BENIN CAMPAIGN SUMMARY (DECEMBER 2018)
THE TEAM
A new “Cirujanos En Acción” campaign was organized in the “Albergue del Amor Redentor” in Dangho in the Benin Republic. For most of the participants it was their first experience in cooperation. The team was made up by eight volunteers: Irene Osorio Silla and Eduardo Gutierrez Iscar, general surgeons of the La Paz University Hospital in Madrid, Miguel García Botella, surgeon of the Lluis Alcanys Hospital in Xátiva, his daughter Sara García Ballester, R4 in anesthesia, who, together with the anesthetist Alberto Pi Lopez and the nurses Elena Valenzuela Cuberos and Mercedes Rodriguez Sanchez who were coming from the Bellvitge University Hospital, and as coordinator Antonio Satorras Fioretti, surgeon at the Public Hospital of Mariña in Lugo.
We started our journey in Madrid and we flew till the Cotonou airport with a stop in Casablanca. Royal Air Maroc allows for 40 kg of medical and surgical material as our respective centers had given us.
Trip and customs go on without any difficulty. We arrive at dawn and are welcome by Opportune, a religious sister of the Redeeming Love Order of a very dominating character, who was the chief of the hospital. We loaded our lorry with volunteers and luggage, and after an hour and a half through badly tarred roads with heavy traffic we arrived at Danbgo, a rural village with many children and no lights.
THE STAYING PLACE
We stayed at a place which Antonio Bonou, president of the electro-medicine STE BEREC had arranged for us. We had three rooms and a bathroom, and cool drinks always at pleasure. We had to use our towels, bed linen and mosquito net. The place was very close to the hospital and we can go walking under horrible heat and dampness. The table in the garden is the only place to relax at the end of the day. Close to the hospital there is also a hotel where we can eat something and connect with Wifi, though in a very irregular way.
THE HOSPITAL
The hospital is made up by several buildings. In one of them stay the four nuns in charge of the hospital, Sisters Opportune, Ruffine, Clare and Francis, and it is our dining room for the meals they prepare for us. The meals are abundant, but still we take at times food we had brought from Spain well packed in tins.
Surgery takes place in another building where there is a small operating room which we divide into two with a sheet so that two teams can work simultaneously. There is a surgical lamp with two ends, two electroscalpel units, a single ECG and TA monitor, an anaesthetic Dräger Fabius plus with works with Sevofluoritan and a lace for the oxygen. As it has air conditioning it is the only place in the whole hospital where one can support the heat. Electricity cuts are frequent but short, and they do not hinder the operation.
Next to it there is a room for evaluation and preparation of patients, and a small crowded room for random storing of material left from previous campaigns even if may not be in a condition to be used. In charge of all that is Sister Ruffine with whose help we placed all our luggage in a few hours and we prepared all the instruments to begin work. She accompanies us without fail through all our work, and she provides us the scarce material and proposes useful solutions to resolve all problems.
In front stands the main building. One of its rooms has 10 beds without any mobility system which are used for control after the operation. All interventions are done with rest after them for the night, so that the number of operations is limited to 10 a day, and the difficulties for vigilance reduces very much the work we can take up.
We daily program three interventions for the morning and two for the afternoon for each team. Work begins at 8 am. After visiting the previous day patients we take our breakfast while they prepare the new ones. Surgery begins at 9. Then a break for lunch word does not end before 18:30.
Preparation and control are taken care of by the male nurse Gabin who is also a volunteer and comes from Porto Novo to help us with great zest and skill. He spends the night at the hospital and is in charge of the work.
The hospital has also a pharmacy, maternity room and lab, although the timings and the delays did not allow us to make any previous study which would have been necessary.
We had enough bags with surgical instruments to carry out the work of abdominal wall. Although there are two autoclaves, they are not used to sterilize clothes, so that the first difficulty is that there are not enough gowns and surgical fields than those left by previous campaigns.
Although we often proposed an hystopathological study of surgical material, this was made impossible by the preparation and shifting that had to be done by the patient.
THE PATIENTS
Patients have been seen by the staff of the center and we receive them in order. They are chiefly men who come with pathologies we can take up. A few have to be rejected as we cannot offer them basic security conditions, but we accept the most of them, and on Sunday evening the operation theatre list is settled. Along the whole week other patients will come up in order and we can program all the work. Each one pays 90.000 franks (140 euros), the fifth part of the expense in the city hospitals. In this country, those who have no money have no health assistance, and this is accepted by all. On arrival at the operation theatre they have a box with a bottle of glucose serum, a bell, analgesics, syringe, povidona and dressing.
A problem comes with the patients who speak Fon, one of the local languages, or French. The hospital staff does not speak English, so the difficulty is serious as there is no direct translation.
INTERVENTIONS
We had to dedicate the whole morning of Tuesday to a rendezvous with professor Dossou, President of the Benim Doctors Order, so that the whole team had to go to the Porto Novo hospital to get permission for our temporary permit. Thus we lost one of the surgical sessions. During the rest of the week the patients kept showing up irregularly, so that we could not carry out all the sessions we had planned. This, together with the fact that some of the programmed cases did not turn up, made us take up the last patients on Friday morning and end up the campaign.
On the whole we treated 37 patients (two did not turn up on the appointed date) with a total of 44 procedures (double in five and triple in one case). 31 men and 6 women with ages between 16 and 70 years (an average of 47). Partial anesthetics was used in 28, general in 7, and local with sedation in 2.
The most frequent procedure was inguinal hernia, with 27 cases (16 right, 8 left and 1 bilateral; from that total, 15 were inguinoscrotal and one repeated). We treated 5 hidrocels (one bilateral and one repeated) and 3 umbilical hernias (1 recidivated). In all the hernias we did hernioplasty with mesh (25 Lichtenstein, 2 Rutkow y 2 umbilical) except for a Mayo umbilical. Finally we treated 8 soft part lesions (6 lipomas, 1 tumoration in the thigh, one queloid).
As the only notable complication we carried out a revision for hematoma in the postoperation after the exeresis of a lipoma. In 6 patients drainage was left.
Dr. Antonio Satorras