Hernia Mission – Southern Brazil
Background
This is the third mission by Hernia International to Brazil. Recent economical downturn in one of the world’s largest economy has led to reduced funding in an already challenged healthcare system. The distribution and quality of health care provision is known to be patchy, particularly in rural areas; whilst funding varies vastly amongst different states and municipalities. Elective surgeries, such as inguinal hernia repair, have an extremely long waiting list in the public sector due to the lack of funding.
The mission visited four hospitals in the state of Rio Grande do Sul, the southernmost region of Brazil that borders Argentina and Uruguay, in three phases. 103 hernia repairs in 80 patients were conducted between 30 August to 9 Sept 2015. The service was delivered in collaboration with Brazilian and international surgeons. Our Brazilian team consisted of: Artur Pacheco Seabra (mission leader), Alberto Meyer, Miguel Nácul, Cristiano Mourão, Marcos Tannhauser (anaesthetist) and Mauricio Seabra. The international team: Todd Heniford (USA), Martin Kurzer (UK), Hugh McGregor (Australia), Keith Towsey (Australia), Bentos Domingos Vieira (Italy) and Henrietta Poon (UK). We mustered at Porto Alegre, the capital of Rio Grande do Sul, before heading out to our first destination.
Phase 1: Sananduva
Sananduva is a small agricultural municipality with an estimated population of 16000 inhabitants, with an economy primarily driven by soya bean, corn, wheat and meat production. It is approximately 230 miles and 5 hours drive through narrow windy roads from Porto Alegre. Hospital Beneficente Sao Joao (a state funded hospital) is the only hospital in Sananduva, the nearest alternative health facilities are located in Passo Fundo which is 60 miles away.
Anaesthetic support, patient consent and selection was facilitated locally by the only general surgeon and anaesthetist in Sananduva: Drs Márcio L. de Abreu e da Dra and Etaine Roxo. We had three operating theatres with wonderful theatre staff, who worked extremely hard to understand our mispronunciation of surgical instruments in Portuguese and made the quick turnover of patients possible.
Over the two days we treated 30 patients; we repaired 35 hernias (26 inguinal, 1 femoral, 5 umbilical, 3 epigastric/ventral) and performed 1 appendicetomy. Sanadunva had laparoscopic facilities and we were able to perform two TEPs. The patients were kept in contact via telephone with the local team for any problems that might arise.
We were hosted wonderfully throughout our time in Sananduva, and stayed at the Sao Jose Palace Hotel for 2 nights. The highlights were the gift hampers of the local produce and a fantastic evening of delicious churrasco and gaucho music with the Grupo Tradicionalista Os Aporreados.
Local press coverage: http://www.oiregional.com.br/2015/08/ato-que-marcou-o-inicio-dos-trabalhos-da-missao-humanitaria-internacional-no-hospital-sao-joao-em-sananduva-2/
Phase 2: Porto Alegre
We returned to Porto Alegre for the next phase of the mission, which began with the International Hernia Symposium held at Hospital Moinhos de Ventos. It was an educational day covering variety of topics in hernia surgery by excellent speakers. Surgeries were conducted in two hospitals: Hospital Moinhos de Ventos (private hospital) and Hospital Porto Alegre AFM (funded by association of the municipal employees for its members). The cost of theatre facilities and inpatient stay were kindly donated by the hospital, patients were selected from waiting list in the public healthcare system and otherwise could not afford the surgery privately.
Over the two days, we treated 18 patients and performed 27 hernia repairs (17 inguinal, 2 femoral, 5 umbilical, 3 epigastric/ventral). We were able to perform 6 laparoscopic inguinal hernia repairs (5 TAP, 1 TEP).
We stayed at Hotel Ibis Porto Alegre Moinhos de Vento and the après surgery program was excellent. We were hosted by Prof Cavazzola at his place for delicious homemade churrasco and had the opportunity to try the local German and Italian cuisines.
Phase 3: Lagoa Vermelha
Lagoa Vermelha is a municipality with a population of 28000 inhabitants with an agricultural and furniture production industry, located 750m above sea level. It is approximately 160 miles and 4 hours drive from Porto Alegre. Hospital Sao Paulo (a charity hospital funded by Fundação Araucária) is the only hospital at Lagoa Vermelha, with the nearest alternative healthcare facilities at Passo Fundo 60 miles away.
Over two days, we operated on 34 patients (25 male, 9 female) including 3 children and 1 pregnant woman. 41 hernias were repaired (28 inguinal, 5 umbilical, 6 epigastic, 2 incisional), of which 8 were laparoscopic repairs. Some of the patients had been waiting for surgery for some time, one as long as eight years. The theatre staff and anaesthetic team worked extremely hard to allow the early morning start and quick turnover of patients.
During our time at Lagoa Vermelha we stayed at Lagoa Parque Hotel, and were treated to a sumptuous churrasco at the town hall. Representatives from the local government also visited the hospital during the mission.
Local press coverage:
End of mission
We concluded the mission on the 9 September when we left Lagoa Vermelha for Porto Alegre and said goodbyes to the new friends made across the globe.
Acknowledgments
The mission is grateful to Sociedade Brasileira de Hernia e Parede abdominal (SBH) for logistical sponsorship; B Braun, Covidien, J&J and Bard for the donation of the surgical materials.
Henrietta Poon
Major RAMC