Spanish Team revisits success

REPORT of September Sedhiou Campaign, Senegal 2016

  

 TECHNICAL MEMORY

PARTICIPANTS

-      Nuria Agulló Marín (Nurse)

-      Ana María Gay Fernández (General Surgeon)

-      Beatriz Revuelta Alonso (Anaesthesist)

-      Carlos Andrés de la Torre (Paediatric Surgeon)

-      Davis Fernández Luengas (General Surgeon), Team Leader

-      Mariama Badji (Senegal local contact)

DURATION

September 13th. Journey from Dakar. Preparation and placing of the medical material.

September14 to19. 6 working days, 12 hours each.

First thing in the morning ward round to the patients operated the day before.

8:30 to 20 operation time with a break for lunch.

At the end of the day ward round.

September 20th journey to Dakar.



CAMPAIGN RESULTS

64 patients operated upon (33 adults, 31 children).

81     81 procedures.

  

And we land in Senegal without difficulty. Thanks to Mariama Badji we passed through customs without problem. This was the first of many tasks she had to carry out throughout the whole campaign. Without her all this would have been very difficult.

Even when we already knew that, we find it odd to have to spend 3 days in Dakar doing nothing. Unfortunately the dates of our trip have coincided with Tabaski, the feast of the lamb, which is one of the most important feasts in the Muslim calendar which paralyses the whole country. As a result, since the night of the 10th in which we landed in Dakar we could not go to Sedhiou till the 13th.

The best part of this compulsory delay was, no doubt, that we were able to discover some sample of people’s habits in that country. We enjoyed the Tabaski feast with a family (thanks, again, to Mariama who invited us to her home), and we shared with the people there a wonderful feast day. We could understand something about the ritual of the lamb’s sacrifice, and we collaborated in the preparations of the feast.

But let us come now to the most important things. Sedhiou is a place at the South of Senegal, bathed by the Casamance river, with about 25.000 inhabitants. Its buildings are low houses, usually of prefabricated bricks and metallic roofs. There are many poorer constructions, and one could see how people spend almost the whole day on the street. A great part of the city lacks basics as asphalt and lights, running water or electricity. The capital of the region is Sedhhiou with about 400.000 inhabitants. In the city are found the Prefecture and, of course, the Hospital Centre for the Sedhiou region which was our aim.

We could not easily call this a hospital centre according to our own concept and our resources. This is the first lesson one learns on arrival: Here we are not going to work as at home. The hospital has several buildings, though we only used what they called the surgical block: a one-story building with several rooms for patients, some personal offices and a surgical area with two operation theaters, one of them small with a table and a respirator which we would use for paedriatic patients, and a larger one with two tables and a respirator which we used for adults. They have only one generator for the electroscalpel. We had brought two other generators with the idea of using three tables.

With respect to the sterilisation service and the surgical material the situation was very bad. There is one autoclave for sterilization with damp heat, and they have a few metallic containers for sterile surgical cloths, and several boxes with surgical material. There is no organized separation of material and cloths, so that the same boxes have to be used in several operations, selecting the necessary material for each with the evident risk of losing sterility. This is one of the things to be improved in the working of the operation theatre.

Our arrival at the hospital with all our material in our bags, the charm of the first day, our desire to give of our best… stumble against the reality of the place. During the last three days the hospital has only taken urgent cases, the operation theatre has been used seldom, and the whole atmosphere is Dantesque. Nobody has cleaned the operation theaters nor collected used clothes.

  

Well, that’s what we came here for. For those who are coming for the first time the impact is greater. Still we begin working on the same afternoon, we set everybody to work, and by the end of the day we have organized the whole material and the operation theaters are clean and ready. On arrival we found some posters of a gratuitous surgical campaign run by AMREF, for 15-19 September, organized by the surgeon of the hospital, Dr. Cámara, in collaboration with the “Cirujanos en Acción” foundation. We were then told that we would be sharing operation theater and team activities with two paediatric surgeons and one anaesthetist.

In spite of the problems and objections of Dr. Cámara we managed to begin operations on the 14th. The basic routine each day consisted in examining the patients selected the previous weeks to see their pathology and a pre-operation study basically consisting in blood analysis. When selecting the patients we program each day the surgical work with adults in one operation theatre and children in the other. The team is divided in two: in one of them Carlos with the help of a local male nurse (Xavier) or David or Ana, and Beatriz as anaesthetist in one place and in the other David and Ana with a local anaesthetist, Dr. Thiam.

After the 15th we shared the paediatric cases each day with the medical team of AMREF that had come from Dakar. They operated on in the other table of the large operation room with a respirator.

The larger part of the operations on adults took place under spinal anaesthetics and on children under general anaesthetics.With a few exceptions the operations have been inguinal hernias, umbilical hernias, fimosis and hidrocels. The operated patients have spent their first night interned till the checking the next day when the first revision takes place and they are given instruction and medication for checking out.

Some special cases exceeded the capacity of the hospital, as 1 month old child with an anal imperforation and rectovaginal fistula which we sent to a general hospital in Kolda in collaboration with the Sedhiou social attention service, with the FCA taking up approximatey one 70% of the chirurgical intervention. We also were witnesses of the birth of a male child with a broken onfalocel, wand with an intestinal and hepatic evisceration, who was sent to Dakar.

All the surgical interventions have taken place without any incidents, and we have treated all the appointed patients. However, a better organization on the part of the hospital would have permitted us to operate upon more still. There is no doubt that the inscribing of patients is another clear point to be improved in future campaigns.

Taking into account the situation of the hospital and of the community where we have worked, and with the limitations all this implies, I think we can say that our campaign has been a success, in the many procedures we have carried out as in the capacity our team has chown to work together with all the local professionals at the hospital, sharing our experience and knowledge, which is at the end the main objective for deep improvements in the work of the hospital.

PROPOSALS FOR IMPROVEMENT

1.       Previous selection of patients according to resources and days available to get best results.

2.       Improvement of the sterilization circuit, dividing surgical cloths and instruments in smaller batches without reducing sterilization. 

3.       Formation of auxiliary staff in the basic principles of aseptics and antisepsia.

4.       The scarcity of fungible material is evident. Another diathermic generator is needed.