January 2016 update

The recent 'hernia' trip to Uganda was very successful.

 

One of the team, Sue Chandler, has written the following report:

 

Operation hernia mission: 7th-14th November 2015 to Luwero Uganda.

This mission was the first to Uganda as a joint venture between the charities Hernia international and Care for Uganda. The team consisted of 2 consultant surgeons Mr Tim Brown and Mr Scott Caplin (Swansea), consultant anaesthetist Dr Penny Howell (Ipswich), surgical trainees John Whitaker and Sue Chandler and ACCS trainee Emily Adam.

Andy Pilcher CEO of Care for Uganda had kindly and very ably organised our travel plans; everything went smoothly and we arrived at Entebbe airport in the early hours of the morning and passed through customs uneventfully. We then travelled to our base, Care for Uganda headquarters in Bbowa, about an hour north of Kampala. 

After a brief rest we went to Bishop Caesar Asili Hospital in Luwero, approximately 45 minutes away depending on road/weather conditions.  Hospital staff greeted us warmly and showed us around.  We found the theatres were large and clean. We had use of two theatres leaving the third for emergency use.  A handful of patients had already arrived so we used this opportunity to review these patients hoping for an early start the next day.

The next morning we were up early and fed well by the Care for Uganda staff with a cooked breakfast and locally sourced fresh fruit watched by a friendly forest woodpecker.

The first day passed quickly, with us finally finishing in the dark, despite agreeing that we needed to finish before dark as the roads are not safe in the dark.   A thunderstorm in the afternoon had lead to issues with power supply and we were thankful that some of the team members had head torches.  The nurses and local staff worked hard and we were able to operate on 13 patients throughout the day including a short lunch break. Penny, our anaesthetist, was used to full effect for spinal anaesthetics, general anaesthetics and rescuing patients getting to the end of the limit for their local anaesthetic.

Local surgeon Geoffrey and doctors from the hospital joined us during various parts of the week when they were able to. They showed us techniques they use locally for hernia repair and we showed them the Lichentenstein mesh repair which by the end of the week they had also carried out. The local anaesthetists also ably supported us. Fitting it around their clinical duties, firstly helping Penny get to grips with the equipment available and Penny helping them to work out how to maximise the anaesthetic machine they had (with some slight hiccups along the way). Resulting in the final case of the week successfully being able to deliver oxygen through the anaesthetic machine and not just room air.

For the second day we were on the ward for 8:00 sorting out the first patients. The memory from the day was the incisional hernia Mr Caplin repaired. A young man who had undergone an emergency laparotomy a couple of years ago, the wound had been complicated by infection leading to a large incisional hernia. Penny would be providing a general anaesthetic, all was going well until 15 minutes into the operation and there were problems with the anaesthetic machine coupled with power cuts.  The luxury we have in the UK with facilities was brought into sharp focus during this man's surgery. Mr Caplin has repaired many complex hernias in his career: this chap's hernia has now memorably joined the list; not because of the nature of the hernia, but the difficulties of the working environment, failing anaesthetic equipment, limited surgical instruments and the stress of dealing with this. Mr Caplin managed to finish the repair without compromising the integrity of it, and the patient being well and comfortable. We however decided at this point that general anaesthetics were not feasible at present. This was a shame as we had a couple of children we were hoping to operate on the following day, but did not feel it safe to do so.

We arranged lunch to be brought from the canteen to theatre for the rest of the week meaning less time was spent away from treating patients and that the team and local staff can enjoy a meal together. This practice is highly recommended for future teams as enjoying lunch all at once bought the team together from a diverse background and experience.

Day 3 started early with some of the team attempting to watch the sunrise, however were thwarted by low cloud and mist that hung over the green mountain scene but still provided a picturesque start to the day. Mr Caplin went scouring the wards today to review the progress of the patient who underwent the incisional hernia repair. He was frustrated by both being unable to find the patient and the persistent attention of a patient following him around. After a short while however he realised that it was the patient, not as expected to be lying in bed recovering, but eager to find Scott and ask whether he could now start to eat. His recovery impressed all, except perhaps some of the locals!

All the patients scheduled for the day were operated on by 2pm. Anticipating that the next few days might bring an influx difficult to complete by the end of the trip we managed to call some of the patients due for Friday to see if they could come straight away.  Having a gentle pace to the afternoon on the third day of our trip has allowed us all to get back to the accommodation in the daylight. A beautiful rainbow greeted out arrival home, enjoyed with a cold drink to also end the day in a picturesque way.

Day 4 was another busy day, we treated 16 patients, performing 21 procedures on patients including the youngest of the week at 4 years old. The oxygen cylinders had been refilled, making the anaesthetic machine usable again, and so the 3 children who had been cancelled yesterday had their operations, with a mixture of local block and general anaesthesia. Penny again showing her versatility and willingness to adapt admirably in the conditions.

An  emergency made it necessary to cancel our last case of the day, as the theatre was needed for a Caesarean section, at which, unfortunately the baby died. It made us think a little about the different values here, from those we are used to in the UK. It is not that life is taken lightly, but that maybe there is a more realistic view of life, particularly within this society. I doubt there is the money or the facilities in Uganda for expensive neonatal intensive care, or for the on-going management of severely brain damaged children.

The final day continued much in the vein of the previous four; over the 5 days we operated on a total of 62 people with 72 procedures carried out. The patients’ ranged from aged 4 to 83 years old.  The hospital are very keen for us to return for further missions; even our able local taxi driver, Saul, informed us the local people had not truly believed that we would come to help them and that if we returned he was sure that there would be many more wanting our help.  Following our final day operating we organised a hot buffet at a local restaurant to say thank you to the team from Bishop Caesar Asili hospital. In total 28 people attended. The evening started off with speeches and ended with the local staff presenting us with some incredible local carvings as a way of thanks which we were all touched by. It was an enjoyable way to finish the mission and to build relationships with the local staff and to show them how valued their help over the week was. They also impressed upon us how keen they were for us to come back.

 Our final day before leaving was spent with Andy and brother Monday, Care for Uganda Operations Manager, who gave us an insight into the work Care for Uganda carries out which we all found humbling and fascinating. We visited families who had children sponsored by Care for Uganda and had also received equipment such as energy saving stoves. We also visited a local health centre. 

Local people were kind enough to let us see their homes and see firsthand the invaluable work Care for Uganda does to help.  Understanding more about the work of Care for Uganda on this visit has helped many of us appreciate how its work can act as a source of hope for many of the children and families supported through its programmes.

The local health centre was an eye-opening experience with very basic equipment and no running water or electricity. Over the week seeing many patients "signing" their consent forms with a finger print, highlights how much of the society here lacks the educational opportunities that we take for granted. 

For myself the trip has been a highly rewarding experience, and I have learnt invaluable skills not only operative but adaptability and team working skills that I will carry forward into my future training. 

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Scott, Tim, Andy, Penny, John, Sue and Emily

 

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