REPORT of KAMUTUR CAMPAING-FEBRUARY 2020
The campaign began on February 21 at 8:00 Virgen del Rocio of Sevilla, a center where all the volunteers of the present mission worked. Before that Manuel Bustos had got two vehicles of great power capable of transporting the 10 members as well as the two 23kg (with a total of 460 kg) till the Barajas Airport from where our journey started.
We managed to place the whole luggage and we put on the shirts Ana Senent´s sister had designed specifically for this campaign with the logo of “Cirujanos en Acción” and the banner of the country of the place were visiting. In the center Dr. Padillo, chief of the General Surgery and Digestive Department came to see us off. The journey to Madrid takes 5 hours in which the interest of all the members of the party and of the last 3 new members:
- Diego Angulo: Radiologist of the Urgency Unit of the Virgen del Rocío Hospital who intends to work with the ultrasound for the diagnosis of the patients in the hospital.
- María Dolores Gonzalez: Nurse at the Urgency operation theater who has shared in the preparation and collection of the material. Besides, she carries material for teaching the health staff of the Center in which we are going to carry out our mission.
- Maria Guillén: Good photographer whose personal project is to gather as a personal project the work of the Foundation and the need of more help for the Hospital.
The travel begins, and after three short stops in Rome and Addis Abeba we land in Entebbe 12 hours after leaving Madrid with the fear of the actual pandemic of the Coronavirus present in every airport.
We pass customs without many problems thanks to the permits that Moses Aisa (director of the HIH in Kamutur). They only try to keep some Lidocaina ampoules with less than 6 months caducity which we finally succeed in passing.
The driver of the bus that will take us to our final destination is waiting for us. The travel by bus takes place without problems through some places of difficult driving. We feel tired of so many hours traveling and we want to rest before the beginning of our work.
After 9 hours we reach Holy Innocents Hospital in Kamutur, Bukedea district, a real place in the middle of nowhere. Moses receives us with a ready meal and some beers at room temperature but welcome after the long journey. Together with Moses we come to know two more persons who will help the mission and form part of it however involuntarily: Hans (retired anaesthetist of Dutch origin who works in a concern called PUM and studies the possibility of investing in the centre, and Tom (a Scottish who works as a religious assistance in the Hospital and would like to remain 4 years in the region). The 6 women spread out in two places while we the 4 men were placed in one with the promise that we would change to Manuel Bustos the next day given his agitated sleep.
Our work in Kamutur begins on 23/02, Sunday. There is much to be done. We begin in the morning with a visit to the well for water for our “shower”, and María del Mar had bought some portable showers for good. We breakfasted and spread out in twos.
While Manuel Bustos, Inmaculada Benitez and Eduardo Perea begin to see the sick, Ana Senent and Guiomar Fernandez verify the anesthesia and the possibility of setting up a Sevorane condenser which we had with us (this could not be done as we did not have the necessary material, so that we had to leave the apparatus just as we had found it).
María del Mar and María Dolores unpack the material and, together with the nurses of the center they prepare the operation theater to begin work. Abdul Razak supervises the cases that will be Included in the surgical report, and Diego Angulo works on the ultrasound with which he will work. The operation theater begins working that same day evening, carrying out seven surgeries.
That is the way work has begun in the HIH, operating in two operation theaters from 8.30 till we finish work. While we made ecographies we commented on cases, and we worked morning and evening as people kept coming constantly.
On the second day we attend to burns in our operation theater besides teaching the infirmary staff. During our stay we keep healing burns, a work that goes on very well in our infirmary, besides teaching infirmary staff in the Hospital. Cures continue to be done daily every 12 hours during our stay.
On the third day came the man who manages the apparatus for anaesthesia and we explained to him the many advantages of the Sevorane, and he confirmed that our condenser could be easily adapted to the anaesthetic machine, but the problem was the it would lose the guaranty by being manipulated. To avoid any problem with it we spoke with Moses and we did not insist in any modification.
Except with problems with the electric supply for failures in the generator, and the suffocating heat of the operation room, we had no problems. In one occasion one of the switches (multiple holding devise) came out burning with flames, but the fire was put out and the electrical supply was repaired.
The work of the infirmary of the team has been wordy of praise, not only when preparing the material but also when distributing it, putting it in order and instructing the local workers in the carrying out of different according to the intervention to be carried out.
In the same way one of the pieces of luggage we sent was full of toys gifted by a companion of our center whose son had died recently. We realized at the end of a week of work that the relationship with Moses was more and more distant, particularly with the women, and very dark when we asked him about the possibility of not charging the women all the ecographies we where taking. When interpreting it as an aggression to his activity he begins to give dry and unpleasant answers. The food is simple but abundant, and everything was very comfortable. The showers become and amusing moment, and we always the conversation at table Hans and Tom drinking beers. It becomes necessary to pay Moses an extra with respect to the settled price as according to him we drank too much.
María Guillén and Diego Angulo prefer dealing with the conexion with the local people. As they are outside the operation theater they have more contact with visitors (patients and families) and with the workers of the place. We collaborate in healing burnt patients, particularly children who had fallen into the fire while their mothers were working. We attended to a one year old child with several injuries as he had fallen from his mother`s arms into the fire during a motorcycle ride. He presents a low level of consciousness with a possible cranial fracture. We see it necessary to translate him to another center in Mbale with serum therapy.
One of the activities that has been incorporated in the mission this year is the carrying out of a survey of satisfaction in all patients operated upon in which we collect information about how and from where to reach the center and also ask about their degree of satisfaction with the treatment received.
Finally on Thursday 27 during supper a long discussion started after asking Moses about the toys. He lost all courtesy and answered hitting the table. He threatens to expel us from the hospital that night. It is evident that he is not satisfied with our work in the center. Next morning Moses abandons the center before our surprise and the surprise of Hans and Tom. We, the 10 voluntaries, meet on Friday morning to decide whether to seek transport for that same day or to stay in the center. Finally the local staff and Hans ask us to finish with the already foreseen surgery as the patients were waiting in the center and they were not to blame for what had happened.
We worked on Friday till very late at night to finish the surgery of the patients that were ready for the next day. On Saturday we finished all the work ready for the several interventions, place shifting and taking new patients, together with teaching the infirmary staff some basic notions of ostomies (we were carrying with us bag of ostomy and hiperproteic nutrients for possible reconstruction of the intestinal passage of a child from a nearby village, but we could not find him).
But our experience was completely spoiled and full of sorrow for what then happened. Hands and Tom strive to make us see the success of the work, and they organize an excursion on Saturday evening to see the Sipi waterfalls. On Saturday evening Eduardo Perea, moved by obligation rather than desire, writes to Moses asking him to come to the hospital to explain the situation ad his own behavior.
The final meeting takes place in Moses room that same night, he blames the team for its bad attitude and racism; according to him there exists a superiority towards his person and his race, makes us share the many expenses which he pays for our presence at the center. Not tolerating that speech, and after refusal to ask pardon for the way he dealt with one of the members of the team the meeting finally ends and we go for or final supper. Moses has cancelled the looked for and famous final feast leaving us all rather sorry.
The general feeling of the team is bad, as we have placed much hope, effort and work in this campaign. The final feeling is that we do not want to come back to this center in spite of the kindness of the people and the good working of the center we do not agree to the dictatorial regime with which HIH is ruled.
We mount again on a Matatu which Moses refuses to pay in spite of its having been included in the price paid initially to him. We stop at Jinja, half way between Kamutur and Entebbe where we had the chance to see the beginning of the Nile and have our usual meeting to evaluate the experience.
There still remains the future of the Ambulance and equipment for the center, already presented and defended in the RICOMS by Eduardo Perea under the name of the 6 doctors who made up the mission this year.
The surgical team is made out by:
Two lady nurses:
María del Mar Martinez Gomez.
María Dolores González Sobrino.
Inmaculada Benitez Linero.
Guiomar Rosel Fernández Castellano
Ana Senent Boza (FEA)
Eduardo Perea del Pozo (FEA)
Abdul Razak Muchref (FEA)
Manuel Bustos Jiménez (FEA).
Diego Manuel Angulo Gonzalez (FEA)
Fotographer María del Carmen Guillen Jiménez
OPERATED UPON PATHIENTS:
CARRIED OUT PROCEDURES:
ADULT PATHIENTS: 76 patients, 84 procedures
Inguinal hernia: 16
Sebaceous cyst: 3
Umbillical hernia: 3
Epigastric hernia: 2
Femoral hernia: 2
Anal fissure: 2
Tirogloso cyst: 1
Perianal fistula: 1
Biopsia neoplasia: 1
The patients were operated upon with raquis or general anaesthetics according to the pathology.
Operation theater 3: inguinal hernias, hidroceles, parathiroids adenoma, lipomas and other wall pathologies with spinal and loco-regional anesthesia.
Operation theater 2: all goiters with general anaesthetics (prevalent pathology seen in consult).
In all the inguinal hernias the Lichtenstein technique was used. In the other hernias were also placed Polipropilene meshes of little weight and wide porous. Profilaxis antibiotic was administered with cefazolina 2g i.v. to all patients with whom prosthetic material was used.
1 seroma of a total tyroidectomy of tumoral origin in a patient who returned to the hospital whose cures and we have been in contact with local staff and have helped in his recovery. No late complication has been noticed till the moment.
It is a private center created by the initiative of Moses Aisia, a social worker, as there is no health covering in the zone. From the first campaign carried out by Surgeons in Action in December 2017 that small dispensary, where small operations were carried out in an ordinary room, it has converted into a modest center with a surgical pavilion which, though not yet finished, has allowed us to work without too many difficulties in 3 surgical rooms at the same time. The operation theaters, far from of the standards to which we were used to, allow to work with certain ease, although the heat was uncomfortable, chiefly in the evening.
The operation theater and the reception room are very new and the actual center are very new and we believe to be very favorable. The local staff is very well instructed and they treat the patients well.
The dealings between Moses Aisia and the hired staff is not good in our opinion and in the saying of lady doctors and technicians. In some occasions we have observed that the way the director deals with patients is not the most desirable.
-surgical material for small and medial interventions, which is sterilized in small pressure receptors.
-2 diathermy generators working properly.
-3 operation lamps whose light is insufficient so that the use of frontal is necesary
- surgical tables and legs (which allowed us to carry out perianal surgery)
-laboratory where to carry out basic analytics
-they do not have gowns or surgical drapes, that is why we have to take them for every mission (there remain those who were left in this one).
- Universal anaesthetic machine
- Two oxygen bullets that are not compatible with the machine, so that it can be used taking into account that the oxygen is obtained through the internal concentrator of the machine.
- Taking into account that several groups of “Cirujanos en Acción” and “Hernia International” they have a generous excedent of local anaesthetic and hipnoticous (propofol), AINES, atropine and other medicines.
- Fungible material: raquideal needles, nasal glasses, facial mask, laryngeas, Guedel.
It is advisable to make a little revue at the end of each mission, just as we did, to replace in the next one, and not to take too much material with the risk that it may be out of use for not having used it. Our nurse took care to explain to the staff of the Centre the material and to put it in order. We explained to the doctors the medication they had in the operation theater.
In general the conditions have improved considerably so that we could carry out anesthesis more safely. We told Moses the great benefit it would be to get mussel relaxing and Sevorane to operate upon pediatric patients and adults more surely.
5- LOCAL STAFF:
At the present moment the hospital has 2 doctors, Andrew and Victor. They made the previous selection of the patients and they helped us with the surgical interventions and the post-operation care. They were always eager to learn and improve as much as possible.
Besides we had the help of Moses, anaesthetic technician with a year of experience, who strives to learn the technics that our anaesthetists tought him.
The staff of the operation theater takes care to help us with the material and work. The lady nurses help us with the healings and the postoperative care of the patients.
We also had staff for shifting and placing of patients in the operation theater, very efficient in their work.
6- Aspects to be improved:
- Training of local staff in the care of postoperatory immediately, and possible following late complications that can appear after the campaign, something essential for more complex surgeries.
- Gathering of a number of patients according to the length of the mission.
- Use Sevorane instead of Halotane.
- Supply of light and running water.
- Ventilation according to the operation in theaters.
- Possibility of more laboratory tests
- Change the manager of the center.
7 – CONCLUSIONS AND THANKS.
The Holy Innocents Hospital is the best center where we have worked in missions of “Cirujanos en Acción”. In spite of the very evident evolution in the center, 6 years the inversionis the same, and in the ANAS project, the good formation and kindness of the local staff and in the subjectic good health, we believe that the center has much to improve.
Understanding the country in which we are and its culture it is still too much for the dictatorial and authoritarian of the Director of the same, the treating of the patients, just as with the volunteers. We were sorry about the catastrophic ending of the campaign, and at some moments we felt even fear when we felt that with the changes of mood of a person with much power in the center in the midst of a helpesness where we could do nothing.
During the days following the campaign we established conversations with different workers whom we do not mention to preserve their identity.The common feeling is that they are abused of them, they do not receive more than 3 or 6 months and their conditions are not the proper ones. We believe that the getting of resource of is very good but the dealing with the persons is very poor.
Fdo. Dr. Eduardo Perea