Status: COMPLETED

Leader: Ana María Gay Fernández

TECHNICAL REPORT:

DATES AND LOGISTICS DEVELOPED: campaign carried out between 9 and 17 June 2023 in Dangbo.

For this campaign we have received several donations of all kinds of material (consumables, medication…) from several pharmaceutical companies: Medtronic, Baxter, Iberian Care, Bexen Medical, Mölnlycke, Fermon, Diquisan Canarias and Prosaga. We have also received logistical support from our hospitals: Hospital Álvaro Cunqueiro de Vigo, Hospital Universitario de Pontevedra, Hospital Universitario de Gran Canaria Dr. Negrín, Hospitales Universitarios San Roque Las Palmas de Gran Canaria and Meloneras. Our most sincere thanks to all of them.

Six of us travelled from Vigo, one from Gran Canaria and one from Madrid. We flew from Madrid to Cotonou with Royal Air Maroc, with a stopover in Casablanca. The company made several changes after the purchase of the tickets, which forced us to change all the return flights and some of us had to spend a night in Madrid before returning to Vigo. We chose this company because the stopovers were very good and the price was much more affordable, however, the change in the return flight meant an extra disbursement, and a much longer return trip than expected.

MEMORY OF THE CAMPAIGN:

THE PLACE: Redeeming Love Shelter Hospital in Dangbo. It has several blocks with a hospitalisation area for adults and children, an obstetrics area and a single operating theatre (air-conditioned, which makes the work much easier) which is only used during campaigns, as there are no surgeons there. The hospital is located in Dangbo, a small town about 30 minutes from Porto Novo, the country’s capital, and approximately 1.5 hours from Cotonou airport.

THE TEAM:

General surgeons: Ana Gay, Enrique Moncada, Cristina Roque, Fatima Sanchez Cabezudo.

Anaesthetists: Miguel Angel Pereira, Yolanda Sanduende.

Nurses: Eva M Sanchez, Verónica González Casal

LOCAL STAFF: 4 Souers live in the hospital: Opportune, Nadine, Isabella and Pascaline. All of them have treated us with great affection and we have to thank them for their great culinary skills with which they delighted us every day. In the months prior to our arrival, Souer Opportune screened patients very well in all cases. Souer Isabella helped us in the operating theatre together with Silvie, mainly for patient transport and cleaning. The nurse Gabin, a great professional and a better person, was in charge of the post-operative care of all the patients, working tirelessly and very efficiently during the 7 days we were operating.

EQUIPMENT: given that the hospital only performs surgeries during the campaigns of different NGOs, consumable material is scarce, although they keep things that are left over from other campaigns very tidily, so I have suggested to Souer Opportune to make an inventory prior to each campaign to inform the team leader of the updated material available (so as not to carry material that is already there and to be able to focus on the most necessary things).

They have a well-functioning electrosurgical generator, and 2 fairly good operating lights, although it doesn’t hurt to bring headlamps for certain surgeries.

They have a suction system, but no aspirators and hoses.

We have not had any problems with the electricity supply at any time.

ANAESTHESIA : in the surgical block we had :

1 haemodynamic monitor

1 basic respirator (volume and spontaneous mode) with vaporiser, although it only measured programmed parameters, not those supplied to the patient.)

1 oxygen concentrator (initially a single outlet that had to be removed due to technical failure and we were provided with another one with two oxygen intakes).

1 aspirator

The material available included basic material for intubation (laryngoscope blades and airtraqs of various sizes, orotracheal tubes and laryngeal masks) and material for administering oxygen (cannulas and ventimask). In addition, each patient brought a kit with a couple of serums and antibiotics.

As for medication : In the store room there were anaesthetic drugs ( propofol, ketamine, ) opiates ( fentanyl and other opioids ) , vo and iv analgesics, local anaesthetics ( lidocaine, bupi isobara and hyperbaric, mepivacaine, prilocaine hyperbaric) and general medication (atropines, adrenalines, amiodarone, antihistamines, corticoids, antiemetics, naloxone, flumacenil, oral analgesics and vo and iv calcium). They did not have needles for spinal anaesthesia.

We carried the necessary medication for the campaign, so almost none of this material was used.

We divided the patients simultaneously on the two tables according to the type of anaesthesia required. One table had a hermodynamic monitor and a respirator with halogenated vaporiser, which is the one we used for general anaesthesia and deep sedation. The other table did not have monitoring and we used our own pulse oximeter to record HR and O2 saturation, guided by the radial position to detect hypotension as far as possible, where spinal anaesthesia and more superficial sedation were performed.

In this campaign, as we were going to perform thyroid pathology, we brought our own video laryngoscope which we used without having any problems with difficult airway (in 1 case we opted for awake intubation with Airtraq, the rest with video laryngoscope for convenience). We provided all the medication and muscle relaxants (rocuronium and reversor).

The activity we carried out was :

Type of anaesthesia Type of surgery
General Intubations 18 Thyroidectomies.
Laryngeal mask 2
Large and/or deep lipoma

Eventration

Local Sedation + Sedation 5 Lipomas, epigastric hernias
1. Deep sedation 2 Large and/or deep lipomas
A. Intradural rachidian 50 Hernias and infra-umbilical abdominal wall
Total 77

For the postoperative period, general anaesthesia patients were kept in the ante-operative room as a PACU, in order to monitor their clinical condition. The rest of the patients were transferred directly to the hospitalisation area.

Up to the end of the campaign, except for one patient who we decided not to intervene due to comorbidity and lack of resources for post-operative care, we had no major complications and among the minor ones we only had to deal with some nausea or insufficient analgesia and pruritus possibly related to intradural opiates.

ASEPSIA AND SURGICAL MATERIALS: The surgical material available is sufficient to perform hernias but there is no specific material for thyroid surgery, so it is necessary to bring small dissectors and forceps, as well as some separators. It is also necessary to bring a high energy generator for thyroid surgery, as it is not available there (in this case it was a loan from Johnson & Johnson).

They have a well-functioning autoclave, so the material can be re-sterilised quickly and efficiently.

SURGERIES PERFORMED: The main procedures performed were abdominal wall pathology, goitres and soft tissue tumours in adults.

46 inguinal hernias (15 of them giant): Lichtenstein technique was performed.

18 goitres, most of them giant: 10 total thyroidectomies and 8 haemithyroidectomies.

10 lipomas (8 of them giant)

3 umbilical/supraumbilical hernias

2 epigastric hernias

1 eventration: Rives technique.

1 laparotomy wound infection (carcinomatosis of ovarian tumour operated on at another centre)

1 sebaceous cyst

Total patients: 77

Total procedures: 82

No complications of note 1 month after the end of the campaign.

Patients who underwent total thyroidectomy were provided with thyroid hormone for several months. They will be followed up in the hospital and will have access to thyroid hormone, which is readily available and affordable as Souer Opportune informed us.

LIFE IN DANGBO: We landed at Cotonou airport on 10/06 at 3:45 a.m. To our surprise, Christophe, the airport policeman, was waiting for us there and diligently helped us with the always cumbersome bureaucratic formalities and the customs clearance of our 14 packages of equipment and medication. Haddad, a tour guide in Benin, is waiting for us at the exit. He collaborates with the sisters and, thanks to his perfect Spanish, he helped us a lot in the first days of our stay. Souer Opportune is waiting in the car park with the hospital ambulance and a van for the transfer to Dangbo.

On this occasion, we stayed at the Behova Hotel, located about 15 minutes walk from the hospital. The house that Monsiuer Bonou usually provides for the team was not available, as some relatives had come for his brother’s funeral. We were very comfortable in the hotel, with single rooms and air conditioning. To our surprise, on the last day we were informed that Monsiuer Bonou had very kindly taken care of all the hotel expenses.

On the first day, the surgeons saw all the patients who were candidates for surgery (approximately 80) in the consultation room, and the rest of the team unpacked all the material and put everything in order to start operating. We started the surgeries without incident that same day and scheduled the following days. In the following days we saw a few more patients and added them to our list.

In the following days, after breakfast at the hotel, we went for a walk to the hospital. On our arrival at 8 am, we made the visit pass and the corresponding discharges before starting to operate. The postoperative stay of the patients was between 24-72 hours depending on the pathology. We performed 13-14 surgeries a day for the next 6 days. We had lunch and dinner there, food cooked with care by the sisters. As a first course we were delighted with a salad of fresh produce from their garden, and as a second course chicken, pasta, and one day they even surprised us with a potato omelette. We went back to the hotel at night in the hospital ambulance.

On the afternoon of the last day, once the work was finished and we had collected all the material we had to bring back, we were able to stroll around the village, get to know the area a little better and even buy some small souvenirs.

We went back home with a very good feeling and a great union in the team, since from the first day we worked very closely together. Thank you for having given the best of each one of us in this mission. Between all of us we have done a great job in this special little place, which generates a feeling of homesickness, that even before leaving, catches you and makes you only think of returning as soon as possible….

CONCLUSIONS:

Strengths of this place: Souer Opportune, a great person and a great professional, works hard every day to maintain good health coverage in Dangbo.

The Hospital Hospital has the necessary logistics to perform surgeries with general anesthesia safely and securely and a wide hospitalization area to support the volume of patients who operate daily in this type of campaigns.

Objectives for improvement:

-Circuit of entry and exit to the operating theatre.

Training of local staff in asepsis and antisepsis, and post-operative care.

-It would be highly recommendable to have for future campaigns:

-A capnograph for monitoring respiratory volumes, O2/CO2 inspired / inspired and anaesthetic gases, during general anaesthesia.

-A basic haemodynamic monitor (ECG, PANI and SatO2) for use during regional anaesthesia.

A portable pulse oximeter or other basic haemodynamic monitor for immediate post-operative monitoring in the ante-operative room, which could be set up as a PACU.

-Soda lime refills compatible with the DRAEGER FABIUS plus ventilator.

BUDGET:

COST PER PARTICIPANT: 848,07

TOTAL COST OF THE CAMPAIGN: air tickets Madrid-Cotonou 4.959,78 + tickets from Vigo/Gran Canaria 1.400 euros approximately. Visas 424,8 TOTAL: 6784,58

Ana Gay

Responsible for the campaign

Surgeons in Action

Visit our Gallery to see some photographies of the campaign.