Fourth Hernia International mission to Korogwe District Hospital, Tanzania. June 27- July 4, 2015

Our team from Cologne and Hamburg consisted of:

Dr. Wolfgang Reinpold , Consultant Surgeon and team leader,

Dr. Bernd Stechemesser, Consultant Surgeon,

Dr. Thomas Specht; anesthesiologist,

Jessica Hellenkemper, resident in surgery

Heike Hendricks, OR technician

Daniela Lucks, OR technician and anesthesiology nurse

Ingo Leiser, OR technician

Jörn Haß, OR technician

Lasse Reinpold; student

All of us were visiting Tanzania for the first time. The team consisted of professionals from Hamburg and Cologne. The Cologne team was lead by Dr. Bernd Stechemesser. We opted to fly with Turkish Airlines via Instanbul which allowed all team members to bring 46 kg of free luggage. We arrived at Dar Es Salaam airport at 3 AM on 27 June 2015. We passed customs with more than 50 boxes of medical supplies without any problems due to the excellent preparations of Chief Surgeon Sister Avelina Temba. Early in the morning the climate was much cooler and less humid than we had expected.

 

On sun rise we were very warmly welcomed by Sister Avelina Temba, and our driver Omari. On our trip to Korogwe we stopped at the Catholic Convent in Dar Es Salaam where we were cordially received by Sister Gaspara. The Sisters invited us to a nice breakfast where we all had our first Africafe (tasty Tanzanian instant coffee)

Due to the dense Saturday morning traffic it took us more than two hours to leave the colourful and very busy metropolitarian area of Dar Es Salaam behind. The drive to Korogwe took a little longer than 6 hours. We had a nice lunch break on our way. The local food was good and tasty. The country road to Korogwe is in good condition. The countryside is very scenic and diversified with lush green African hills, savanna and rural areas. On our way we saw a troop of baboons who looked magnificent in the green landscape. We arrived in Korogwe in the late afternoon. The hospital staff gave us a very heartily welcome.On Sunday morning Avelina organized a trip to a scenic Indian Ocean beach. Swimming was very refreshing and we had lunch with excellent fish.

In the afternoon we went to District Hospital to meet, greet and examine our patients for our first operating day (Monday, 29 June).We brought all our supplies to the Theatre section. There is a special need for suture material, surgical instruments (scissors, forceps, clamps, graspers) and mesh. However, mosquito mesh can be used.

 

 Korogwe District Hospital has basic facilities. There are two wards for surgical patients. All our patients were hospitalized. The patient selection by Sister Avelina, GP Dr. Joseph and other local doctors was excellent. Our patients were all well prepared with correct diagnoses, HIV and hepatitis screening.The operating unit consists of 3 theatres, one of these is used for emergencies, mostly cesarean sections. The two theatres we were operating in are spacious and have basic equiment with air condition. Cautery machines, operating tables, operation light are satisfactory. There were two ventilation machines. Future teams should make sure that spare electric bulbs for the operation lamps are available. During 5 operating days from 29th June to 3rd July 2015 we operated on 51 patients with 56 hernias. The patients were between 1 and 85 years old.

There were 30 primary, mostly large and scrotal inguinal hernias, 8 recurrent inguinal hernias, 8 incisional hernias (5 large incisional hernias after cesarean-section), 7 umbilical hernias, 3 epigastric hernias, 5 hydroceles. We operated on 10 children, the youngest being 11 months old.primary and recurrent inguinal hernias in adults were operated on using the Lichtenstein technique. Incisional hernias and umbilical hernias larger than 1.5 cm had a sublay repair, small umbilical hernias were treated with a suture repair.All children had a suture repair. Pediatric inguinal hernias were operated on with high ligation of the hernias sac.We performed 5 Hydroceleectomies.Small and medium size inguinal hernias were performed under local anesthesia, In large inguinal hernias, recurrent inguinal hernias and umbilical hernias we used epidural anesthesia. Children and incisional hernias were operated on under general anesthesia. The colaboration with the local operating theatre staff was very good in a friendly and professional atmosphere.

 

Fortunately there were no complications.The patients were all very grateful and very satisfied with our surgical treatment. We educated local surgeons and residents. Avelina was especially interested in our sublay repair of large incisional hernias and the pedeatric operations. Dr Joseph assisted us in several operations. The anesthetists Thomas Specht and Dr. Moja did a great job. Future hernia teams should inform Sister Avelina before the mission whether the team is willing to operate on children.It is advisable to bring own sets of instruments, especially scissors, needle holder clamps and forceps.Tap water supply was interrupted several times during our stay. However, there were only two very short power breakdowns.On Wedneday evening we visited Sister Avelina´s Clinic at the Catholic Convent in Korogwe, and her single operating room loaded with the basic equipment.

Sister Avelina is the soul of all Korogwe Hernia missions. She organized our registrations to Tanzanian GMC and prepared our hernia project at Korogwe District Hospital with great heartiness and professionalism. We had good accomodation at the White Parrot Hotel. The room cost was 25-30€ per day, breakfast included, and dinner cost in a range of 10€ per person. Each member of the team covered the cost of living individually. The hotel staff was very friendly and helpful and their local cuisine was of very good quality.Compared to other hotels in the Korogwe area, the White Parrot Hotel offers good facilities for a reasonable prize. Apparently, it is the best hotel in the Korogwe area. However, tap water supply was not always available during our stay.

On this occasion I want to thank our team from Cologne and Hamburg very much and heartily. All of them did a wounderful and professional job in preparing and performing the mission. All of them participated voluntarily in their vacations and paid for travel and accomodation out of their own pockets.

I also want to thank the whole staff of Korogwe district Hospital for their very friendly and excellent professional collaboration.We thank all private donors, companies, health care suppliers, the German Hernia Society, Hernia Center Cologne, Gross-Sand Hospital Hamburg for their generous support and donations. A list of donors is attached.

Dr. Wolfgang Reinpold

Team Leader