On 26/04/2019 we 9 members of the team met at Barajas after three months of preparation for the mission. Meeting friends, nerves, chaos…. but above all best for the new adventure that expects us on the next days. Friends come to see us off at the airport and to give us more material for the mission, and Teresa Butrón, head of the Foundation and without any doubt the one who makes it possible for these campaigns to be carried out, and David Fernandez Luengas, great friend and companion, who feels very much not to be able to board the plane with us. We prepare the bags, 17 of them with 23 kg each.

The journey begins, and after a short stop at Addis Abeba, we land in Entebbe 12 hours after leaving Madrid. We clear customs without any problem thanks to the permission that Moses (the director of HIHC in Kamuntur) had got for us. The journey is long and heavy, and each one manages as he can. Gus tells us some jokes, we doze a little, stop for meals at a street post with roasted chicken, and finally, 10 hours later and without any trouble, we reach Holy Innocents Health Center in Kamutur, district of Bukedea, the lonely place that is now full of hope for the population in the whole zone.

Moses receives us with a ready dinner and a few warm beers after a long journey. We go to our rooms, one for the girls and a smaller one for the boys.

On 28/04, Sunday, our life in Kamutur begins and there is much work to do. We begin in the morning going to take water at the well for our shower in a space with low walls which give us some relative privacy, then we take breakfast together, some coffee, eggs, some fruit and bread with the Nutella, which is a classic in our missions and is Bea´s contribution.

Work begins, and so while we surgeons see the more than 100 patients with are waiting, Bea, Blanca, Isa and Gus place the material and arrange the operations theaters. We manage to begin operations on the morning. The first day we operate upon 17 patients in the 3 operation rooms. The respirator does not work properly, so they are rejected in such operations as require general anaesthetics.

We get little by little used to our daily work, and we organize our routine. First visit to begin with followed by the corresponding admissions, examining new patients and operating upon for five and a half days. Apart from electric failures in the generator and the unbearable heating the operation theater we had no difficulties.

As for our life there, the place does not offer many conveniences, and even so we adapted without mayor problems, except for some inconveniences in the communal latrines (“the hole”), since the WC placed some months before, could only be used for urinating. Our nurse Isa planned during the months before the mission how not to visit the latrines (and I think she never visited them) and some members of the team shared in that plan and it worked fairly well (for greater information ask Isa Pons directly).

Food is simple but abundant, basically rice, potatoes, beans, eggs and some chicken or lamb.

International phone calls and SMS could be sent and received without problem.

On a day of less work we went to visit the school of the zone and we gave the professors some teaching material we had with us. More than 800 children studied there in some classrooms which of course have nothing to do with those we know. They hardly have a blackboard and the ground to seat on, but they certainly are eager to learn and to improve themselves. We have verified that the new generation has access to a basic education as all children and young people know had to read and write, and they speak English.

The last day comes and they prepare for us a great farewell feast with gifts, thanksgiving speeches and music with dancing. To follow the local people’s rhythm is quite a job.

We start our return journey on 03/05 day evening after collecting everything and listing all the material we leave there. We get into our furgotaxi, and we stop in Jinja, half way between Kamutur and Entebbe, where we had the chance of visiting the Nile’s birth.

The time comes to turn back to our routine again… but already thinking of coming back.

TECHNICAL MEMORY

1-PARTICIPANTS:

Ana María Gay Fernández, general surgeon, Complejo Hospitalario Universitario in Vigo, Beatriz Revuelta Alonso, anaesthesiologist, Complejo Asistencial Universitario in León, Blanca de Prada Martín, anaesthesiologist, Complejo Hospitalario Universitario in Valladolid, Daniel Pastor Altaba, 5th year resident of general surgery, 12 de Octubre Hospital in Madrid.

Enrique Montada Iribarren, general surgeon, Complejo Hospitalario Universitario in Vigo

Gustavo Sánchez Bravo, male nurse, San Francisco de Asís Hospital, Madrid

José María Pradillos Sema, pediatric surgeon, Complejo Asistencial Universitario in León.

María Isabel Ponce Pérez, nurse, Complejo Hospitalario Univesitario in Vigo.

Paula Troncoso Pereira, general surgeon, General Hospital Mateu Orfila of Mahón

2-RESULTS OF THE CAMPAIGN:

OPERATED PATIENTS: 106

USED PROCEDURES: 132

PAEDRIATIC PATIENTS: 29 patients, 36 procedures

Inguinal hernia: 16, Hidrocele: 4 -  Fibroma: 2 – Granuloma: 2 –Umbilical hernia: 1 – Varicocele: 1 – Hipospadias: 1 – Orquidopexia: 1 – Apendicectomy: 1 (by Amyand hernia) –Cervical Linfangioma: 1 – Orquiectomy: 1 – Uretral stenosis : 1 – Desmoid cyst: 1.

The paedriatic patients were operated upon with general anaesthetics with a concentrator of oxygen.

ADULT PATIENTS: 77 PATIENTS with 96 procedures.

Inguinal hernia: 27 – Lipoma: 14 – Hidrocel: 9 – Sebaceous cyst: 9 – Umbilical hernia: 4 – Epigastric hernia 4 – Femoral hernia: 4 – Granuloma: 4 – Anal fisure: 3 – Keloid scar: 3 -  Ganglion: 2 – soft parts of tumor: 2 – Spiegel Hernia: 1 – Petit Hernia: 1 – Perianal hidrosadenitis: 1 – Perianal fistula : 1 – Orquiectomy, 1 – Axilar politelia: 1 – Mastectomy: 1 -  Rectal neoplastic biopsy: 1

Adult patients were operated upon with spinal or local anaesthetics and sedation, according to procedure. We could only carry out a general anaesthesia for a mastectomy, as we could not get the respirator work till the last day (probably because of lack of electrical power, as it worked only with the large generator).

In all the inguinal hernias we carried out the Lichtenstein technique. In the other hernias we also placed nets. Antibiotic profilaxis with cefazolina of 2g.i.v. was administered to all the patients with whom prosthetic material was used.

On the two last days we operated upon fewer patients for lack of patients, and this should be taken into account in future campaigns.

COMPLICATIONS:

1 urinary retention required bladder catheterage.

There were no reinterventions

Till this moment no further complications have been notified.

3-THE HOSPITAL: This is a private center, created by the initiative of Moses Aisia, social worker, given the lack of sanitary coverage in the zone. From the first campaign carried out by SURGEONS IN ACTION on December 2017, that dispensary where small operations were carried out in a common room has been converted into in a modest hospital center with a surgical pavilion, which even not fully completed has made it possible for us to work without too many difficulties in 3 operation theaters at the same time. The operation theaters, very far as they are from the standards to which we are used, allow us to work with some easiness, although the heat becomes unbearable, chiefly on the afternoon.

Since our previous campaign the time of transit from the surgical pavilion to their rooms has been reduced. In fact they are building another building for rooms in front, in order to facilitate the transit of patients and postoperative surveillance.

The work for the improvement of the center is continuous, and is in a  part financed by donations received by our foundation after a specific campaign to collect funds.

There is still pending the installation of solar panels enough to provide electricity supply in the operation room (in this campaign we have still used a generator) and the installation of running water.

4-AVAILABLE TOOLS:

-      surgical material for small or medium interventions, which is sterilized in small pressure recipients.

-      2 diathermy generators duly working.

-      3 operating theater lamps, whose light is insufficient so that the use of frontal illumination is still necessary

-      1 ultrasound

-      surgical tables and such as needed for perianal surgery

-      laboratory where basic analytical work can be carried out

-      they have no gowns, neither surgical drapes, so that it is indispensable to bring them for each mission (some were left by us)

-      anaesthetical material:

-      oxygen concentrator donated in the previous campaign

-      universal anaesthetical machine: taking into account that if the generator they use is little powerful, the machine does not work.

-      two oxygen measures which 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 apparatus

-      taking into account that several groups, both of Cirujanos en Acción and of Hernia International, have a generous excess of local anaesthetics as well of local hipnotics (propofol), AINES, atropine and others,

-      fungible material: spinal needles, nose specs, face and  laringeal masks, guedel…

It is advisable to make a small recount at the end of each mission, just as we did, so as to keep it for the next mission, not to bring too much material with risk that it would be out of date without having been used.

In general the conditions have improved considerably so that we can give much safer anaesthetics. We commented to Moses the great benefit that could be to obtain muscular relaxing drugs and halothane with a view to be able to enlarge the kind of surgery.

5- LOCAL STAFF: At the present the hospital has 2 doctors, Andrew and Victor. They made the pre-selection of patients and helped us with surgical operations and postoperative care, always ready to learn and to improve. We also had the help of Rose, anaesthetic nurse, who strives to learn the techniques taught by our anaesthetists.

The operation theater nurses help us with the surgical instruments and sterilization. The ward nurses help us in cleaning wounds and postoperative care of the patients.

We also have some staff for translation and placing of patients in the operation theater, very efficient in their work.

6- THINGS TO BE IMPROVED:

 -Training of local staff in immediate post-operative care of patients and possible late complications after the campaign. This is necessary for more complex surgical operations.

- Streamline surgical material sterilization circuit. It would be convenient to get an autoclave.

- Recruitment enough number of patients according to the duration of the campaign.

- Provision by the management of the HIH of the necessary drugs for general anesthesia which cannot be taken from Spain.

- Supply of light and running water.

- Proper ventilation system in operating rooms.

- Suitable space for all team members that meet basic hygiene needs.

7- CONCLUSIONS AND THANKS:

The Holy Innocents Health Center was born thanks to its director, Moses Aisia, and in a short time it has become the leading center in the region, with basic medical help which allows for surgical campaigns to be carried out with great safety. I think that soon they will be able to begin to carry out more complicated surgery.

Kamutur, although without the facilities we are used to, is a special place, and when you are there you fit so much into their life and their customs that you forget the rest of the world. All their people, and chiefly Moses, make you feel as a part of their great family.

The local staff, doctors, nurses, matrons, wardens, cooks, cleaners, safety staff… all of them have collaborated and worked exceptionally together with us to make this campaign a success.

With respect to the team, it was a real pleasure to work and to share this campaign with you. We have shared many laughs and above all we have shared in a great experience. Thanks to you all for your effort and dedication in this mission.

Dr. Ana Gay