GATUNDU-KENYA CAMP 2023
Jan-23-2024
TECHNICAL REPORT
DATES AND DEPLOYED LOGISTIC
The team of collaborators began to be formed in the month of August 2023 under the coordination of Dr. Teresa Butrón and Fundación Cirujanos en Acción (Surgeons in Action Foundation) with the collaboration of Hernia International Foundation. It was prepared in two months and a half and it was made possible with the help of Lizz Beth, secretary of the Gatundu Hospital Director. She responded very quickly and clearly to all questions related to documentation needed to obtain the temporary permissions (Passports, VISA, C.Vitae, diplomas and profesional certificates of professional suitability). The hospital provided transport from the airport to the hotel in Tikka and daily from the hotel to the hospital in the morning an back to the hotel in the evening.
All volunteers collected all the consumable material needed for the campaign, including surgical gowns, drapes, surgical fields, sutures, meshes of different types and sizes, bladder catheters, sterile and operating gloves as well as drugs (anesthetics, muscle relaxants, antibiotics, analgesics and anaesthetic material such as spinal needles, epidural catheters, endotrachael tubes and rest of the material.
MBA company in Madrid donated 3108€ in laryngeal maks of differents shapes and sizes.
It is very remarkable that the team components could get 3 electrosurgical units to be used during the campaign and one of those was delivered to Gatundu hospital after the end of the working period.
The air tickets were taken through Angelis (freelance of Halcon Viajes Company) with the company Turkish Airlines, which allowed the transport of 2 bags of 23 kg per person + cabin bagage.
The group left from various parts of Spain on Friday, November 24, 2023. The whole group gathered at Istanbul Airport to leave for the 12 members of the expedition to Nairobi. The campaign ended on Saturday, December 2, 2023 and we arrived Spain Sunday 3th.
- A total de 118 patients were operated on during the campaign period
ADULTS PATIENTS: A total of 60 surgeries were done on adult patients with the following procedures performed:
Hernioplasty prefascial 31 cases
Lichtenstein 25 cases
Incisional hernia 3 cases (Rives Stoppa, resection and resection plus reconstruction)
Preperitoneal hernioplasy plus left PSC 1 case
PAEDIATRICS PATIENTS. 58 cases in infants and children; 10% female and ranging from 1 to 14 years of age (median age 4 years).
Undescended testicles: 31 cases, two of them bilateral
Inguinal hernia: 15 cases
Umbilical hernia: 6 cases
Supraumbilical hernia 1
Hydrocele: 4
Ectopic testis: 1
COMPLICATIONS: Once the team left Gatundu Hospital, the follow up of patients was done by Dr Chacha. There were no relevant complications in the first 30 days after surgery
CAMPAIGN REPORT
THE PLACE. Kenya is a big country located in the east central coast of Africa. Kenya’s population was reported as 47.6 million during the 2019 census compared to 38.6 million inhabitants in 2009, 30.7 million in 1999, 21.4 million in 1989, and 15.3 million in 1979. This was an increase of a factor of 2.5 over 30 years or an average growth rate of more than 3 percent per year. The population growth rate has been reported as reduced during the 2000s, and was estimated at 2.7 percent (as of 2010), resulting in an estimate of 46.5 million in 2016. According to the 2022 revision of the World Population Prospects, the total population was 53,005,614 in 2021 compared to 6,077,000 in 1950, and around 1,700,000 in 1900. The proportion of children below the age of 15 in 2010 was 42.5%, 54.9% between the ages of 15 and 65, and 2.7% of the population was 65 years or older. Worldometers estimates the total population at 48,466,928 inhabitants, a 29th global rank. Kenya’s GDP per capita, an indicator of its standard of living, was 2.081 in the year 2022 (Spain $30.103), and it ranks 152nd out of 192 countries, what means a very low standard of living.
Gatundu is a small town of about 20,000 people located at 1600 meters de altitude in Kiambu County with a population of 1,600,000 habitants and is situated about an hour’s drive from Nairobi. The town’s infrastructure is very poor, with most of the houses and shops located on both sides of the main road. The population lives on a dollar a day. Rice, vegetables and other farm produces are the staple food.
The V Level Gatundu Hospital was built in 2013 with the financial support of the Chinese Goverment. In 2016, its clinical activity began and in recent years there has been a very evident deterioration in the architecture with structural repairs currently underway.
Another wing is currently under construction and will be used for oncology. It is an annex to the old Gatundu Hospital, consisting of several single-storey pavilions connected to each other, with large green areas.
The hospital has 5 floors and, in the third floor is the surgical area with two large operating rooms which are called theatres 3 and 4.
There are two anesthesia machines fully operational but with basic monitoring that does not include capnography or inspired gas analysis.
The post-anesthesia recovery area is very poor, consisting only of 3-4 beds without any monitoring and with the possibility of administering oxygen through a facial mask or nasal cannula. Surveillance in this space by local staff is quite limited but, due to the proximity to the operating rooms and the work of Dr Amanda García with the pediatric population, we were able to do direct clinical surveillance of the patients and intermittently monitor SpO2. using portable pulse oximeters brought from Spain
THE TEAM was composed by a total number of 12 volunteers:
- General Surgeons: Teresa Butrón (team leader). María del Mar Viana Miguel. Juan Pablo Alarcón Caballero. Jesús Manuel Bollo Rodríguez.
- Neurosurgeons. Alina Costache
- Pediatric surgeons. Alejandro Unda Freire
- Pediatric intensivist. Amanda García Palencia,
- Anesthesiologists. Irene Merino Martín. Santiago García del Valle
- Nurses. Patricia Arenas Suarez, María Cristina Gutiérrez Moreno. Marina Remesal Oliva.
LOCAL STAFF. Dr Clifford Chacha Mwita, Gatundu hospital’s surgeon, our contact there and and the person responsible for coordinating all the clinical activity that we carry out there, actively participated as a surgeon in several cases, teaming up with Dr Butrón. We had support, both in the operating room and in the hospitalization ward, from local general medicine doctors. Since we were able to have 3 operating room tables from the first moment and there were only two anesthetists in the volunteer team, we were able to count on the collaboration of a team of local anesthesiologists, some displaced from Nairobi like Dr Ruth Muiruri, Dr Eric Karuri and Dr Isaack Karaba. We also have the help of nursing and auxiliary personnel in the 2 operating rooms used
- EQUIPMENT. The surgical instruments available at the Gatundu hospital such as forceps, retractors and scissors are not in very good condition and there are not adequate sizes for some of the longer and more aggressive interventions performed. There was no diathermy generators available although fortunately the team was able to transport 3 units from Madrid.
ANAESTHESIA. The paediatric population was operated under general anesthesia in most cases by the Dr Irene Merino. The anaesthesia in the adults patients was done by Dr Santiago Gª del Valle and the local anesthesiologists and it was general anesthesia in 17, cases, general plus epidural in one case and spinal anesthesia in the remaining 42 cases.
ASEPSIS AND SURGICAL MATERIALS: Sterilisation was carried out with a heat-operated autoclave.
OUR DAILY LIFE
We arrived at Nairobi International Airport on Saturday 25 November at 3:00 am. There were no difficulties with customs formalities and from there we were transferred to the Maxland Hotel in the town of Tikka, about 60 minutes from Nairobi. Maxland hotel is very secure as it is within a fenced compound with access controlled by security guards. The rooms are single, with en-suite bathrooms and beds with mosquito nets, and are very clean and hygienic. It has wifi which works very well both in the rooms and in the common areas (hall and dining room). Breakfast is buffet style. There is a shopping centre next to the hotel with small shops, a pizzeria and a big supermarket with a great variety of products
After resting for a few hours, we travelled to the Gatundu Level V Hospital, 20 minutes away from Maxland hotel, for what would be our transport and driver (Mr Samu Macharia) for the duration of the campaign. We arrived at the hospital and we were wellcome by Dr Chacha. That same day we started unpacking the equipment and organised it in the two surgical rooms available as well as to check the monitors and anesthesia machines available. Surgeons and anesthesiologists we went with Dr. Chacha to see the patients ready to operate the following day. This clinical visit was repeated every day in the evening. At the end of the day we came back to the hotel to buy some food and drinks in the market near the hotel before dinner.
We worked during 6 days (Sunday to Friday inclusive) from 8:00 -19:00, even later several days. The last surgery performed ended at 18:00 the Friday, december 1, 2023. On Saturday 3rd, 4 volunteers left the hotel to visit the Masai Mara Park to return to Madrid on the 5th of December, the rest of us went to Nairobi National Park a wonderful place where we saw a great variety of big wild animals such as rhinos, Monkeys, buffaloes, etc.
CONCLUSION
Strengths of this place: Very good organization in the selection of patients to prepare the daily surgical report, both in the pediatric population and in adults. Possibility of having three surgical tables throughout the period. It is very important to have the collaboration of local professionals, both surgeons, anesthetists and nurses.
Improvement objectives: It would be very useful for future campaigns if the Gatundu hospital could have an electric scalpel unit and Dra. Butrón made this known to both Dr. Chacha and the hospital director during a small farewell ceremony.
BUDGET (VOLUNTEERS COSTS):
COST FOR PERSON: Flight ticket 650€, Hotel (room plus half board) 340€ (42€ per day x 8 days). VISA 60€. Total amount 1050€ per volunteer.
TOTAL CAMPAING COST: 12.600 €
SIGNED: Santiago García del Valle
Volonteer
Surgeons in Action Foundation
You can see some photos of the campaign at our Gallery