Surgeons in Action operate in Gambia

SURGEONS IN ACTION ("CIRUJANOS EN ACCIÓN") Foundation

Hernia International: Gambia. Farafenni. 24/10/2015 - 6/11/2015.

Team leaders: Virginia Gª Gutierrez, Elisardo Bilbao

Surgeons: Elisardo Bilbao, Sandra del Barrio, Virginia Gº Gutierrez, Jose Trapero, Oscar Cano, Manuel Cires

Anaesthetist: Alexander Lupke

Barajas-Adolfo Suárez airport, Madrid, 5 o'clock in the morning. We started arriving at that time, each one on their own and from different places, at terminal 2. Sandra del barrio, Virginia García, José Trapero, surgeons at the Segovia Hospital, and Montse Sánchez, a nurse at the Gregorio Marañón, together with Elisardo Bilbao, retired surgeon of Bilbao, greeted one another on meeting again after they had become acquainted at the feast organized by the "Cirujanos en Acción" foundation which took place on October 2nd. Then came Manuel Cires, from the Estella Hospital (Navarra) whom we did not know but could easily identify by the huge bag and luggage on a cart that almost hid him from view, but not quite, with his bewildered look… hopefully only for the moment. Introductions, greetings and expectation in the air.

   

Checking in looks complicated as the queue is very long, and the large amount of luggage we are bringing is not going to speed up the process. Now comes security control, and some of us have to undergo the excessive zeal of the man in charge.

Once at the gate, Alex Stanek appears. Nobody knew him. He seemed to me too young. Our mission (or our adventure) begins at last. During the flight some take advantage to sleep, others to talk so as to come to know one another. We have started late (for a change) and we are worried we may miss the connecting flight at Banjul. We land, and we run through the whole airport to the Binter Canarias gate where we have to go through passport control and board the plane. For a moment we fear our luggage may not have been so fast and may have remained back. That would be the worst news and a total failure. There we came to know Oscar, surgeon in La Candelaria in Tenerife, who is scared that we´re not going to be in time and feigns anxiety to make us hurry up. Quite a genial fellow. Fortunately the flight is also late in starting, and all goes fine. The plane is only half full, they give us something to eat and drink, and in a little more than an hour and a half we land at the Banjul international airport.

After passport checking, and not without some curious incident, we get our luggage back. Everything is there. Dr. Mamadi, director of the Farafeni hospital, whom we'll not see again till the introduction and then the last day in the farewell function with speeches, gifts and a shared supper together with some of the workers there. Saine Dibba is also with us and will be by our side the whole time in all our goings. He (or she?) seems to be in charge of us and helping us in all things. He (or she) would need a whole chapter apart.

We have two vehicles at our disposal, an old ambulance in which we place our luggage and in which the four of us accommodate ourselves together with Dibba and Manbabou, our marvelous driver throughout our whole stay. In another track go our other four companions and all the material.

More than half an hour till La Barra, where we have to board the ferry that will take us to the North side of the Gambia river. Sainey shows his ability making us jump to the first place in the long queue of trucks, cars and vans that are patiently waiting to cross. I had heard that the waiting lasted at times two days. We placed ourselves in a covered space with benches where we appreciated the shadow and the breeze. We saw the boats that are used for fishing and occasionally to transport persons. Forty minutes of observation studying people. Elegant people, women in style with colourful clothes. Serious, thin men. Some talk on their cell phones. So far I don't see the country of smiles of the propaganda pamphlets. We take photographs. Manu films with his minicamera and nobody protests. Things will soon be different.

We disembark, change money, the first 50 euros (2.500 dhalasis), and stretch our legs amidst the resigned calm of the people all around. Intense heat and humidity which make us sweat. Our winter clothes are quite uncomfortable. We have still two hours by road till Farafenni, crowded in and uncomfortable but expectant and smiling. Comforts there are none. The road is good at the beginning but potholes begin at once although our driver has no problem driving at 100 Km/h. Even with all the windows open we get no relief. There is no space and our legs ache. Herds of cows, goats, police controls without any apparent aim make our way look even longer, even with our driver helping us always.

  

Reaching Farafeni we see the hospital on our left. That is our first stop and we unload our material. They show us the central pavilion on whose first storey will we receive the patients, the pre- and post-operating hall and the operation theatre. This has two surgical tables and exploring tables and another one which we'll use for surgery. They are separated by two screens so that we can perform three simultaneous operations just as the February mission this year by an international team of Swiss, German and British surgeons.

The hospital is quite modern in its structure with a practical and intelligent design. It was inaugurated in 2003, although it was functioning since 1.999, and it gives the impression of being poorly used for lack of means. Besides the 30.000 inhabitants of the locality its area of influence extends to almost 300.000. The best help would be to invest in its development with grants planned to grow with the help of an experienced team for a certain time. But that is another story. We had to manage as we could, and we did it with the great help of the staff of APFR Farafeni.

After we unloaded in the chirurgical area and checked the storing, washing, sterilization and clothes we recommended cleanliness for the next day when we would be distributing medicines, material, etc. By then our helpers had begun to write down all the proceedings and activities as an aspect of our mission.

We had our first meal in the meeting hall where we had been solemnly received by Dr. Mamady and part of his (her) team. Welcoming speeches and meat with vegetables to eat with all of them. All meals will be on the outside of the hall. The cook attends supper every day, and she is paid daily for the menu she brings. Sandra and Oscar take charge of all this with great skill and zeal for the common good. We had to buy even our water to drink. I was forgetting to say that Sainey and Manbabou had all our meals with us.

Another trip, this time in the only conveyance, the ambulance we have for us through our stay in Gambia. Destination: Eddy's Hotel. This is our first contact with the people with whom we are going to be for 14 days. We observe the people with as much curiosity with which they observe us. Much movement and all kind of selling stands along the roads. People are tall, and the women walk with a natural elegance in their colourful clothes. There are children, many children who, as everywhere, great us and smile. Photos and videos. A few days later we'll come to know that taking photos without asking for leave may create problems…

The Hotel is just as it appears in Internet. The inner court, full of vegetation and with tables and chairs, will become our home, our meeting place with Winto and cold local beers (very good in fact) served by the hefty Ismail. We cannot forget his emotion when we took off. He did everything for us and always with a big smile. There we'll wait for our conveyance tomorrow and some of us will write our diary and have super together.

Distribution of rooms, unloading our luggage, rest and supper. We comment that there has been no mention of the 200 patients supposedly prepared for operation. We fell disappointed when we learn that for Monday, our first working day, only six sick people had been called. We decide to wait for the day and then decide what to do. There is much heat, but later a good shower and airconditioning in our rooms help us and we set down to rest not without having first having joked about mosquito nets, silk coverings and repellents. One learn how to do without many things.

 

We spend Sunday 25 October placing all our material in order at the hospital. Our faithful Manbabou has come to fetch us at 8 in the morning and sits with us for breakfast. We'll need him all the way.

We meet another "toubab" (white) who is called Francisco Díaz and who is a Cuban anaesthesist sent there for two years by his government. Several Cuban doctors look to emergencies, internal medicine, paediatrics, radiology. Still he is going to be essencial for our work as we'll say later.

We finally are able to keep everything in order for our work. It is then that we live our first emotional impact, a dead child whom our Cuban friend is not able to keep alive while the mother of the child weeps before our compassion and shock. Unfortunately we are able to verify as days go on how true the figure of 97/1.000 for children's deaths is true. What a pity!

Our protector helps us to know a weekly market that works on Sundays. Food, fruits, dry fish, instruments, field machines they repair on the spot, clothes, bags, etc. Everything is in apparent disorder, but everything can be found. The most curious thing is that at the end of the day they share their gains between all. How do they do it? It is surprising that in spite of the obvious needs they are all ready to share.

Our interest to record everything gets us into trouble when we start taking photographs. We are surrounded by people who tell us something, but we don't understand whether they want us to take more or to stop taking. Our protector comes to our rescue telling us that it is better to ask permission before taking photos, just in case.

Back at the hotel we eat rice with vegetables and fried fish which to me seems delicious. Abundant water, siesta for some and table talk for others. At 5 pm they come to fetch us for an excursion to a nearby village, but it starts raining and we unanimously decide to come back home. Beers, refreshments, supper, table talk and to bed. Tomorrow will be harder.

October 26 will be remembered by Many and by me as one of our most surprising days there. We decided that the youngest among us should go to operate on the patients that have been called, which are only a few, but we'll be adding those who come later. The most veterans among us start to organize the following days.

To reach the corridor and to see such a crowd frightens us for a start. A security guard allows each patient in when the previous leaves. Between the two of us we see 92. Sainey helps me with the translation because the patients speak their dialects and very little English or French. Manu is helped by Eliou, a male nurse of the house, with whom we manage very well. What hurts us most is having to reject some patients, as operations for associated pathologies, age, technical impossibility under our means, goiter and others were beyond our possibilities.

The publicity given to our mission in mosques and through radio had been quite effective. Our work was insured.

Before lunch, after our morning work, I speak with Francisco about the possibility of his helping us in child surgery when he is free. We would use the urgencies operation theatre which is well provided and to which he is used as he works in it.

After lunch, some surgery as prepared in the morning, and back home to prepare ourselves for the hard work that will begin tomorrow and last till the end. Everybody was ready for the challenge It is thrilling to see such enthusiasm. It's really striking, and this is what we've come here for. Our computer is constantly at work as each one elaborates his report after each intervention.

After this moment, each day two of us will, first thing in the morning, visit all those operated upon who have remained at the hospital, and then will examine patients for the following days, taking into account that on Fridays work has to be interrupted at 12 noon for the Muslim to say their prayers. We never have less than 18 patients, and some days we reach 22. The exception, as I said, was Fridays.

 

Hernias, generally, are enormous, gigantic inguino-scrotum with huge hidrocels at times. Many ranging from childhood. We fear the "loss of a right to hospitalization", and such cases do occur. Fortunately our resident for anaesthetics, Alex, helped by the Nigerian nurse, Christiana, deals with the case and we are able to finish happily the job. We'll never have another such case.

Manuel concentrates on paediatric surgery which is carried out in the urgencies operation theatre on the ground floor. He is assisted by Francisco and Mathew, the Gambian infirmarian who is very active, well prepared and a good help in all our transactions. He gets for us or first Wifi connection after some days, which gives us our best moments when we can at least communicate with our own people. They help him to operate, and all get on well together. In some cases Janneth, the local surgeon, also helps. Thanks to the experience of our Cuban friend a child is saved from a broncospasm, not without some anxious moments. The next days we concentrate on checking the clinic so as not to overwork the operation theater. We get out at 19.30 or 20 h. and we cannot lengthen our daily work. Manuel, cith the children, is always the last. He never tires.

Tired but happy we come daily back to the hotel with a thousand anecdotes to share. Best of all is the union we have established among ourselves. Such intense experiences make us believe we have known one another for ever. The table talk, the laughter makes us forget the heat, the lack of water some days, and the limitation of the hours of electrical connection. It's all the same, we are fine. We have acquired abilities for personal hygiene and for eating with light from the front. The friendliness of the hotel staff who let us use even their kitchen helps us much. We'll always remember Ismail.

Still, there was some difficulty of understanding with the management of the hospital. On the third day we invited Francisco to share our meals as he spent the whole time in our operation theater. His help was invaluable to carry out our mission, and we took it for granted. He was so far from his own home, and yet he was so happy to share his time with us, speaking the common language and telling us about his experiences as those of his three years in the Angola war as a health worker. Apparently the administration did not take that collaboration well, and we had to ask for Sainey to mediate. Finally it all was settled and he became one more in the team

On October 30th we reduced our work as it was their day of prayer and we had to end by 12 o'clock. Oscar shows his surgical prowess as he well have to do again with piles which we have included in our proceedings. Analgesics begin to be scarce, and we have to operate with local activity only. After lunch, rest, and the girls take advantage to buy cloths and to get blouses made in less than 24 hours (!).

On our first Saturday we went for an excursion. We went into the country towards the West. Always in the ambulance where they placed some chairs at the back so that we all could fit in. We have to cross the Gambia River in a ferry and we arrive in an hour. The queue to board unending as usual. Lorries and more lorries. Lots of people. Heat. We place ourselves on the first line thanks to Mr. Dibba. Manu and I buy sun hats to avid the rays of the sun. Boarding is a mess with water up to our ankles. Some of us, misguidedly, take their shoes off. This looks like the metro in Tokyo, and this is not a joke.

We land and are taken in a boat along the river to see a birds sanctuary. Birds everywhere, and we meet a group if Spanish ornithologists who are travelling throughout the world in search of new species. Their discussions on the hormonal influence on the change of colour in their feathers are interesting. Back at the hotel and after the usual police stop where Sainey helps us we eat the ham and cheese Manuel has brought from home and a few oranges we have bought on the street. We talk, laugh and feel happy at all that we have done. It has been hard but it has been worthwhile. We are getting into our rhythm and, the most important, we are getting the local helpers to fit in and to share in our enthusiasm.

On Sunday a new excursion to reach a natural reserve, again to the East, with a long way this time by road. We board a boat with various guides. The idea is to see chimps along the forest. The warn us that they are not very friendly with men. About 30 families, and in a corner a splendid specimen on a palm tree looking at us. We see the head of a hippopotamus which quickly disappears. We come back to our place to eat in the open the Gambian chicken with the usual rice. Heat, heavy heat. In the evening we visit the dolmens and the stone circles included in a tourist guides. A guide explains their history as described in posters around. Back at home Sandra, Virgi and Jose cook for us at the hotel some tomato pasta with onions they have bought in a close-by shop. It all tastes wonderful. We keep planning our work for the next week which looms heavy.

  

On Monday, after breakfast in the canteen, some go to the operation theatre and Montse and me to the consult. This time only 25 after rejecting many, chiefly goiter. We can't do them, and we feel it very much. What will happen to these poor people? Banjul is not the solution. We see other pathologies which would be easy to handle in our places, but not there… The rest of the day is as usual with operations galore with three of us, and in urgencies for children with Manuel, Francisco and the rest.

Tuesday is a full day, morning and evening. Alex feels bad with fever, cold and bellyache. He is taking Doxiciclina. For a moment we think of malaria and we advise him to take the test. We know there is a wave of the sickness and the Cuban she doctors at the hospital are dealing with 20 or 30 cases per week. He prefers to wait for 24 hours.

On that day he tells us other stories as that of having to sew up a Catalan engineer (who had come with a companion on the previous day to place some solar panels) for a fronto-parietal gap as he had hit an iron beam. At 15 hours, in full table talk, we receive the call of Angel Expósito to get directly into Cope radio. We speak about our work and our feelings.

Wednesday November 4th turns out special. Alex is still bad. We speak with Christina about his taking the test. She comes to the hotel after the morning session and stays with him. Thanks to Francisco we carry out our work, but unfortunately we have to stop operations for children as we have run out of atropine. We try all solutions but there is no way. It is a full day, and we end it up collecting material for use in other missions. Tomorrow we'll operate only in the morning. We have programmed for five patients with raqui and some with local anaesthetic. Francisco has been essential today. The concusion is that in future missions we must have at least two anaesthesists or of one very experienced. Difficulties call for veterans.

Back home we find Alex better, but we make him promise that tomorrow he'll come to the laboratory. After supper we go to the tailor so that the ladies and Oscar may collect their orders. They show us the clothes. They look very elegant, and he looks quite a Gambian. Laughter and chatting at supper.

The last day at the operation theater does not turn out as expected. There are two patients extra imposed by Alieu. We feel annoyed but we understand him. Before lunch we take leave from all the wonderful persons who have worked with us these two weeks. Photos with all, deep feelings, and a growing regret that such intimacy had not been established from the beginning. But such is life. They will always be in our memory.

Alex has gone through all the tests and the result is fortunately negative.

We take lunch and we are told that in the evening they'll come for us at the hotel to take us to a farewell function in the canteen. We take the afternoon for rest and walks. Some go to buy some balloons for the children and there is quite a stir, but it has been worthwhile. A shower, fresh clothes and back to the hospital.

  

The speeches conducted by the chief infirmarian begins according to a programme distributed beforehand. Thanksgivings, acknowledgement of their astonishment at seeing us work from 8 to 20 each day and of having operated so many patients, etc. We, on our turn, thank them for their hospitality, the wonderful help of Francisco, the care taken by Sainey and Manbubou, etc. We remember the infirmarians and the nurses, security staff and others, and we assure them they will always be in our heart. In fact we would have liked to stay longer. We are left with the sensation that we only have patched things up. What will happen till the next mission? At the end they give some dresses to the girls and some typical shirts to the boys. And back home.