Hernia International Mission:
Bewal, Pakistan, April 2018
If you were to choose an ideal location for a Hernia International Mission, it is unlikely that Pakistan would come to mind. Since 2014, however, the Bewal International Hospital in the Pothohar region of Pakistan has successfully hosted such a mission with a tally of 293 hernia procedures completed.
Pakistan-Kashmir Border
Officially the Islamic Republic of Pakistan, created in 1947, this beautiful country is home to diverse landscapes ranging from hilly and mountainous regions through ancient and historical monuments and finishing in bustling, crowded cities. Perhaps most notorious and very evident is the hospitality and generosity of its inhabitants.
Many people in Pakistan, particularly those in rural areas, are affected by both poor access to healthcare and the variable quality of these services. Bewal itself is a small town approximately 50 miles from Islamabad on the east border of Tehsil Gujar Khan in the Rawalpindi district. The Bewal International Hospital, which opened in 2010 serving a population of approximately 300,000, is a modern facility that aims to provide quality healthcare services for those in need, regardless of ability to pay.
Bewal International Hospital
The hospital has 2 operating theatres which were ready and waiting for our 4 days of operating from the 2nd to the 5th April. Patients had identified in the weeks leading up to the mission and were ready and waiting for our arrival on the Monday. Our team consisted of Atiq-Ur Rehman, who alongside other ex-patriot Pakistanis’ had designed, fundraised for and overseen the building and running of the hospital and its’ previous missions, Dr Sajed Mohammed, a consultant anaesthetist based at Russells Hall Hospital, Mr Hakan Gök, a consultant surgeon specializing in hernia surgery from Turkey and myself. Mr Khaleeq-Ur Rehman, a maxillofacial surgeon and a founding member of the hospital was also on hand to assist and arrange much of the logistics of the mission.
The Team outside the Operating Department
Operating
Over the 4 days we performed 71 hernia repairs, including inguinal, umbilical and epigastric herniae as well as a couple of incisional hernia. The vast majority of these were performed under spinal anaesthesia. Paediatric hernia repairs were also performed under general anaesthesia which provided its own unique challenges given the age of the anaesthetic machine and the difference in monitoring that is accustomed in England. To provide some variety, an open cholecystectomy and 3 excisions of lumps were included in the mix.
We were supported by an incredibly hard-working team from the hospital, without whom the mission would not have been possible. In particular we would not have been able to accomplish the number of operations we did without the work of the local ODP who not only performed a large number of spinal anaesthetics, but also acted as runner and assistant on a number of occasions. In addition to this, surgical residents from nearby hospitals attended each day which was a high help.
Having worked hard over 4 days we allowed some time to see some of Pakistan and spent a day sight-seeing around Islamabad. Islamabad is a new city, surrounded by beautiful scenery including the Margalla Hills which provides views over the entire city. Other sights included Faisal Mosque, one of Asia’s largest mosques which is said to hold around 100,000 people and is a mix of both traditional and modern architecture, and the Pakistan Monument which highlighted the unique history of this country.
Margalla Hills
The Pakistan Monument at dusk
During the week we were fortunate to be housed in a beautiful (and new) family house in Bewal with the added luxury of an excellent chef. Numerous family members and friends visited providing support (and more food), making us feel welcome and at home in their country.
The week spent in Pakistan was an amazing experience. Having the opportunity to visit this beautiful country and be welcomed into the community was an immense privilege. The ability to provide surgical care to members of the community was an added bonus. I would encourage anyone looking for a challenge to consider a Hernia International mission and contemplate the captivating country of Pakistan as your destination.
Emma Upchurch
Surgical Registrar, Gloucester Royal Hospital