A number of healthcare workers have now spent time undertaking voluntary work in Kambia Government Hospital and reported their experiences. There is therefore little purpose in repeating all of those things which are, by now, quite well known about the desperately impoverished people, their enormous healthcare problems and practically non-existent infrastructure in this remote north western district of Sierra Leone.Instead I have simply picked out one or two features of interest from our short trip which are perhaps slightly different and hopefully may be of some interest to prospective visitors.
The first irregular feature of my trip was that I took my 16 year old daughter. Ruth had just started her A-Level studies and she had the intention of applying for a place in Medical School in a year or so. The purpose of the trip for Ruth was of cause to broaden her horizons and allow her to see a different form of health care in a grossly underprivileged society. The difficulty for me was that I had little idea of how Ruth would cope with what was inevitably to be a challenging experience, with severe illness and death amongst the patients a high probability even during our short stay. Not only would I have to do my job but I would also have to look after Ruth’s physical and emotional welfare. In the end, as it turns out, Ruth was probably more responsible for my physical welfare than I was for hers! For example she helped my extreme discomfort during intolerable sweating whilst operating and she also looked after me when I almost collapsed on day 2 with heat exhaustion and dehydration. As it happens I needn’t have worried about her ability to cope with the emotional turmoil of what we were to witness. She did, with characteristic maturity, face up to the upsetting situations perhaps somewhat better than I did myself! We discussed this afterwards and it is probably in no small part due to the fact I’ve had children of my own and found it particularly distressing to see little ones so ill and helpless. Ruth also acknowledged that it wasn’t until sometime after the trip had finished that she started to ‘unpack’ a lot of what she saw and was able to process it. Perhaps the greatest success of all for me in this trip was when, as we finally turned off the key in the ignition after a long and arduous journey home, Ruth turned to me and said ‘Thank-you dad. I have had an amazing time’. She also pledged that she would one day go back.
The second slight deviation from normal in this trip was that I had agreed to go to Kambia to carry out hernia surgery. The idea was therefore simply to go and do very little else apart from repair hernias. An advert had been put out on the local radio Kolenten suggesting anyone with a hernia who could afford to pay half of the usual price should present themselves to the hospital.
As it turns out the demand outstripped the ability to deal with all the people that turned up and I was left having rapidly to try to train a local community health officer to carry out mesh repairs, and the Kambia Appeal boldly stepped in to provide more funding and allow more hernias to be prepared once I had left.From a personal stand point there were also substantial problems with trying to do so much operating. In the event I only carried out 25 operations in 22 people. All of the operations were hernia or hydrocele related apart from one lucky lad who only presented to the hospital because he thought he had a hernia. In fact his pain was due to acute appendicitis and we were lucky enough to be able to save him by carrying out an appendicectomy. The difficulty I encountered with doing this much operating as a newcomer to Kambia was primarily to do with the conditions in the operating theatre. I had not had sufficient time to become acclimatised and the heat was unbearable. Walking into the operating theatre was like entering a sauna. It was hot enough outside but the heat and humidity hit me like a brick wall when I entered the theatre. I then had to don a thick canvas gown and hat, sometimes with these having just been removed from the heat steriliser, still hot to the touch! The air conditioning that is supposed to work when the big generator is switched on seemed to work on a rather random basis. This also meant the lights would sometimes fail and I remember on 3 occasions having to finish an operation by the light of a pen torch shone into the wound by a willing assistant. I referred above to Ruth helping me in the operating theatre, essentially mopping my forever-dripping face and head under these conditions. Despite my conscious efforts to keep up with the fluid losses by drinking, on the 2nd day where I had carried out 5 operations I felt distinctly ill and nauseated. I could no longer tolerate drinking more water without a high risk of vomiting. On arriving back at the base camp I had to go and lie down. If it hadn’t been for my colleagues threatening to put a drip up and forcing me to drink gradually over the next few hours quite a large quantity of oral re-hydration solution I think I would have been a lot more poorly. In any case I woke up the next day feeling like I had a hang over, further testament to the residual dehydration. Back in the operating theatre that day I had vowed to look after myself better and swore that I would not operate without the air conditioning working. This was of course in vain and we ploughed on regardless, although I made massive efforts to take in 500mls of water after every operation and even this wasn’t quite enough. When I got back to England to do my first case, a small easy hernia in an air-conditioned theatre with all the lights working beautifully, and wonderful theatre equipment by comparison, etc. I can’t tell you how enjoyable it was!
And the final feature to nail home to me that we all complain too much about surgery in the UK? I had genuinely gone to Kambia thinking that because I worked in a resource rich hospital environment there would necessarily be tricks and tips, advice and ideas that I could take with me and pass on. However what I brought back with me was far more than I took. This was a great appreciation of how massively wasteful we are in our hospitals, and how we could if we had a mind to do so save enormously on cost and wastage at, arguably, no additional risk to patients. Kambia Hospital is very resourceful when it comes to minimising the wastage of water, medical consumables and electricity. My next challenge is persuading our hospital management to listen to some cost cutting ideas and to see if they can be implemented.
I would like to thank The Kambia Appeal for the support it gave me in many different ways before and during the trip, the Gloucestershire Hospitals NHS Foundation Trust for granting me a week of special leave and its many members of staff who helped me prepare for the trip and who made it possible to take out surplus equipment, to the Nuffield Hospital for providing me wound dressings and to the representatives of those medical supply companies who so willingly gave so much that my hold luggage was almost impossible to carry!
Mr M R Whyman MS FRCS
Consultant General and Vascular Surgeon
Cheltenham General Hospital
