1.   TECHNICAL REPORT:

We started the trip on 09/05 in the morning. 2 members of the group left from Vigo, 2 from Gran Canaria, 1 from Granada and we met in Madrid with other 4 members of the team to take the flight to Doha. There we meet the last 2 members of the team, leaving from Barcelona. In total 11 people take the next flight to Abuja.

We buy the plane tickets through Angelis, agent of Halcon viajes.

To enter the country it is necessary to obtain a visa, which has been a terribly complicated procedure and has caused us a lot of problems. First you have to fill out an on-line form and pay 258 dollars. Afterwards, we have to take to the embassy in Madrid our passports, proof of payment, 2 photos of each of us, an individual letter of invitation from the bishop of the diocese of Makurdi and a copy of the bishop’s passport. Keep in mind for future missions, if any of the members of the group has a trip for which they need the passport in the weeks prior to the campaign (as happened this time with 2 members of the group), because you know when you deliver the passports, but not when they will return them. We were fortunate to have the help of Yaili, a contact who already helped us in the previous mission, to get these passports in time. Thanks to Damian and his great patience, as he went to the embassy 6 times spending the whole morning there, we got the last visa 1 week before leaving. We also had to pay for one of the visas twice, due to a logistical problem, apparently impossible to solve without filling out a new on-line form.

This campaign is carried out in collaboration with Henria International, although in this case all the participants are volunteers from Surgeons in Action. We coordinated the campaign with Dr Austin Ella, Associate Director Program Management at the Catholic Caritas Foundation Building and Dr Thaddeus Aende, physician at Bishop Murray Medical Center.

Number of patients: 89

Mainly abdominal wall pathology, goiters, hydroceles and large lipomas were operated on.

Number of patients: 20

Inguinal hernias, umbilical hernias and hydroceles were operated.

135 procedures + 3 cesarean sections in which anesthesia was performed.

Adults: 106 procedures

Boccytosis: 8 total thyroidectomies, 23 hemithyroidectomies, 1 thyroglossal cyst.

Inguinal hernia: 35 unilateral, 6 bilateral. All were repaired with Lichtenstein technique.

Epigastric hernia: 6

Umbilical hernia: 4

Crural hernia: 3

Hydrocele: 2

Lipomas: 8

Eventration: 1

Testicular tumor: 1

Reinterventions: 2

Children: 29 procedures

Unilateral inguinal H.unilateral: 11; bilateral: 3

Umbilical H.: 9

Hydroceles: 2

Gastric H.: 1

109 patients

As complications, in the immediate postoperative period it was necessary to reoperate 2 patients: 1 hematoma in an inguinoscrotal hernia and 1 bleeding in the immediate postoperative period of a total thyroidectomy. All complications were resolved without further incidents.

To date, one month after our return, we have not been informed of any incident.

2.   MEMORY OF THE CAMPAIGN

The hospital has a large surgical room with 3 tables, which allows 3 patients to be operated on at the same time, with a screen between each table. The room is air-conditioned, which is appreciated considering the high temperatures that are reached during the day. There are lamps on each of the tables, but they are insufficient for the surgeries, so it is essential to bring a head light. We had some power cuts, but not for long.

Next to the surgical room is the sterilization room. On the other side is a small room where we did the recovery of patients under general anesthesia.

There are several rooms for men, women and children separately. They are large rooms with many beds, where the heat during the day is very intense. In addition, in one wing of the hospital, they have single rooms with air conditioning, very comfortable for patients who can afford them, although with the disadvantage that they do not have adequate surveillance by the staff.

They have a laboratory where they do analytical tests, microbiology cultures and even have a small blood bank.

The accommodation is about 15 minutes away by car. It is a residence of the diocese where we stayed free of charge. The rooms are simple, with a large bed and a bathroom with toilet, sink and shower (with buckets of water). It has air conditioning, but at night they turn off the generator around 12 noon, until 7 am. There is no wifi in the residence. In the hospital there is wifi in the dining room area, although not very powerful. Some of the team members used e-sim, although not all of them worked properly. Dr Thaddeus got us some Nigerian sim cards which also worked irregularly, although it was enough to be able to communicate with our families without problems. These cards are also available at the airport in Abuja.

General surgeons:

Ana María Gay Fernández

David Fernández Luengas

Cristina Roque Castellanos

Natalia Afonso Luis

Salifou Hankouraou

Urologist: Francisco Enrique Valle García de la Guardia

Anesthesiologists:

Rocío Díez Munar

Adrián Martínez López

Irene Macía Tejada

Nurses:

Nuria Agulló Sánchez

Paula Salgueiro Alonso

Guadalupe Martí Farre

Dr Thaddeus Aende, a physician with surgical training, screened patients prior to our arrival, and during our stay we had his collaboration in some surgeries.

Benedicta, an anesthesia technician, was with us throughout the campaign, helping and showing a lot of interest in learning.

We had the help of Lawrence, Nicholas, Jacob and Slim among others, for patient transfer and organization.

Charity and Agnes, tireless workers, were in charge of sterilization and cleaning of material.

Father Peter, health coordinator for the area, looked after us throughout the campaign.

The operating room is equipped with:

- 2 Scalpel generators donated by hernia international and solidarity scalpel, which are working properly. We took with us 1 ligasure generator with electric scalpel from the foundation and another scalpel generator that was not necessary to use.

- Autoclave for sterilization.

- Dragger ventilator model Atlan 300 with Philips monitor, donated by the foundation bisturí solidario in the previous campaign, which remains in good condition.

- Surgical material: there is a lake of surgical material, although it is scarce and deficient, so we carry several boxes of instruments from the foundation.

- Sterile clothing: they have gowns and cloth cloths, which we have not used, since for the surgical rhythm of the campaign, it is necessary to give priority to the sterilization of material.

The facilities have 1 Drager ventilator, model Atlan 300 with Philips monitor. The ventilator has the capacity to ventilate in Manual, VM, PC and PS, as well as an external flow system where an adult or child Mapelson can be adapted. It has soda lime system, which does not change color and is changed with the emptying and refilling of the same container; in the hospital they have to do it. The monitoring of the respiratory system consists of flows, volumes and most importantly, Capnography and inhalation and exhalation gases. The Philips monitor has EKG, PANI, Respiratory Rate and optional Temperature. There are 3 sizes of blood pressure cuffs.

The ventilator is plugged into the wall with Oxygen and medical air, but the 2 bottles on the back of the building are Oxygen, so you only ventilate with 02 at 100%, but at very low flows. If you remove the soda lime, this ventilator has the ability to take ambient air and mix it with your oxygen, lowering the FiO2 you give to the patient.

The ventilator also has 1 Sevorane and 1 Isoforane vaporizer, both from Baxter.

For the other 2 OR tables there is no monitor available, but there is another oxygen bullet and a concentrator in poor condition.

We have used the anesthesia machine for the thyroidectomies, which we have done with propofol in pc (we have carried a pump). 4 of the 30 patients were intubated with videolaryngoscope, although without major complications. It should be noted that there was no laryngoscope, both the Macintosht and the airtraq were carried by us.

On one table only spinal anesthesia for hernias and 2 large lipomas were performed with local anesthesia and sedation. It should be noted that on this table 3 caesarean sections were also performed by the hospital team, but with our collaboration in the spinal anesthesia and monitoring. The pulsiosimeter and the PANI were ours.

On the third table we combined adult rachis with pediatric general anesthesia. For this we set up a sevorane vaporizer connected to an oxygen bullet on one side and a Mapelson on the other. All the children, except for one 9-year-old and one 10-year-old, who were given a sedated spinal tap, had a spontaneous laryngeal mask, without complications. These patients only had a pulse oximeter for monitoring.

We set up in the exit corridor a small “Awakening” for the thyroidectomies and the children.

We have not had any serious episode to highlight.

We left medication and material to the anesthesia technician in charge, Benedicta. This 47 year old nurse is very well trained, has a lot of interest and is a great help.

On the last day we did not have enough fentanyl and she got it for us from the pharmacy. I think that given the circumstances and knowing that you can get it there, you should not bring it from Spain.

The patients do not come to the OR with a needle and the serums available there are mostly SF and 5% Dextrose. We got several boxes of Ringer’s after protesting, but not enough.

In spite of what it may seem, we worked well, comfortably and quite safely.

They have an autoclave, and 2-3 people dedicated exclusively to washing and sterilization of material, very efficient, so that except for some occasional moemnto, we had no lack of material at any time.

We landed in Abuja on Saturday May 10 at 6 am. We were held up at customs on arrival because of the equipment, which was quickly sorted out as soon as Dr Thaddeus arrived, which was delayed by about 1.5 hours.

We started the trip to Makurdi in 2 vans, 1 for the material and one for us, with a security guard. The trip is really uncomfortable, as the van is too small for the 13 people in it. It takes a little over 6 hours to reach Makurdi. There a big welcome awaits us with local songs and dances. They have also prepared a big welcome sign for us. Afterwards we eat in the hospital dining room and then we are ready to unpack the equipment to prepare the operating room for the next day.

Dr Thaddeus did the pre-selection of patients and prepared the surgeries for the 3 tables over the next few days. The patient selection was very good, but not the planning, as he planned many goiter surgeries and few surgeries for children and adults with abdominal wall pathology, despite having made the indications previously. Fortunately in the following days more patients appeared with whom we were able to complete some days. It was also somewhat complicated for us to make them understand that the order of the surgeries should be from the most complicated to the least complicated throughout the day, and not randomly as planned. In addition we encountered more complex patients in the last 2 days, so for future missions it would be good to warn that patients with giant hernias and goiters should be operated on in the first days because of the complications that may arise.

On Sunday the 11th, we were joined by Dr Salifou Hankouraou, a doctor with surgical training, who had made a 3-day long trip from Niger. Salifou worked hard throughout the campaign, always trying to learn as much as possible with us.

Each day we started with breakfast at 7 am at the residence. Then we drive 2 cars to the hospital. Two or three members of the team visit the hospital and discharge the patients. Others are in charge of seeing the patients to be operated on during the day and organize the order of the surgeries on the 3 operating tables.

In this way we operate without many incidents during 5 days and a half, stopping for lunch, finishing the day between 9 and 11 pm. Every day before leaving for the hotel, the team that finished first made a round of the rooms to check the condition of the patients.

Meals are taken at the hospital, in a dining room in the office area. We had a very good and varied meal throughout the week. We have to thank the cook for the special gluten-free menu she prepared every day for Nuria and me.

Dinner is in the residence, not as good or varied as in the hospital, but quite acceptable.

One night we were visited by the Bishop of Makurdi, Wilfred Chikpa Anagbe, we were offered a big dinner in the open air, they gave us each a gift and we all ended up dancing.

On the last day, Friday 16, we operated on the remaining patients, collected everything we had to take back, and before lunch we were taken to a nearby market where we were able to buy some souvenirs.

We started the return trip, another almost 6 hours to the Caritas residence in Abuja, where we stayed to catch the plane the next morning.

We return home with very good feelings of this place and its people. Despite all the difficulties we encountered on the way, as always, it was worth it. Many thanks to all the extraordinary people who have been part of this team of volunteers, for all the effort made with so much humor and good vibes.

3.   CONCLUSION

The hospital has a good infrastructure for this type of mission, with plenty of space and very cooperative staff. The donated material is well cared for.

Dr Thaddeus is helpful and makes a good selection of patients. All the staff is very involved in the campaign and are very nice and caring.

Although patient selection was good, there is a need to improve daily surgical planning to optimize time and resources.

To obtain more monitors and to adapt a room for recovery of patients under general anesthesia.

Undoubtedly the great handicap of this campaign is obtaining visas, which has nothing to do with the destination hospital, but it is something to take into account when it comes to coordinating this mission. Above all, it is essential to have someone on the team who can go to the embassy in person.

4. BUDGET:

4.1. COST PER PARTICIPANT:

Approximate cost per participant: 1,479.75 (± depending on the place of origin).

Flight tickets Vigo/Gran Canaria/Granada-Madrid: 1,347.48

Air tickets Madrid-Abuja: 9 flights 8.632,56

Air ticket Bacelona-Abuja: 2 flights 2.159,68

Cancellation insurance: 449.46

Transportation Abuja-Makurdi round-trip: 600 euros

Visas: 2,838 euros

Hotel Abuja: 250 euros

TOTAL COST OF THE CAMPAIGN: 16.277,18

5. SIGNATURES

Ana María Gay Fernández

Responsible for the campaign

Surgeons in Action

A photo selection of this campaign is available at our Gallery