MEMORY OF THE MISSION HELD BY “CIRUJANOS EN ACCIÓN” FROM 26/01/2019 TO 02/02/2019 IN THE ESTHER AND JERELINE MEDICAL CENTER OF GANTA CITY (LIBERIA)
This is the second mission I have directed in Ganta City (Liberia) in less than a year and it started at the same moment we came out from there in April 2010 after the first successful one. We left out many patients without operation, we were very well treated and besides we were left with the thorn that we could not operate women in Liberia with a pathology that is endemic there, the gigantic goiter. From the beginning it was a formidable challenge. The expedition was finally made up by 7 members: Cesar Ramirez (surgeon and team coordinator), Oscar Cano (surgeon), Marta Jimenez (lady surgeon), José Miguel Moran (paedriatic surgeon), Sonia Trabanco (anaesthetist) and Paco Gomez (infirmarian). We started each from his or her city on 26 January (Málaga, Santander, Badajoz, Barcelona, Gran Canaria and Madrid) and we met at the Casablanca airport to take the Air Maroc flight of 23 hours towards Monrovia. After 4 hours flight in a commercial plane with a horrible heat, we arrived at Monrovia at 2.25 a.m. where the Medical Director of the Esther and Jereline Medical Center and alma mater of the local mission, my friend Dr. Peter George, and the main authorities of that center were waiting for us; the Monrovia airport has not changed at all in 9 months, it is as miserable and lacking in security and luggage control, with only one customs gate which works with great leisure. In this campaign we have again had trouble with our luggage (15 bags of 25 Kg each from Málaga including a generator for the electric scalpel and a Ligasure lent, respectively, by Teleflex and Medtronic) and the help received by the from the earth staff in the Málaga airport has been miserable without any understanding of what we were doing and having to pay almost 500 euros for excess luggage to be able to take everything. It is intolerable that they tell you that you have a limit because the plain is small, and then, when you pay, the limit has ceased to exist.
The way from Monrovia to Ganta City takes almost 3 hours and a half on a rudimentary byroad, and we were on 3 miserable lorries that Dr. George rents for us during all our stay in Liberia. Our place in Ganta City has again been Jackie´s Guest House, the hostal-pension in which we had individual rooms at the price of 50 euros each including breakfast: it is the best in the city and we have hot water, aircondition and one meal of the type “tex-mex”, more than acceptable, which we get for breakfast and super “in situ” and is taken to the E&J Medical Centre at the noon meal time. There is absolutely nothing to see in Ganta City and no possibility of excursions to places of tourist interest, and so our days were very intense and much repeated. Every morning we met at 7.30 a.m. for breakfast, and half an hour later they took us to the Medical Centre. The first day there was a large amount of patients waiting for us, about 400 persons who had been recruited the previous days by Dr. George and his E&J-MC, children and adults, and particularly a great amount of cases (almost women) of giant deforming goiter. I had promised them that if they managed to get a working respirator for goiter surgery, we would daily operate tiroidectomies in one of the operating theatres. Every day one of the surgeons and the pediatric surgeon had at our disposal a small room for consults where we saw the patients, explored them and selected them for surgery. We have not asked for a single preoperatory and patients (children and adults) have been operated upon after clinical evaluation. The E&J-MC is something similar to what in Spain could be a small ambulatory in which there are two operation theaters with very basic sterility conditions and they arranged two small patients rooms to use as third and fourth operation theaters, so that during a good part of each day we were busy simultaneously in four operation rooms; we were given only one electric scalpel and it was used for children, so that thyroids have been operated upon with Ligasure, and in the two operation theaters in which we operated hernias there were no lights in the ceiling and no electric scalpel, so that we had to operate with the frontal Photophore and in the dark with cold scalpel, ligature and dissecting scissors. They have practically no material since in the medical centre they only had cesareans, although they are beginning to do some urgent surgery in urgent cases like acute appendicitis. We have taken with us 3 complete sets of surgical material to operate hernias and one for pediatric surgery which we have gifted to the EandJ-MC after the end of the mission; similarly we have used in full the more than 400 Kg of surgical material we had brought since they hardly have any gloves, gauzes, compresses, antiseptics, sterile gowns, sterile camps or apposites (in fact, since our coming they have used our material for their surgical needs). Similarly we had taken with us and donated more than 200 boxes of omeprazole, paracetramole and analgesics for them to use in Ganta City.
During the mission we operated upon a total of 186 patients (45 children and 141 adults) in which we carried out 268 surgical processes; in this way in 74 patients (almost 40%) we carried out 2 or 3 surgical procedures. We were surprised at the great amount of patients with inguinal hernia who had umbilical hernias of at least 1.5-2 cm, and even more as their largest part they were young patients, thin and with apparently good mussels. We have used 80 mosquito nets donated by Hernia International and about 100 nets of low molecular weight which had been donated by BBraun; even so there were more than needed. One of the aspects more remarkable in this mission is that we operated upon 35 total tiroidectomies with giant goiter, and only in one case has a reoperation been needed for disnea in relation with paresia/paralysis immediately recurring, so that the patient could leave without problems after the traqueostomy. We have not had any striking postoperatory hipocalcemia, and we had brought 18000 LT4 tablets which we left with Dr. George so that they can give alternative treatment to patients operated upon in the next year and a half. The patients remained for a night (the hospital some common rooms of 3-4 patients and then a large common ward for men and another for women where at least 20 patients could be accommodated in each) and we examine them at the beginning of each day so that they could be admitted and no problem remains. A patient operated upon for an epigastrical hernia showed a sharp neurological during the operation, had a heart-lung stop and died during the operation. 3 patients have shown minor postoperatory scrotal hematomas which have not needed any special care. Dr. George explicitly asked us to carry out two urgent operations for an ileal perforation and an obstetric hysterectomy for a postpartum atony with massive bleeding, both with a favorable postoperatorion.
The medical and administrative authorities of the E&J Medical Center have given us all possible facilities. We have received, as in the prior occasion, all kind of help and they have tried to make us as comfortable as possible. On the day we came just as in the day we departed they greeted us with local songs and prayers from the local people, and as a sign of thanksgiving they gave us cloths with tribal motives which we’ll keep with much love. They have urged us to come back as soon as possible as there is much need, abd for us it has surely been an unforgettable mission.
NOTE: We thank the Teleflex, Medtronic and BBraun for their contribution to the campaign.
Fr. Cesar Ramirez
ICOMEM collaboration