Camp May 2016

No mission resembles a previous one, but one thing is certain, Bwindi Community Hospital will always surprise us! There is always this discrepancy between the dynamism shown prior to and upon our arrival and the old habits that we often fight but which refuse to die.

On this mission we had four projects on our agenda.

The start-up of the radiology service, thanks to the presence of Philippe Besson, engineer from Philips.
The first orthopaedic programme, led by Dr. Georges Kohut.
A detailed proposal for the extension of the operating theatre building.
The unloading of the container which had been sent in February.

This time we were 11 in the group; rather numerous, but all with very specific tasks.

A painful awakening, Thursday May 5th was a public holiday in Fribourg and whilst most people were able to take advantage of a leisurely morning, our travel schedule demanded that we get up before 2:00 am. We left Fribourg in a rented bus to go to Geneva Airport accompanied by 21 suitcases, most of them filled with electronic and orthopaedic equipment, the latter mainly supplied by the Clinique Générale in Fribourg. The usual transit through Amsterdam gave us the option to stock-up with duty free alcohol for our aperitifs at the end of the working day; I had taken the sausages but Kosta had to compensate for forgetting the 2kg of cheese which he had left at home.

We arrived in Entebbe at 22.30 where the customs officers allowed us to pass without raising an eyebrow, which was ironic, as we had armed ourselves with documents and organised our reception by the director of Bwindi Hospital to guard against the possibility of a baggage search!

We left the next day for the hospital in two groups, five by plane and six by car (to accompany the luggage). The road trip allowed the newcomers to see the countryside, to stop at the equator and to profit from the road along Elisabeth Park, where we were lucky to see elephants, baboons, warthogs, monkeys, a buffalo and even a lion! For Philippe, Marie (Scrub-nurse)and Marie-Aude (Anaesthesia nurse) their compensation preceded their first day’s work, as they were able to take part in a gorilla trek, which is something not to be missed.

At Bwindi, the work began with a tour of the site by everybody, followed by the discharge of the container early on Saturday afternoon. As in 2013, two hundred cartons littered the floor of the administrative building. We had to sort, store and paste the labels prepared by Dr Kosta Nassiopoulos and take stock! Under the pretext of outdated equipment, we “lost” speculums, masks, gloves and baby bottles! In fact, thankfully, nothing serious!

Baby beds, children’s beds, oxygen concentrators, two monitors, trolleys, mattresses, sheets, blankets, duvets and countless surgical instrument boxes, etc… were either distributed to the appropriate units or put in a storage room, all thanks to Kosta, Chantal Mory ( a faithful member of Africomed) and Alain Kolly, the building engineer who accompanied us.

Meanwhile, Dr Georges Kohut began preoperative consultations of the more than 70 prospective patients who came for this mission: unfortunately only a few could be accepted, because the sterility of the operating theatre is not irreproachable and cases such as osteoarthritis cannot be treated with prostheses. The number of untreated fractures resulting in disabling deformities, chronic infections as well as cases of contractions due to burns was overwhelming. The relative increase in prosperity of the locals also causes problems, due to our so-called civilization: More and more young people own boda-bodas (small motorcycles) which they operate as taxis, zigzagging along the roads to avoid potholes, going downhill in neutral (to save gasoline) and taking up to three passengers at a time. They sometimes have to brake with their feet!

For many years we had been trying to contact Dr Seth Frenzen and his wife Meg, an American couple who have been visiting Bwindi for the last seven years to provide palliative care for orthopaedic cases. This time, Georges had been able to contact them in advance and organise a meeting at Bwindi. They arrived two days after us and Seth (who specializes in upper limb surgery) participated in the preoperative consultations with George and was able to take benefit from his experience.

The two were able to operate together which had the secondary advantage of giving the staff some on-the-spot training

Marie and Marie-Aude were assigned the task, under the supervision of Dr Ralph le Dinh, our anesthaesist, to restore a semblance of order to the operating theatres; every year we try to facilitate the flow of work and every year on our return, we find everything stacked up in a happy-go-lucky manner. Marie-Aude’s principle responsibility was to second Ralph during anaesthesia and to have all the necessary equipment to hand. For Marie, it was the discovery of an impressive quantity of operating instruments, some eaten away by “Geek” (a kind of bleach used both for the floors and for the equipment!) . Only a few of the instruments were really useful for orthopaedic work. The challenge here was to teach the staff to recognise useful instruments and how to prepare surgical trays.

Philippe Besson , the radiology engineer, disappeared into his container with the challenge of making the X-ray machine work. We had brought it in November 2013 and, despite many attempts, had been unable to make it work. All the Ugandan or Kenyan technicians had insisted that the problem was due to a failure of the X-ray tube but Philippe was not convinced! Five cases of electronic equipment, prepared months before his trip did not obviate the need to use the bus from Kampala: five sets of relays and then 15 Kg of lead were delivered to us successively by the night bus, which had a breakdown which delayed us on the last day. To be only delayed,

what a miracle of collaboration!

On Tuesday, May 10, the machine spat out its first X-rays.
On Wednesday, May 11, Philippe Besson thought that the fluoroscopy function might work as well, which was excellent news as we had previously drawn a line through this function!
On Thursday, May 12th, Samuel Grenier, our ever-present Xray technician, had an X-ray done of his own chest and hip!
On Friday, May 13, we made three fluoroscopic hysterosalpingographs (examinations of the uterus and tubes in search of causes of sterility).

It would be impossible to go into the details of the enormous amount of work that activating this machine had generated, with the local staff, with the local tools and with the inability to go to the corner store for a missing piece There is no end to my gratitude!

Rémy was a free electron. He was nowhere and everywhere at the same time, visiting patients, in discussion with the two English internist volunteers, studying incomprehensible cases, in front of an X-ray image, searching for diagnostic and therapeutic, or, unfortunately, often palliative solutions,

He was in the laboratory and was also present in orthopaedic and operating room consultations.

The use of antibiotics and analgesics is often abusive and is regarded as the solution to everything! Laboratory equipment was once again on the agenda. The chemical analysis equipment, of which the Risch laboratory has been a major contributor, thanks to Mr Egger, is working well and has improved patient management. The question of bacteriology arose again and again.

Rémy proposed testing by PCR, a test less expensive than bacteriology with an antibiogram, the test requires fewer personnel and provides faster results; however it has the disadvantage of not being able to study antibiotic resistance. Rémy requested an in-depth study of the expected frequency of use and costs, so that a detailed request for assistance can be submitted to us for a financial contribution.

The same goes for the need for a more suitable refrigerator for the blood bank. At present, blood can only be stored for 6 weeks, which is not long enough. A situation that creates bi-monthly journeys for supplies that are expensive and which are insufficient for the demand, and uselessly and unnecessarily prolonging some hospitalizations. Blood is provided free of charge and donors are all volunteers.

Finally, the demand for an apparatus for the analysis of glucose hbca1 (glycated haemoglobin) is considered unnecessary if not dangerous because it cannot be applied to people with a tendency to haemolysis (malaria, spherocytosis, thalassemia), which is frequent in Africa

On Thursday 12th, in the presence of the administrative staff and their building engineer, Dr Kosta Nassiopoulos and Alain Kolly presented the project for the extension of the operating theatre and the refection of the operating theatre building, the extension whose funds will mostly come from the Michèle Berset foundation. Kosta’s presentation was exceptional, showing the project and the envisaged work plan step by step. It was quickly accepted by all. It is now a question of finding the material in Africa to avoid long journeys and new container shipments. The deadline for this study and the cost estimate is planned for the end of June. Alain and the local engineer, who speaks French (oh Bonheur) will be responsible for planning. We would like construction to begin in July.

We must not forget the warm welcome that is always reserved for us at Bwindi View, where we were occupying all of the lodge that we have frequented for years. We invited the two internists, as well as Dr Seth Frenzen and his wife and, one evening, we even dined on a “coq au vin” prepared by Kosta and Alain !

The result of our visit was very positive, even though there is still so much to be done – in the training of personnel – in teaching them how to maintain equipment – in ensuring the sustainability of certain key positions (gynaecologists, surgeons, ultrasound) We left on-site an apparently undamaged ultrasound machine which we had unloaded from the container but which refused to function.

If we take into account the contract signed with the Hospital five years ago our work should have come to an end, but this is not acceptable! The progress made since our very first mission is immense and we often forget that. We are impatient and above all, we are not present on site often enough! It is essential that we prepare a minimum of two missions per year (and without the inconvenience of presidential elections, because this event cut us of from the world for three days as all the the social networks were blocked!).