Austrian-Slovenian-Australian-Liechtenstein Team Mission
Ngarenairobi, Nov 7th-11th 2022
Ngarenairobi is an administrative ward in Siha District of Kilimanjaro Region in Tanzania. The ward covers an area of 172 km2 (66 sq mi), and has an average elevation of 2,111 m (6,926 ft). According to the 2012 census, the ward has a total population of 9,431.
The Ngarenairobi Health Centre (NHC) belongs to the Congregation of Spiritus Sancti Fathers. The NHC was host for Hernia International (HI) mission for the first time in history. The reason for the mission was dr. Ally Kombo, skillful and ambitious young surgical consultant, who was inspired by HI-charisma after hosting our 2019 mission in Momella village. He made the contacts with the hospital owners, especially fathers Damian and superior father Calistus.
The travel from our homes to NHC took us about 24 hours. Some of us summited Mt. Meru Mountain (4566m) in the days after arrival.
Summit of Mt. Meru (4566m)
After that, the team met on Sunday prior to the mission at the Provincial house of the Congregation and from there and back we were transported to the NHC daily (about 30 min). Our team consisted of 9 members: 3 surgeons, 1 anaesthesiologist, 1
radiologist, 1 scrub nurse, 1 nurse anaesthetist, 1 future student and 1 photographer.
Additionally, at least 5 local surgical consultants/residents and anaesthesia consultant/residents and nurses came from many parts of Tanzania, even islands Zanzibar and Mafia to learn. We imported 220 kg of equipment and drugs in 11 bags. This year there were no difficulties at the customs due to previous communication with the TMDA from our medical hosts.
Our team – dr. Kombo (in the middle) has become independent in hernia surgery
Checking patients for surgery was the first task on sunday evening and monday morning. As NHC is a village, a bit away from civilization, patients came every single day after they were informed via posters, local radio and social media. Every single day, there were just enough patients for 1 day, not too many, not too few.
The turnover of the patients was fluent. We were not used to take a lunch break, biscuits, soft drinks, coffee and delicious cashew nuts / ground nuts were sufficient for most of us between operations. Besides goiter and hernia surgery and small operations for other indications, assisting to local doctors and nurses was high on our priority list. We took time to do this as education and teaching is important on our missions. Local doctors, especially dr. Kombo, became independent and self-confident in hernia surgery.
Parallel operations on 2 and sometimes 3 tables, enabled 51 procedures on 46 patients in 4 days.
Preoperative check-in
Good work in the hospital was also possible because we were accommodated well (breakfast and dinner) in the Provincial House of the Congregation of The Community of Priests (in the Opus Spiritus Sancti). First, there was a plan to stay in a dormitory closer to the hospital, but after some talks it was evident that proper meals could not have been organized there. NHC might host new hernia missions in the near future, as there is readiness from the side of the organizers.
Thyroid surgery – big goiters are still endemic in Africa
Among 46 patients (with 51 procedures), we operated on 8 children (28%) and 33 adults (72%). 20 patients (43%) were female. The most frequent operations were hernia repairs (10 inguinals, 10 umbilicals and epigastrics), followed by Jaboulay`s procedure for hydrocaele operation. In inguinals in children, Mitchell-Banks repair was performed and Lichtenstein repair with LDPE mesh was performed in the vast majority of patients with inguinal hernia. The youngest patient was 2 years old. Thanks to the excellent anaesthesia team and Ligasure device (which we brought with us) we performed 3 subtotal goiter resections in big benign goiters and cancelled two more due to not optimized preoperative medication. They should be operated on during the next missions. There were 5 orchidopexies due to undescended testicle in children and 1 circumcision in a boy with symptomatic phimosis. Other diagnoses/operations were operations for benign breast lesions and other smaller excisions.
Preoperative ultrasound examination
Maria performed 52 ultrasound examinations with her portable US. This was of great help
pre-operativelly in goiters and other diagnoses (hernias/hydrocaeles) as well as postoperatively to discern haemathomas from normal tissue swelling.
In OT 1 (good lights, we brought diathermy and left it there), mainly general anaesthesia was
performed, while procedures in OT2 (week lights, diathermy) were in spinal and local anaesthesia. In OT 3 (which was improvised due to the strong surgical team from the recovery room), we used head lamps.
Teaching good surgery/anaesthesiology was high on our priority list
Scrub nurse Manuela was capable of preparing tables and material in 3 OTs – which was only possible because she managed to teach and motivate local scrub nurses to help and be active. It is also a good idea to have a (future) student on such a missions – Timotej was helpful in every situation. Nik as professional photographer helped him many times when he was not busy filming and taking great photos. He was even able to repair the electronics of the table in OT 3.
We felt privileged for having no complications (minor or major) which we contribute to a not
overcrowded programme. Again, we took enough time for every single procedure, without hurrying. A normal working day started at 8 am and ended at 6.30 -7 pm. Good working and a friend- building atmosphere was a result of mission preparation several months before (great thanks to dr. Ally Kombo, dr. Thomas Kosiano, father Damian and others). The prayers of the priests of the hosting order supported us additionally throughout the mission.
Team Members:
Dr. Dominique Robert – consultant surgeon, Colac, Australia
Dr. Marija Jekovec – consultant radiologist, Ljubljana Medical Centre, Slovenia
Manuela Logan, scrub nurse, Liechtenstein
Prof. Mirko Omejc, MD, PhD – consultant surgeon, Ljubljana Medical Centre, Slovenia
Dr. Michael Wirnsperger – consultant anaesthesiologist, Krankenhaus Zams, Austria
Wolfgang Walser – anaesthesia nurse, Feldkirch, Austria
Timotej Gorjanc – future student
Nik Gradišnik – professional photographer
Assist. prof. Jurij Gorjanc, MD, PhD, FRCS, FEBS AWS – consultant surgeon, team leader, Krankenhaus der Elisabethinen Klagenfurt, Austria
Our sponsors:
Krankenhaus der Elisabethinen Klagenfurt
Medical Center Gorjanc
Implantoloski institut / Implant Institute
Krankenhaus St. Vinzenz Zams
LKH Feldkirch
Spital Grabs
Kirurgija Bitenc
University Medical Centre Ljubljana
Local children with members of the Team