Katharina and Team return to friends at Farafenni hospital

Hernia International:   The Gambia, Farafenni, February 2015 Report

Working in Farafenni alongside the Gambians was a great experience for our international team - Katharina (anaesthetist and team leader), Michael (medical engineer), Christoph (surgeon) - all from Switzerland; Margaret (RN) from UK, Frank and Stefan (surgeons) from Germany. 


Initially the mission had been planned for 10 days, but unexpectedly the airline that we had all booked with, altered the flight schedules about 6 weeks before departure, resulting in the mission being reduced to 1 week. However, we quickly set about rescheduling our program of operating hoping not to reduce our productivity too much or let down the expectations of the local people.

Sainey Dibba, Public Relations Officer of Farafenni Hospital picked us up from the airport and had already made arrangements with immigration and customs. After a first night in a nearby hotel we were driven to Farafenni, a four hours drive on a surprisingly good road (two year ago it was just a bumpy sand road).

Dr Mamady Cham, Medical Director of Farafenni Hospital, and all the Hospital staff were so very welcoming and accommodating, and for those of the team who had been before, there were the rewards of re-acquainting with friends and colleagues. We spent the afternoon setting up the theatres with the supplies we had brought with us, in advance of starting work on the next morning.


The hospital had made preparations for the mission with a designated day clinic area, recovery area and an operating theatre where 3 operating tables were set up with screens. In the months before our arrival, recruitment had taken place through the network of medical centres in the vicinity of Farafenni, and publicity on the local radio. Some patients travelled from nearby Senegal, and many had travelled considerable distances - up to 3 days journey by foot. 

In comparison to the last mission in December 2012, the hospital indicated a huge progress in matters of clinical staff: This time our team was supported by several trained anaesthetic and theatrical nurses plus a young Gambian surgeon, Dr. Lamin Jammeh, trained in Russia and permanently located at Farafenni hospital. He also invited a team from a health point 80km distant from Farafenni - a surgeon, an anaesthetic nurse and a scrub nurse - to work with us.

It has to be said, on the Monday morning at 8am we all took a deep breath when we saw how successful the recruiting had been - 60 or so people patiently waiting in the clinic area when we arrived to commence our first day's work. Triaging was the first job to be attended to by the team, and we were keen not to have to disappoint anyone who was suitable for surgery. The children were always prioritised and accommodated at the beginning of each operating day.


There was no doubt that the anaesthetic, medical engineering and surgical skills that the team provided were of a high standard. Katharina was an excellent team leader, and sensitive to how we should pace ourselves, at the same time facilitating great collaboration with the hospital staff. 

Again it has worked out that having a medical engineer in the team is a great advantage and would be an excellent addition to every mission. Michael has trained and monitored the nurses how to operate the sterilizers and prepared a SOP-document for the hospital. He was also quite busy to mend a variety of operation tables and broken medical devices which were constantly delivered to his repair room.

The opportunity of working with the Gambians enabled a depth of experience, and a unique understanding and insight into their culture. The connections and associations with people were especially significant - hearing the personal stories of life, living and working in the Gambia was heart warming and enriching. In addition, the learning that took place was enormous – the continuous sharing of professional knowledge, skills and experience will be long lasting for us all.


Katharina put considerable effort into teaching anaesthetic skills and spinal techniques to the local anaesthetic staff. It was fascinating to encounter various medical conditions that manifest and/or present quite differently within the African population compared to what we have experienced in Europe. And for both the Hernia International team and the local Gambian hospital staff working with us, it was most satisfying that we completed 56 operations - comprising 50 hernia repairs, 1 appendecectomy, 2 removal of lipomas, several large hydroceles, and 1 orthopaedic procedure for osteomylitis (we had 2 orthopaedic surgeons on our team).

The main impact of this mission from our prospective was the training for the two local surgeons in operating hernias in children (including general anaesthesia), providing surgical and anaesthetic material (especially sutures, mesh, Propofol, thin spinal needles) and to improve the hospitals sterilisation process to secure the success of further operations. This should be monitored by subsequent missions.

Those of us who were new to such missions, quickly learnt to let go of our normal practices and routines of working, and adapt to creative new ways within the resources available, whilst endeavouring to provide the best possible care. In Gambia, nothing is wasted, and everything used, reused, repaired and re-cycled - huge learning and lessons about new and alternative ways of working which we all have taken home to reflect on and integrate in our individual work situations.


There were other experiences beyond the professional work. Gambia celebrated its 50 Years of Independence whilst we were there, and part of that celebration was the laying of the first stone of a new bridge to be built near Soma where, at present there is one of the few ferries that enable a crossing of the Gambia River. Trucks piled high with peanuts and other goods currently queue for up to 2 weeks to cross the river on the ferry. There were relaxing evenings in the open courtyard of Eddy’s hotel where Jenaba, our cook, brought us her beautifully charcoaled cooked spiced chicken, fish and vegetables at the end of our working days. And there were memorable outings in the late afternoon/evenings to a local vegetable garden, scenic fishing village, the local radio station, and to the nearby Senegal border. The sound of the regular call to prayer, the stunning African sunsets, fabulous night skies and the cicadas at dusk are lasting memories, along with the special connections and friendships that were made.