HERNIA INTERNATIONAL MISSION NYANDARUA COUNTY, KENYA.
NOVEMBER 22-30, 2024.
STATUS: COMPLETED
Coordinator: Dr. Gachara Boniface (Kenya), coordinator Samuel Wainaina (Kenya), Medical Superintended Beatrice Mugure (Kenya), Team leader Thorbjorn Sommer (Denmark).
The International Team: Hugh Warren, (UK), Emma Sanchez (Spain), Thorbjorn Sommer (Denmark), assistant John Warren, Nurse anesthetists Lene Scheffmann Gosvig (Denmark).
Total: 5 volunteers
TECHNICAL REPORT
DATES AND LOGISTICS DEPLOYED:
Campaign conducted November 22-30, 2024.
ADULT PATIENTS: Hernias (inguinal, umbilical, ventral, inguinoscrotal), lipomas, hydroceles.
PEDIATRIC PATIENTS: Hydroceles, umbilical hernias, inguinal hernia.
CONSULTATION AND SURGERY PERFORMED:
Total procedures: 153
Total operated patients: 140 patients (of which 61 were pediatric patients, aged from 1 months to 14 years)
Patients seen in consultation: 160
Complications (within 7 days of our arrival):
Acute: one scrotal hematoma evacuated post OP day 1.
After 1 week: one incisional hernia had an infection and one scrotal swelling, both managed conservatively.
CAMPAIGN SUMMARY
JM Kariuki Memorial County Referral Hospital
The Hospital is a major referral center for 700.000 people living in Nyandarua County.
It is located 2,5 hours’ drive north of Nairobi. The Hospital is under constant development with new departments and development of various health projects.
The hospital consists of different departments: Surgical department, emergency department, Intensive care (4 beds), medical care, vaccinations center, facilities for child-mother care, maternity, laboratory and testing etc, CT and Ultrasound scanning facilities.
Concerning the surgical department there were two operation theatres, with two tables each of which three was used for the current Hernia mission, the other was used for acute surgery, primarily caesarean sections. Other types of surgery (like ortopedics) were directed to other hospital during the Hernia mission. As such it was possible to perform 3 operations simultaneously, which we found very efficient, also making it possible to collaborate with each other with difficult cases.
The operating theatres were well equipped with air conditioning, allowing for a comfortable work environment. Power cuts were rare and did not affect our work.
The hospital was equipped with three diathermy machines, and we brought an extra new one donated by Medtronic Healthcare Denmark.
The Team members brought each what was possible to collect of up-to-date equipment (gowns, sutures, scalpels, drapes, dressings, meshes etc.)
We had a terrific anesthetic service from anesthesiologists George, Esau and Daniel and Karaoke making it possible to do surgery under general or spinal anesthesia. Local anesthesia was used in selected cases. Lene Scheffmann Gosvig enjoyed this cooperation very much.
The General Surgeon at the Hospital Jyrus Ochieng was a very hard working and skilled general surgeon, and we had a very inspiring and joyful time together discussing treatment options in individual patients, indications for surgery and of course also technical aspects of Hernia surgery.
We did ward rounds every morning to see the patients who had undergone surgery the previous days before discharging them.
In between surgery we saw patients who requested screening for a variety of surgical/non -surgical diseases, and patients coming for check-up after surgery.
The patients were seen dressed in gowns ready for surgery in a room in front of the theatre where they were marked by the operating surgeon before the operation, they were informed about surgery, written information about the surgery, operative procedure, risks etc. and consent of the operation was ensured.
Cleaning between the shifts were swift, making it possible to do fast track surgery
Patients were schedules to stay in the ward to the following day, where they were seen before discharge.
THE TEAM
The team consisted of three surgeons: Hugh Warren (UK), Emma Sanchez (Spain) and Thorbjorn Sommer (Team leader Denmark). Anesthetic Nurse Lene Scheffmann Gosvig (Denmark) and John Warren (son of Hugh) assisted with the procedures together with the local staff. Two months before departure we had 2 virtual Zoom meetings, with participation of our Kenyan colleagues, where we were introduced to each other, discussed the mission, the need of equipment and had a very good introduction by Dr. Gachara, Samuel and Beatrice (medical superintended) from the Hospital.
TRAVEL/VISA/PERMITS
Travel to Kenya is easy since there are a lot of departures to Nairobi. eVISA must be obtained (online) before departure. Samuel did a terrific job securing Temporary Surgical License to the surgeons operating before arrival.
SCHEDULE
Our routine included Breakfast at 7.30 AM before starting surgery at 8-8.30 AM.
We had a lunch break at 2 PM, and finished the last surgery between 4 and 9 PM, depending on the number of cases scheduled. We had visit of the local health authorities, the bishop and representatives of the governor, showing a lot of support for the Camp. Thursday night a party was arranged at the Hotel together with all the staff, local organization and everybody involved in the Hernia Camp with tasty food, a lot of good talks and the team members were granted with gifts (Masai Blankets and a very nice sculpture), which we all are very thankful for.
LOCAL STAFF
The local staff had done a significant job in recruiting patients using various channels such as posters, newspapers and radio advertising, ensuring we had a lot of patients. In fact, some patients unfortunately had to be turned down and await further missions due to the limited time of the camp. Some patients had waited +8 years for hernia surgery – so the camp was really needed. Arriving in the Hospital all patients were carefully registered and prepared before being seen by a surgeon prior to surgery, with evaluation and marking of the hernia.
It was an important and primary focus of all staff to ensure patient safety from the first step. Doctor Aisha and nurse Lucy were phenomenal to arrange everything logistically, kept the files in place, knew were the next patient was and where the previous should go. The Medical Superintended Beatrice Mugure did a terrific job with competent overview of the organization. Extra personnel had been called in, so we were well equipped with competent staff from anesthesia, surgical and ward assistance, making it possible to upscale the number of procedures substantially. Working together with the local staff was a very positive experience for all of us, sharing expertise, skills, technical tips and ways to go forward in the care of hernia patients.
EQUIPMENT
The Hospital was well equipped, and the Team brought what was possible for each member to collect from their home Hospitals of new equipment. Medtronic Denmark had donated a Diathermy Machine.
ANESTHESIA
The Theatres were equipped with ventilators and at each operative table, there was monitor with a pulse oximeter and a blood pressure cuff, and ECG. Anesthesia was obtained using Ketamine, Halothane and Desflurane, spinal or local anesthesia. The majority of patients received local blockage with Marcaine as post operative pain treatment together with Paracetamol and Ibuprofene.
ASEPSIS AND SURGICAL MATERIAL
All patients had washed before arrival for surgery. At the hospital they were washed with appropriate antiseptics, hair was removed, the site of operation was preoperatively marked on the skin and local anesthesia was applied. All patients received a single dose of Ceftriaxone as SSI profylaxis. The local staff practiced aseptic procedures making it easy to secure clean procedures. Sufficient surgical material boxes were available, we also brought supplementary instruments for future use by the local staff.
ACCESSIBILITY FOR THE POPULATION
Before our arrival, the Hospital had conducted a major information campaign with information about the possibility of hernia surgery. The patients paid a small fee, what they could afford, some came a long way to be operated (many hours of transportation).
ACCOMODATION IN NUANDARUA
We stayed at the nice 818 Hotel situated 1 km from the Hospital, making a short morning walk possible. In some days after dark transportation was promptly provided, making sure none of the team were eaten by hyenas on the way back. The Hotel had a very nice staff, nice spacious rooms with aircon, clean bathrooms, a nice restaurant with a variety of local and international meals. However, the best was a Tusker Beer after long working hours.
CONCLUSION
Strengths:
The Hospital is not too far away from Nairobi Airport, reducing time for transportation to a minimum. Transportation is swift and well organized. Patients came from far away, and the standard at the facility made it easy to do high-volume Surgery with good quality in every aspect. Accommodation is nearby so no time is wasted on transportation.
The staff is very well educated and a tremendous help in assisting us with everything. They have the capacity to raise awareness of Hernia surgery, planning a comprehensive surgical camp and secure patient safety in a high-volume setting. It is highly recommended to further develop Hernia Camps in Nyandarua, since all capacities for further hernia surgery is present. There is also a wish to do laparoscopic hernia surgery in the future, and if it would be possible to provide laparoscopic equipment it would definitely be the place to do it.
Things we might do differently:
We found it very useful to divide patients in groups according to hernia type, adult/pediatric and male/female, since competence of different hernia also varies among surgeons. We did that the last days and in future missions it will be useful with this strategy from the start.
Bringing more local anesthetic will be helpful.
In Conclusion we highly recommend Hernia Missions conducted on an annual basis in Nyandarua, and I would be grateful to do a mission there again next Year.
On behalf of the Team 2024
Yours sincerely,
Thorbjorn Sommer
Head of the Hernia International Mission to Nyandarua November 2024
