1. TECHNICAL REPORT:
a. DATES AND LOGISTICS USED:
Campaign conducted from 3 to 13 November 2022.
b. ADULT PATIENTS: Inguinal, umbilical, ventral hernias, goitres, lipomas and sebaceous cysts,
c. PEDIATRIC PATIENTS: Joint campaign with another paediatric campaign in Banjul (Gambia) where all children seen in consultation are referred.
Total procedures: 105 procedures
Total patients: 90 patients
d. COMPLICATIONS (at 7 days PO):
2 urinary retentions, 1 cervical seroma.
2. REPORT OF THE CAMPAIGN
a. THE LOCATION
The General Hospital of Farafenni is a centre created in 1999 with the government’s commitment to be the centre of reference in the east of the country Gambia, with health resources centred in the capital (Banjul). It is a large, well-equipped and well-organised centre, consisting of 250 beds with a current occupancy of 175 due to the possibility of human resources.
Farafenni is a small inland town situated in a strategic location near the only bridge located across the Gambia River. It is therefore a place of passage not only for local trade, but also to allow the crossing from one part of Senegal to the other. The population to which it provides services is indifferently from both countries. The languages spoken by the the population are mainly Wolof and Mandinka. The hospital is divided into an initial office and emergency care area, and a nearby laboratory and testing building, from where different walkways go to surgical patients, maternity, children’s, internal medicine and dentistry, all of which are on two floors.
in the operating theatres, there is a clean circuit with two large operating theatres, one for maternity and the other for general surgery. Each operating theatre is equipped with a basic respirator with halothane capacity and a diathermy generator. The operating theatres are equipped with split air-conditioning which allows comfortable working hours despite the high temperatures outside. The obstetric equipment could not be used for our campaign, due to the large number of caesarean sections.
The operating theatre can be structured in such a way that 3 tables and two operating theatres can be placed inside in a spacious and functional way with space for entering patients on a stretcher
b. THE TEAM (members of the group)
Specifically, the team is made up of the following specialists
General Surgeons: Eduardo Perea, Manuel Bustos Jiménez, Isaías Alarcón del Agua,
Abdul Razzak Muchref Al Dandal, Carlos Javier García Sánchez (the trainee);
Anaesthesiologists: Guiomar Fernández Castellano, Jessica Gallego Solana;
Nurses: María del Mar Martínez Gómez and Daniel Luis Nadales Muñoz
c. LOCAL STAFF
Hospital with a large team of staff available in addition to the extra staff hired for the impact of patients recruited for the campaign. Those involved in the campaign have been: – 6 Cuban doctors working there, one of whom is a surgeon and allows for helping as assistants as well as follow-up of patients who have undergone surgery.
– 3 security personnel who are with you at all times in the outpatients room and in the hospital and translate Wolof and Mandinka.
– 4-6 ward assistants/nurses who monitor patients in the postoperative period and take the IV before surgery.
– 2-7 operating theatre staff with various functions: from cleaning to orderlies. One nurse with basic anaesthesia skills and 2 nurses who can circulate or handle instrument. Presence in the operating theatre varies according to the time of day.
d. THE EQUIPMENT
The operating theatre consists of 3 tables of which only 1 is a surgical table in itself. A diathermy generator that only accepts one terminal. Various sutures from leftovers from previous campaigns. No meshes. Two monitors with pulse oximeter and BP cuff.
e. ANAESTHESIA Operating theatre equipped with an anaesthesia respirator with manual ventilation and possibility of using halothane and isoflurane.
Oxygen cylinder (possibility of up to 4 or 5).
Physiological saline solution and Abocath.
Cabinet with some ampoules of noradrenaline, bupivacaine with dextrose and adrenaline.
2 monitors.
f. ASEPSIS AND SURGICAL SUPPLIES
Basic surgical set boxes consisting of sufficient but deteriorated instruments. One laparotomy box with additional material that was not used during the campaign.
The gowns and drapes are sterilised in the same way in an autoclave. Depending on the target number of interventions, it is recommended to add more gowns and drapes, sometimes there is not enough time to sterilise. It woule be better if another diathermy generator could be provided.
g. ACCESSIBILITY FOR THE POPULATION
Due to relative poverty of the local population the cost of hospital admission is very low and accessible, 40 euro cents per admission for the Gambian population and 80 euro cents for the Senegalese population. Imaging and laboratory tests are charged separately and are not excessively expensive.
h. OUR LIFE IN FARAFENNI
Day 1: Arrival in Banjul in the early morning. The proximity of the country and the many combinations allows flexibility of schedules, but most flights arrive very late in the capital. In our case, due to the Vueling strike, our tickets from Barcelona were cancelled only 72 hours in advance and it was necessary to buy new flights from Valencia, delaying the start of the campaign by one day.
With Air Maroc it is possible to carry two pieces of luggage per person of 23 kg each. Our problem was the transport of all the material from Seville to Valencia in 2 vans that we rented without prior notice, increasing the budget of the campaign. On arrival we were kindly picked up at the airport and taken to sleep a few hours in a nearby hotel, the Woodpecker. Room for up to 6 people at a good price.
Day 2: Transport in two cars from Banjul to Farafenni by the southern road to avoid the ferry.
4 hour drive with good road conditions. Arrival at the Wallyman hotel, very close to the hospital and pleasant with a garden with access to air-conditioned single rooms. Nearby mosque with prayer at 5 a.m. as anecdotal information. We moved to the hospital on foot (15 minutes), a safe and closed area, but poorly lit. We recommend headlamps.
A warm welcome at the hospital and a consultation to prepare the next day’s operation schedule by the surgeons. Anaesthetists and nurses unpack and prepare the operating theatre, checking the ventilator and the oxygen available for the large number of goitres.
Day 3-8: Incessant OR activity to try to compensate days lost due to the plane strike. Very large consultation with many patients coming from very far away, taking a ward round before starting the operations and numerous surgeries until 7 pm. Very good local staff collaboration for the development of impeccable activity.
Due to the strategic location of the centre and the effect in local media publicity, 189 patients have been seen in consultation. As an extra contribution to our activity, we have carried out satisfaction surveys with all patients and we have collected the geographical dispersion of the patients attended as well as the environment and the hours from origin.
Day 9: Return to Banjul one day before the flight to sleep in Banjul the night before, one of the cars breaks down on the way back, delaying arrival at the hotel until early morning.
Day 10: We take advantage of the morning to visit a local market and eat fish in a tourist restaurant. Departure in the afternoon to the international airport to return to Spain.
3. CONCLUSION
Strengths of this place:
– Strategic location with a large population in need
– Presence of a Cuban community with which it is easy to communicate and patient follow-up.
– Great collaboration of the local hospital for patient recruitment and to assist in consultation, ward and operating theatre.
– A large number of Spanish foundations and NGOs working in Banjul, which can be of help in accessing the population in need.
Objectives for improvement:
– It is recommended to bring a urologist, there are a large number of urinary disorders.
– Endocrine surgeon recommended, although hernias are our target, the area is endemic for goitres and Graves’ disease.
– Bring another source of energy (diathermy generator or Ligasure for goitres).
– Hospital that admits large multidisciplinary team.
4. BUDGET: (small breakdown of costs)
COST PER PARTICIPANT:
– Return flights with material check-in 650€.
– Hotels 250€.
– Food 50€.
– Transport and others 450€.
– Total €1500 per participant
TOTAL COST OF THE CAMPAIGN: approximately 13.500 €.
Eduardo Perea del Pozo
Team leader of the Farafenni 2022 campaign Surgeons in Action