After three months of preparation, bureaucracy and getting permits, and some last minute drop out, on Saturday March 10 the Surgeons in Action team in collaboration with Hernia International begun our Farafenni mission in Gambia. Two groups started together for Banjul. From Barcelona came PepaFornier (nurse in the Badajoz Maternity Hospital) and InmaculadaVilchez (nurse in the University Hospital La Fe, Valencia). From Madrid, Ana Amalich (anaesthetist in the University Hospital Gregorio Marañón in Madrid), Asunción Azpeitia and Nagore Slolaetxe (paediatric surgeons in the University Hospital of Cruces in Barakaldo) and Antonio Satorras (general surgeon of the Hospital da Costa in Lugo).
We arrived in Banjul by night, with Africa’s smell and a wonderful sky. We were received by SaineyDibba for public relationship in the Farafenni hospital who will be our direct and efficient contact during our stay, and Amadou, the driver assigned to us by the Health Ministry. We spend our first night in the Grand Villa Guest Hotel, a colonial stile guest house near the airport.
After a short night, only interrupted by the iman’s calls, we are met in Banjul the director of the hospital, Wandifa Samateh, and later we start for our destination and we cross the Gambia River in a crowded ferry. After two hours, somewhat lengthened by a puncture in one wheel, we reached the AFPRC General Hospital of Farafenni. We met Mr. Famara, the administrator, and some of the team. Local doctors don’t work there, and all the responsibility is with men nurses and a small team of Cuban doctors. There we have our first warm meal.
The center has 160 beds. There are two operation theaters, both badly equipped. One is large with three beds, but with only one surgical table. The others are stretchers without mobility. There is only a surgical lamp and an old anaesthetic apparatus that works on Halotano. There are too few connections, and there is only an oxygen cylinder. Electricity stops are constant, and we often use the front lights we have brought with us. We don’t have wifi net either.
We had brought with us about 200 Kg of material and medicines, with an electroscalpel generator which we set for the next day. We had at our disposal another Valleylab scalpel belonging to the centre. Serums were provided by the hospital. All the material was in a very poor state, just as the condition of surgical material including gownsand gauzes which were sterilized in an old autoclave and are usually wet.
Quite tired we retired to our hotel, MoneBerre Lodge, very close to the hospital, with very poor rooms below elementary care, although they had wifi and a square from which we could see the sky in spite of the sweltering heat. At least we had air conditional, mosquito nets and cold beer Rastaman, the owner, makes our stay pleasant with his conversation and reggae music.
Our day begins with our arrival to the hospital for breakfast at 7’30. At 8 we begin seeing patients. The first day, after announcements of the Spanish Campaign in the media, many patients arrive without any selection having been made, and frequently with troubles or pathologies which we cannot presume. Nobody has any previous study, and we cannot in any way make them. Hardly anyone speaks English, but we have local translators for madinga and wolof, which are the main languages. We make a first selection and, after solving some technical problems we finally begin operations. We find out that there is no local anaesthetist as they had promised us, although Luis Anglada, anaesthetist, and Yudelines Denis, general surgeon (lady) Cubans who are who are also working at the centre, will be a good help as they are able to partially help us. The explain to us the local idiosindicrasy and the African way of doing things, and so we are able to finish up an extenuating first day in which we attend to 11 patients between adults and children, with a total of 13 pathologies. Only later come we to know that such patients remain in a reanimation ward without any system monitorization in charge of a team of helpers with little formation and fewer means. During the whole mission we have tried to teach the staff although not always with the results we expected.
The cock’s crowing and the call to prayer mark the beginning of the new day. They come to take us to the hospital. A local woman cook prepares our meals. For 6 euros a day we have breakfast and lunch in the hospital, and the supper is taken to us in the hotel. Rice and vegetables are the basis, and the protein changes. The taste is good, and the hygiene… Gambian style.
A new day. We go on establishing new patterns so that the patients who are accepted for surgery may come better prepared to the operation theater, at least washed and shaved. The rythm of work is different from our usual one, so that in spite ofour expectations we cannot operate more than 12 patients daily, three for team and session. They come from the whole of Gambia and Senegal. The greater part are men, and it would seem that women have no need for our services. On the other hand it is the mothers that accompany their children, who usually show malnutrition. The services we give is cheaper than the usual, but not gratuitous, and most of them stay in the hospital for their first night. If anyone needs a revision to withdraw catheters they stay in houses of relatives and come back in 48 hours for us to see them. Precautions have to be heavy, given the spread of sicknesses like AIDS or hepatitis which are highly infectious. We work with double gloves as our colleagues have recommended.
In spited of our having informed the director very seriously about our team, the number of paedriatic patients is very small, so that the experience and availability of two surgeons turn out to be in vain. On Thursday, surprise: hardly any patients have come. We don’t know the reason, but very few have come and only six can be programmed for surgery. This gives us a free afternoon and we visit the Farafenni market.
Although they had programmed no activity till Friday noon, given the problem of the previous day we extended the last to include as many patients as possible. Friday night they gave us a farewell supper with all the staff. There were speeches and words of thanksgiving, and we ended up by taking a beer with the Cuban delegation in our hotel.
Saturday is the beginning of our way back. We visit the Wassu Stone Circle and Jamjamboréh, old slaves enclave. On our way back we suffered another breakdown in our van. Lost in the middle of nowhere we had to wait more than four hours for another ambulance from the hospital and complete the three hours by night with much traffic, vehicles without lights, animals along the way and plenty of police controls. Fortunately, the only accident was a lamb killed. So we reached Leybato Beach Hotel where we could rest in better conditions.
On Sunday we went to visit the pool of crocodiles in Kahikaly and the monkeys reserve (quite useless) in the Banji National Park. We also visited the fish market in Tanji. Finally we started on our way back in the early morning, we passed through Casablanca and we finished up without any difficulty in Madrid.
The final result of the campaign has been very positive. We have attended to 53 patients with a total of 61 procedures with double pathologies. We have been able to exhibit the best a maximum technical quality with very few means. Of the patients, 41 were adults and 12 children between 1 and 5 years. The majority (48) were men. We used regional anaesthetic in 35 cases, general in 14, and local in 4. The diagnosis was of inguinal hernia in 38 cases, general in 14 and local in 4. The diagnosis were of inguinal hernia in 38 cases, some giant, and in all adults there were treated with hemioplastia with net, hicrocele in 12, umbilical hernia in 4, one not descended testicle, and 6 tumorations of soft parts. An hydrocele patient needed a hematoma revision; he rest evolution satisfactorily.
The expenses, apart from plane tickets, were 16 euros boarding and 8 euros meals per person and day. That includes the water we had to buy daily. No other one, apart from the excursions on the last days, the tips, and the mementos each one bought at the end.
After the mission we think it would have been better to program it for two weeks, because by the time we got well settled it was already time to start back. We could try to improve the teaching and formation of the local staff, as some of them had a very good disposition and desire to learn. This will have to wait for next visits.
Dr. Antonio Satorras