OPERATION HERNIA RWANDA REPORT
Medical Team at Remera-Rukoma Hospital with the First Patient who underwent hernia operation under Local Anaesthetic
Introduction
The Medical Team of Rwanda-Legacy of Hope, Operation Hernia, has just completed a successful mission in Rwanda. Two surgical teams worked, in a progressive partnership with local healthcare workers at Remera-Rukoma and Nyamata Hospitals February 2013. Overall, this was a successful mission. It follows a pioneering mission to Nyamata Hospital in February 2012. This confirms a commitment to help improve the quality of health of the people of Rwanda through delivery of surgical care.
Impressions of Rwanda
Rwanda remains a very pleasant surprise. The country has recovered from the genocide that ravaged her people 19 years ago. The people are very welcoming. I personally felt the same way I felt in 2012, that I could easily make Kigali my second home in Africa. The capital Kigali has been rebuilt. It is a very clean city. Commerce is booming. French used to be the lingua franca until after the genocide. English is now taught in schools. All the team members were so warmly and affectionately embraced by the city, the hospitals and the people that we would like to start planning a return in 2014!!
The Surgical Team
This was joint UK /Germany Surgical team led by Mr Chris Oppong, a Consultant Surgeon in the UK. and Dr Ralph Lorenz, a Consultant Surgeon from Germany. The team comprised 4 Consultant Surgeons, 1 Assistant Surgeon, 2 Consultant Anaesthetists , 1 Anaesthetic Practitioner and 4 Nurses.
Travel
Every member of the team was a volunteer. Each member provided their own funding for air travel and all related costs. More importantly each member volunteered precious time away from work and family to be able to come. We were all motivated by a genuine and deep passion to use the medical skills and other resources we have been blessed with to help the people of Rwanda. To sum it up we love Rwanda and the sacrifice involved in the mission was a delight rather than a chore.
Hospitality
We would like to acknowledge at the outset, the urgent and crucial assistance given by the Minister of Health to Legacy of Hope to help with customs clearance at the airport.
We were warmly welcomed at the Airport by a contingent comprising officials from Remera-Rukoma and Nyamata Hospitals and ADEPR Church and Rwanda-Legacy of Hope. Throughout our stay in Kigali, our comfortable accommodation and subsistence was generously provided by ADPER Church. Our transportation, hospital accommodation and subsistence during our stay at Nyamata and Remera-Rukoma were provided by the hospital administration through the Hospital Administrators under the leadership of the 2 Medical Directors- Drs Alfred Rutagengwa and Kalinda Viateur. A section of the Medical Team was accommodated at the Presbyterian Hostel at Remera-Rukoma. The Mayor of Kamonyi District hosted a reception for the team. The Health Minister was represented at the reception by her eloquent and knowledgeable Assistant, Dr Josee He gave the medical team assurances of the full assistance of the Ministry of Health to any subsequent missions. The message was received with gratitude.
Medical Equipment
An important part of the mission was the amount of medical and allied equipment that was donated by the team. This amounted to several thousand dollars. I have attached a full inventory of the equipment to this report. In particular, I would like to highlight the following essential items:
- Theatre Air Conditioners: Two brand new Samsung air Conditioners were installed in the 2 theatres at Remera-Rukoma. £1300 was donated for this facility.
- 2. Surgical Instruments: More than Twenty (20) sets of Hernia Surgical Instruments were donated to both hospitals
- Anaesthetic Monitors: 2 Electronic Anaesthetic Monitors were donated to both hospitals. These are essential for monitoring patients undergoing General Anaesthesia.
- Diathermy Machines: One Diathermy machine was donated to each hospital.
- Gloves, Gowns, Surgical Drapes, Antibiotics, Analgesics, Wound dressings and several other consumables were also donated.
As stated earlier, the total cost of all donated items runs into several thousand dollars. This is further evidence of our commitment.
Clinical Outcome
At Nyamata Hospital 52 operations were performed. At Remera-Rukoma Hospital, 41 operations were performed. A total of 93 operations were performed by the 2 teams. The short term morbidity has been insignificant. There were no significant complications. Most of the hernias were repaired with meshes. In 2012, 36 operations were performed in 4.5 days. All the elective hernias were repaired with mesh.
For the first time at Nyamata and Remera-Rukoma Hospitals some hernias were repaired under Local Anaesthetic only with very good results. The obvious advantage is that patients can be treated as day cases, reducing hospital stay and costs.
Training
One of the local doctors at Nyamata Hospital had further training in Mesh Hernia Repair. This same doctor received training last year when the team visited. The aim of the medical mission is to provide service but also to train local doctors.
Recruitment and Screening
More patients could have had surgery at Remera-Rukoma. The recruitment was less than the capacity of the surgical team. A disturbing issue at Remera-Rukoma was the fact that patients were not screened. Hospital management expected the Volunteer teams to finance screening of patients. This expenditure was most unexpected and unfortunate.
Meeting with Ministry of Health Officials
At the end of the medical mission, the leader of Rwanda-Legacy of Hope Pastor Osee Ntavuka and the leader of the Medical Team Mr Chris Oppong were privileged to meet with two highly placed Ministry of Health (MOH) Officials, Mr Francois Habiyaremye and Dr Josee. The following issues were discussed.
1. Pre-visit Administration
Rwanda-Legacy of Hope was supported during the pre-visit preparation by the Rwandan Embassy in the UK. The MOH officials advised us to contact the MOH and arrange a Memorandum of Understanding.
2. Importation of Medical Equipment
Rwanda-Legacy of Hope was advised to inform the Ministry of Health, in addition to informing the Rwandan Embassy officials. The Ministry of Health will then arrange Customs Clearance to avoid payment for the Medical Equipment imported and donated to the hospitals.
3. Notification of Ministry of Health
As discussed above
4. Recruitment of Patients
The Ministry of Health would supervise recruitment of patients.
5. Outcome and impact of the Medical Mission
6. Future visit by Legacy of Hope Medical Teams
7. Critical Support by Ministry of Health
Lessons have been learnt. Rwanda-Legacy of Hope will agree on a Memorandum of Agreement with the Ministry of Health. This will facilitate future missions.
Acknowledgement
The Medical Team of Legacy of Hope would like to express our profound gratitude to the following for the tremendous support we received.
1. The Minister of Health, Rwanda Dr. Agnes Binagwaho
2. The Director General of Clinical Services Jean de Dieu Ngirabega, MD,Phd
3. The Rwandan High Commissioner in UK H.E Ernest Rwamucyo
4. Rev Pastor Jean Sibomana on behalf of The Pentecostal Church of Rwanda. ADEPR
5. President of Presbyterian Church of Rwanda Rev Dr Elisee Musemakweli.
6. The Mayor of Kamonyi District Mr Jacques Rutsinga
7. Dr Alfred Rutagengwa, Director, Nyamata Hospital
8. Dr Kalinda Viateur, Director, Remera-Rukoma Hospital
- The Hospital Administrators of Nyamata and Remera-Rukoma Hospital
- All Doctors and Theatre staff who teamed up with us
- All the drivers who kindly transported us during the mission.
Chris Oppong MB ChB. FRCS (Eng) FRCS (Gen Surg)
Consultant Surgeon
Leader of Medical Team of Rwanda- Legacy of Hope and Operation Hernia
February 2013