the Regional Medical Director.

Team: The team was made up of three Consultant surgeons (Terry Irwin, Roger Watkins and Chris Oppong, the Leader) one Anaesthetist (Stephen Millen), two nurses (Jenny Irwin, Caroline Lee) and a medical representative (Jess Peace). The team stayed overnight at the Baptist Guest House in Accra and were picked up the following day for the trip to Keta. All the surgeons were experienced Operation Hernia Surgeons. The team spirit generated was tremendous.

Theatres: Patients were reviewed by surgeons and their hernias graded and theatre list prepared. All patients had a pre-operative oral antibiotic and an analgesic. We had at our disposal two regular theatres and one theatre that was a converted recovery ward. This latter theatre was used for local anaesthetic cases. All theatres were equipped with diathermy machines. One had to be repaired by local engineers. The theatre and ward staff were all excellent.

Outcome: A total of 101 procedures were performed of which 87 were inguinal hernia repairs, 1 incisional hernia and 2 paraumbilical hernia repairs. 11 hydrocoeles were repaired as well. 5 of the hernia patients were under 12 years old (respectively aged 2, 2, 3, 11 and 12 years). 44% of the hernias were scrotal (Kingsnorth H3, H4). Only 5 procedures were carried out under general anaesthetic. All the other operations were performed under either local anaesthetic or under spinal anaesthetic. GA was administered by the team anaesthetist. Spinal anaesthetic was provided by a competent local nurse anaesthetist and the team anaesthetist. Recovery after GA took considerable amount of anaesthetic time. Teams should equip themselves with portable pulse oximeter. This proved invaluable. Only one immediate complication was recorded: a scrotal haematoma that had to be evacuated in theatre.

To conclude, the premier Keta mission was hugely successful in every department. I will recommend the centre to future volunteers.

Chris Oppong

November 2013

Mission to Nalerigu Baptist Medical Centre
October 2013

Ghana was a very beautiful country. The people were very welcoming, we really felt like at home. The capital Accra is a big nice city. Almost all of the people speak English.

The surgical team comprised two consultant surgeons (Prof Guido Schuermann, Germany and Mr Chris Oppong –Lead, UK), two registrars (Ahmed Elmeghrawi, Germany and Miriam Adedibe, UK) and a nurse Kristina Horvath from Switzerland. Prof Guido was accompanied by his wife. Dr Zainab Alhassan, a surgical trainee from Komfo Anokye Teaching Hospital, in Kumasi Ghana, was sponsored under a new Operation Hernia Ghana Fellowship scheme to join the team for training.

Travel:

Most of us travelled on Portugal Airlines PTA and stopped over in Lisbon before connecting to Accra, Capital of Ghana. Mr. Chris Oppong and Miriam had arrived few days earlier.

We were met at the airport by Mr. Oppong and stayed overnight at the Baptist Guest House. The next morning we flew to Tamale in Northern Ghana and from there went by hospital 4-wheel drive to Nalerigu a journey of a couple of hours. Most roads were mostly tarred but one had a bumpy segment that was not tarred.

Hospitality:

We were warmly welcomed by the Manager of the Guest House in Accra. The accommodation was basic but comfortable. All our needs were met.

In Nalerigu Baptist Medical Centre we were housed on the hospital grounds in comfortable houses set in a picturesque setting of trees. The houses were well furnished. It was a pleasant surprise. The food was delicious, available at three times daily, breakfast (serve yourself), lunch & dinner.
Theatre staff:

There were at least 4 trained nurses and 2 auxiliaries. We had 2-3 anesthetists each day. They offered a good service. All the staff were competent. The anesthetists were skilled in spinal anaesthesia and were committed to quality patient care. The staff were very cooperative and helpful. The intensity of work we asked for was demanding, but they tried to cope. Most of our days ended after 4 pm. Perhaps the scene was set for such cooperation by an engaging speech made by Mr Chris Oppong and Prof Guido when we met the all theatre staff at the beginning of the mission.

Facilities:

2 theatres, one minor surgery room, one changing room, the sister’s office, a stock room, a sterilization room with one autoclave. One of the theatres was very large and was split into two theatres when required, e.g. when they had a Caesarean section. Each theatre had the following facilities:

Theatre table: old but functioning.
Anaesthesia machine: we didn’t use it, because of lack of oxygen cylinder.
Monitor: which was modern.
Ceiling theatre lamp: in only one theatre.
Standing lamps which had poor focus.
Air conditioner worked in both theatres.
Diathermy machine: in both theatres.
Surgical instruments & supplies: were adequately provided.

All theatre gowns, surgical drapes and gloves were provided by the hospital.

Outcome:

We operated on 44 patients and performed 46 procedures. This is a credit to the theatre staff for being willing to work hard to ensure that no patients were cancelled because of theatre time. All hernias were graded using Kingsnorth Grading and all operations were entered into Operation Hernia Database.

All hernia repairs were performed with affordable mesh, and all patients received perioperative antibiotic-prophylaxis (one single shot at induction), then regularly for 5-7 days. Most of the operations were done under spinal anaesthesia (apart from two inguinal hernias in which the repair was done under local anaesthesia).

Training:

For the first time Operation Hernia sponsored a local surgical trainee on a new scheme called the Operation Hernia Ghana Fellowship. The purpose of the scheme is to fund Ghanaian doctors to join Operation Hernia missions to gain more experience in Mesh Repair. The scheme was pump primed by a generous donation from Prof Guido Schuermann and was very successful. Operation Hernia is grateful to Prof Schuermann.

Social:

We could find time to visit Tamale’s famous traditional market, we all bought worthy beautiful gifts, souvenirs, etc.

On the last day in capital Accra some visited the national museum, where we were informed about the dark history of slavery in Africa.

We spent some time on the Atlantic Ocean beach, where we experienced riding horses. We also tried out some of the delicious dishes e.g. chili Fufu in one of the Ghanaian restaurants

Achievements:

44 operations performed in 5 working days.
Mesh-repair of hernias (more effective treatment) under antibiotics cover.
Training one local surgeon in mesh-repair.

Thanks

We would like to thank Dr Lisa Morhman the American surgeon, who delayed her departure to the US in order to supervise the mission. Our thanks also go to Mr Edward Addai, the hospital administrator for his hospitality.

The great success was mainly possible because of the incredible teamwork. Every team member participated fully in all the activities. There was an early start in the morning for post-operative ward rounds, followed by assessing the new cases and then operating all day long and into the evening.

We will be back………….

For operation hernia Nalerigu 2013

Dr.Ahmed Elmeghrawi.

Land of the Blue Sky

Fourth Year for Operation Hernia in Mongolia September 2013

Land of the Blue Sky

Land of the Blue Sky

Mongolia 8-20 September, International Team

Country

Mongolia is a country on the central part of Asian plateau situated between China and Russia. In Europe Mongolia is known as a low-income country, where the healthcare system has poor infrastructure and old equipment – in my opinion it is not truth in 100%. Mongolian people are also known as a very proud and brave nation – and this is absolutely true. The best chance to see all wonders of The Land of Blue Sky is to travel by car (better to take 4×4). What a traveller can see, meet and taste are beautiful and breathtaking landscapes, hospitable herdsmen who own totally 40 million horses, goats and sheep (the goats and sheep were very important for the team). The taste of a mutton stew, horse meat, tea with goat’s milk and especially khoomis is something what cannot be forgotten. Let’s say something about Operation Hernia in Mongolia – because it was the main goal of this trip for all of us.

Team

It was a pleasure to work with this truly International Team comprising Andrew Kingsnorth (UK); Maciej Śmietański Poland), Kamil Bury (Poland), Teresa Butron (Spain), Giorgio Giorgobiani (Georgia) and Martin Kriz (Sweden). We received huge support from every surgeon that we met on our route but especially we are grateful to Dr. Naraa and Dr. Sanchın and Enkhee

A herdsboy

A herdsboy

Performance at the National Theatre

Performance at the National Theatre

Journey

We landed at the airport of Chinggis Khan – Ulan Baatar (UB) on Sunday morning – as it turned out we all flew from Moscow on the same flight so there was no problem with the gathering. After breakfast we set off on a journey through the wilderness of Mongolia.

During the two-day trip we drove nearly 400km, we spent one night in the middle of nowhere and during the same night we took part in a Mongolian wedding. A lot of drinks and strange meals – but it was a marvellous experience. On the way back to UB at the special invitation of one of the surgeons we were able to take part in a horse race – a lasting impression and experience that we will never forget. After returning to UB we were divided into two teams. The team I was operating at the University Hospital and the other at the prison hospital. Operations performed at prison hospital resulted in three interviews for Mongolian TV and an invitation to dinner by the Head of the prison hospital. During our stay in UB, thanks to the hospitality Dr Naraa, we admired a fabulous performance in the National Theatre. The performance presented the culture and history of Mongolia in a magnificent way.

Teaching

Teaching

Operation Hernia

We operated on 78 cases, which included 20 children, 16 prisoners and 4 reconstructions including Ramirez and one cholecystectomy. We had a mixture of incisional and inguinal cases. The operating lists were tightly-organized but thanks to very good organization of work in the operating theatres we had no problems with performing all procedures. So we were able to do cases ourselves or assist and teach the Mongolians surgeons as appropriate. Andrew, Teresa and Martin gave lectures to the local surgeons. In the opinion of Mongolian surgeons the topics were well chosen and the knowledge gained will be very helpful in normal everyday work.

In a nutshell– the work was the same as on every Operation Hernia mission – early start in the morning for a post-operative ward round, followed by assessing into the new cases, then operating all day long and in the evening… night life in UB.

The great success of that mission was mainly possible because of the distinguished capacity for teamwork of every participant. All team-members expressed their wish to participate on the next humanitarian mission under the auspices of Operation Hernia.

We will be back…

For Operation Hernia from Ulaan Baatar

Kamil Bury

The team with Baba (Karim)

Eruwa June 2013

The team with Baba (Karim)

The team with Baba (Karim)

Operation Hernia Report – Mission to Eruwa, Nigeria, 8th-16th June 2013

The Journey

Months of preparation and e-mail contact had come to an end when the Operation Hernia (OH) Team for the mission to Eruwa, Nigeria, assembled in London’s Heathrow airport in anticipation of an exciting adventure. After an uneventful flight, and cordial welcome to Nigeria by the vaccination officials, we were delighted to be greeted by Dr Oluyombo Awojobi (Yombo) and his colleagues in Lagos. We continued our journey to Eruwa the following day and were grateful to the driver and our armed escort for avoiding vast amounts of livestock traffic and successfully negotiating large craters in the road. Having reached Eruwa, the impact and effort of the OH teams before us was evident by the warm welcome we received, the prior organisation by Dr Awojobi’s clinic, as well as the recently opened hernia centre. We had a lot of work to do, and a lot to live up to.

The Team

It was a pleasure to work with this truly International Team comprising Dr Aleksander Stanek (a Polish surgeon from Northen Ireland), Dr Constancio Marco (Surgeon from Barcelona, Spain), Dr Richard Salam (Anaesthetist from Nigeria now working in the UK), Dr Gregory Wirth (Urologist from Geneva, Switzerland), Miss Sophie Pitt (medical student, UK), and myself Dr Iestyn Shapey (Surgical Registrar from UK). The team gelled immediately and worked closely and very successfully throughout the project. Dr Stanek’s prior experience as consultant surgeon for two years in Abeokuta, the nearest large town to rural Eruwa, was invaluable as he led this international team. We were privileged to have Baba Karim, Yombo’s chief theatre nurse, and his staff working with us throughout the week, and without whom the day to day functioning would not have been possible. Finally, a great debt of gratitude to Yombo and his family, and his five surgical registrars who rotated in and out of the various roles of assisting, operating and anaesthetising.

Teaching the local registrars

Teaching the local registrars

Operating until late

Operating until late

The mission

Seventy patients underwent surgery over 6 days of operating with 100% discharge within 24 hours and no immediate complications. Most had large (Nigerian-sized) inguino-scrotal hernias, many with synchronous testicular pathologies, which demonstrated to us the value of our multi-specialty team. Initially, the days were long as we found our feet, and surgeries were being performed well after dark. However, we soon established a sound working-pattern and slick process by starting with a clinic review of all patients, producing an optimal running order according to anaesthetic requirements and pathology, and getting to work. In addition to providing high quality surgical care, the team also sought to teach and supervise the local surgical registrars in performing tension-free mesh (Mosquito net) repair. By the end of the mission three of the residents could successfully perform the procedures themselves from start to finish.

The team with Yombo & Tinu Awojobi

The team with Yombo & Tinu Awojobi

Legacy

The distance that patients travelled to receive treatment at Eruwa (some came from Lagos) was testament to years of Yombo’s hard work, the establishement of the OH mission, and the previous teams’ legacy in building the hernia centre. What would be the legacy of the 2013 mission? We were delighted to learn from Yombo that the five surgical registrars were inspired to continue their experience of newly learnt techniques by utilizing the hernia centre facilities on a weekly basis outwith their regular clinical duties.

Iestyn Shapey

Surgical Registrar, UK

Hebron International Hospital

Phnom Penh, Cambodia May 2013

Hebron International Hospital, Phnom Penh, Cambodia, May 15-25 2013

Team members: Andrew Kingsnorth, Scott Leckman, Denis Blazquez, Petr Bystricky, Simon Clarke, Sheri Kardooni (trainee) & Paulina Mysliwy (anaesthetist)

Darkness descended on Cambodia in 1975 when the Vietnam war extended into Cambodia and the Khmer Rouge took over the country. Evacuation of the cities, genocide of three million of its fifteen million people and 10 years of rule by the Soviet-backed Peoples Republic of Kampuchea resulted in unbelievable suffering and horrors for the surviving population. Since the country was reunited under the monarchy in 1993, huge strides have been made to re-establish the culture and rebuild the economy of a country that originated in the vast 9th century Khmer empire that dominated the Indo-China peninsula. Angkor was the centre of power of this empire, where an unimaginable series of temples (Wats) were constructed and which, through satellite technology has been established as the world’s largest pre-industrial city, with an estimated population of one million.

Food market economy

Food market economy

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Finger print consent

Cambodia has just lifted itself into middle-income status with an average per capita income of $1040, although 20% of people still live below the poverty line on less than $1.25 per day. Health indicators are dismal; life expectancy is 60 for men, and 65 years for women and 23% of children die before the age of 5 years. It is the third most land-mined country in the world; 60,000 have been killed and thousands maimed, many being children playing in the fields or herding animals.

Tourism is the second largest source of hard currency and the main exports are timber, rice, fish, garments and rubber. The legacy of the war-torn countryside is one of the highest levels of deforestation in the world: primary forest cover was 70% in 1969, in 2007 it was down to 3%. There is free compulsory education for 9 years, literacy rates are over 70%. Few hospitals exist, and healthcare provision is largely left to a poorly trained private sector.

Our base in Phnom Penh was in the remarkable Hebron International Hospital (HIH) in a poor district near to the international airport. It is staffed by a Korean Medical Ministry team, which provides two levels of care – primary care for local residents and a base for short-term mission teams such as Operation Hernia. HIH opened in a small house in 2007, progressed to construction of a 70 bed hospital with 3 operating theatres and a staff accommodation block in 2010, with a vision to open a nursing school and a medical school in the next 20 years. This degree of commitment is quite extraordinary.

Sheri assisting Scott

Sheri assisting Scott

We were housed in a respectable but inexpensive hotel in Phnom Penh, and transported by minibus each morning to the HIH. The team had two paediatric surgeons (Simon & Denis). Andrew, Scott and Petr were able to handle the older children, so we had decided to run a “Children’s Hernia Hospital” for a week. Without gaseous anaesthesia Paulina improvised magnificently to enable the team to operate on over 70 children in the week of the mission, which was a remarkable achievement and brought many happy and tearful smiles to the parents of these children .

The team managed a trip to the Angkor Wat at Siem Reap and harrowing visits to the Tuol Sleng torture chambers in Phnom Penh, and the mass burial graves and Genocidal Centre at Choeung Ke.

Operation Hernia has plans to provide a long-term commitment to HIH.

Andrew Kingsnorth