Status: COMPLETED

SURGICAL CAMPAIGN IN YAOUNDE, CAMEROON 16/06/2023- 28/06/2023

LOGISTICS The André Onana Foundation, through Jordi Pascual, its delegate in Spain, proposed a paediatric surgery campaign to Surgeons in Action at the beginning of 2023. In the following 2 months a group of 3 surgeons, 3 anaesthetists and 3 nurses were recruited, material was obtained and the necessary documents were processed: visa, permission to work in Cameroon and letter of invitation from the Foundation and the plane tickets. We contacted Dr William Ngatchou Djomo, director of the “Center de Medicine du Sport” (CMS) who recruited the patients. During the months of March and April we exchanged whatsApps with medical information and images of some patients with more complex processes. Finally the date of the Campaign was set between 16 and 28 June 2023.

Memory of the campaign

1-Working place

We have worked in the “Center de Medicine du sport” in the capital Yaounde. It is a 3-storey building; on the 2nd floor there are 3 operating theatres, a hospital ward with 8 beds and 3 small single rooms, as well as 3 other small rooms that were used as storage rooms. Operating theatre 1 has an operating table, surgical lamp and a basic ventilator, but in good condition. Operating theatre 2 is smaller, the operating table could not be moved vertically and is at a height that forces one to operate from a sitting position. The light from the lamp was dim and would go out unexpectedly, so the operation was usually performed with a head torch. There is a rudimentary ventilator, plus an oxygen concentrator which we used on spontaneously breathing patients. Operating theatre 3 is equipped with an electronically controlled operating table and a newer, well-maintained ventilator. This operating theatre used to perform the more complicated and longer operations. We were also given a consultation room on the ground floor to see patients. All operating theatres were air-conditioned.

2. The Team: consisted of 9 Spanish volunteers and some local collaborators. Spanish volunteers: Three surgeons: Alejo, Lola and Rocío. Three anaesthetists: Javier, Beatriz and Miguel Three nurses: Silvia, Manuela and Marian. At the local level: Dr William Ngatchou director of CMS was the coordinator in Cameroon, he helped us in the organisational tasks and recruited the patients. Three CMS doctors, Sandra Leslie, Samuel Ndjoh, Arllet Kouam, did most of the phimosis interventions and sometimes acted as assistants. In addition, Arllet Kouam helped with triage by facilitating communication with families and patients. The local nurses: Gaelle, Christelle, Jacques… helped with patient management, postoperative care, instrumentation…

3 . The Material: each of the volunteers brought medical material (about 40 kg per person) and toys for the children.

4. Accommodation: We stayed at André Onana’s home, with meals included. The team of cooks, drivers, cleaners… was great. Thanks to Carinne, Franck, Olinga, Julio and other members of the team.

5. Daily life: Every morning at 7 am we were picked up to be taken to the hospital to start the surgical activity, which started daily at 7:30 am. Some patients were rejected due to lack of indication or because they needed an intervention that was too complex for the means we had available. A few patients suffered from an acute infectious process that made surgery inadvisable at that time. At around 2 o’clock we had a 15-30 minute lunch break. We were usually provided with sandwiches, pizza, hamburgers, bananas and coffees during the morning and afternoon. Afterwards, the surgical activity was resumed until 20-21 pm. After surgery, the children remained in the hospital for 4-6 hours; when awake and stable, they were discharged by Emilia after a basic explanation and a brief report and oral painkillers for 24-48 hours. Only a small number of patients remained in hospital for 1 or more days. After finishing, we were taken back to our accommodation, where we showered and had dinner together. The dinner was always very good and varied. Of all the days we stayed, one of them we went out to experience the Cameroonian night together with the local members of the campaign. It was a very enjoyable evening. The next day we took the day off to visit a spectacular national primate reserve).

6. Personal expenses borne by the volunteers: – Visa: 170 euros – Airfare, medical insurance, sending luggage and travel to Madrid about 1100 euros.

7. Results of the activity

TOTAL NUMBER OF CHILDREN INVOLVED 237

TOTAL PATHOLOGY:

PROC. TOTAL INGUINAL HERNIA 65

CRYPTORCHIDISM 49

UMBILICAL HERNIA 32

HYDROCHELIS 28

BILATERAL CRYPTORCHIDISM 17

INGUINAL HERNIA + UMBILICAL HERNIA 9

HYPOSPADIA 9

BURN SEQUELAE 9

BILATERAL HYDROCELE 3

HYDROCELE HERNIA + UMBILICAL HERNIA + CRYPTORCHIDISM 3

CRYPTORCHIDISM + HYDROCELE 2

BILATERAL INGUINAL HERNIA 2

CRYPTORCHIDISM + HYPOSPADIAS 1

URETHRO CUTANEOUS FISTULA 1

GYNECOMASTIA LEFT 1

EPIGASTRIC HERNIA 1

HYPOSPADIAS + HYDROCELE + CRYPTORCHIDISM 1

RETRACTILE PENIS 1

TESTICULAR TORSION 1

TUMOUR FINGER 1

VARICOCELE 1

TOTAL CHILDREN OPERATED ON BY SURGEONS IN ACTION 237

CHILDREN OPERATED ON FOR PHIMOSIS BY LOCAL DOCTORS 56

TOTAL NUMBER OF CHILDREN OPERATED ON DURING THE CAMPAIGN 293

TOTAL PROCEDURES PERFORMED IN THE CAMPAIGN 335

*In addition, follow-up treatment of patients with grafts and a puncture for biopsy of a tumour in the knee were carried out.

CONCLUSIONS

Strengths:

● A good location for recruiting paediatric patients.

● The hospital has acceptable conditions.

● There are doctors and nurses willing to collaborate.

● The accommodation is quite comfortable; the maintenance equipment is very good.

Targets for improvement:

● The selection and organization of patients. Better communication beforehand could avoid unnecessary travel or peri-surgical complications (preoperative fasting), and better management of patients per day could avoid lengthening procedures (on some days we finish the activity at 22:00).

● Improve the resources of the operating theatres: operating table, lighting…

● More institutional support for volunteers from some communities to obtain medical equipment and paid leave for collaboration.

Javier Mora

Campaign Coordinator

Surgeons in Action

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