MISSION SUMMARY:

Date: September 7th, 2023 – September 19th, 2023
Location: Tetteh Quarshie Memorial Hospital; Mampong, Ghana
Mission Leader: Dr. Ziad Sifri
Volunteers: 25
Length of Mission: 7 days (+2 days follow up for Global Surgery Fellows)

MISSION BACKGROUND

This was ISHI’s eighth mission to the Tetteh Quarshie Memorial Hospital (TQMH) in Mampong, Ghana.. ISHI was once again invited back to TQMH with the approval from the hospital leadership Drs. Albert Benneh and Mawuli Gyakobo, as well as the regional tribal leaders, to continue and expand upon the work done in previous years.\

MISSION OBJECTIVES

We anticipated providing both clinical care and the exchange of both technical as well as intellectual information. Surgeries we planned for included: inguinal and ventral hernia repairs, hysterectomies, mass excisions, hydrocelectomies, prostatectomies, and burn scar reconstruction with skin graft. We offered general surgical operations, as well as surgical subspecialty care within the realm of urology, gynecology, and plastic surgery. This was the first ISHI mission to include Plastic Surgical subspecialty. 

Patients from the rural Akuapem region were alerted weeks to months before the mission via recruitment from the local healthcare team. They were then phone-screened by the local healthcare workers to ensure efficient triage. We screened 170 patients; 59 patients were deemed suitable candidates for surgery and the remaining patients were provided consults and referrals.

 SUPPLIES AND EQUIPMENT

ISHI used medications and supplies already in inventory/storage and purchased additional while on site at TQMH.  Further perishable and non-perishable supplies, such as suture and medication, were obtained by donation from MAP/Ethicon, the Afya Foundation, Brother’s Brother Foundation, Americares, and Henry Schein. ISHI surgical instruments were used and many of the supplies used were re-processed and sterilized from the RECOVER Program out of Rutgers – New Jersey Medical School. A dermatome was donated to ISHI in order to perform skin grafts for burn scar contractures, a first for any ISHI trip. Additional donations came from Newark Beth Israel Medical Center, NY-Presbyterian Queens Hospital, and the Burn Surgeons of St. Barnabas. Two vitals monitors were donated to Tetteh Quarshie Memorial Hospital.

TRAVELS

The ISHI team flew from various locations across America, traveling through Belgium and Washington and arriving on the evening of Friday, September 8. From Accra, the team boarded a bus and checked in to Hephzibah Christian Centre that evening. The Saturday to follow the team took part in a cultural day where we went on a safari, took part in team building activities and even competed against one another in an outdoor bowling alley. 

On Sunday, we arrived at TQMH with surgical boxes, met with local staff and started patient triage. This is when we scheduled surgeries for the week, prepared the OR suites and set up the patient wards. Operative days were Monday-Friday.

On Friday, we were invited to a thank you appreciation lunch, hosted by local tribal leaders and our local champion, Nellie. The following day, the majority of the team returned to America, while a small team of three remained behind to perform patient follow up.

SUMMARY OF MISSION AND ACCOMPLISHMENTS

We performed 79 operations on 71 patients, a new record for ISHI for the number of cases completed on a week-long mission.

Patient care:

• Performed 79 operations on 71 patients
• Triaged/performed general surgical, trauma, and EM consultations
• Performed urologic surgical consultations 
• Performed short term follow up and treatment/consultation for post-operative issues
• Performed medical/ultrasound consultations (EM team)
• Donated two portable patient monitors (approximate value: $1,650)
• Donated 50lb of children’s books
• Delivered and donated medication & supplies to TQMH 

Teaching:

• 80+ hours of hands-on teaching and demonstrations to local staff, including on circulating techniques during operative cases
• Continued knowledge exchange and collaboration with the local CRNA
• Continual knowledge exchange between ISHI and local ward nurses

Donations:

• 25 personal hygiene packages
• 100+ IV and urinary catheters
• 3 OR nurses trained, multiple OR Scrub techs were trained
• 3 days of hands-on ultrasound training administered
• 2 anesthesia monitors donated
• 6 Stop the bleed tourniquets

Education Team:

Various members of the ISHI team participated in teaching initiatives including a 3 day ultrasonography course led by Dr. Harsh Sule from NJMS Rutgers. The educational efforts also included a bidirectional knowledge exchange with 20-30 hours of hands-on teaching, demonstrations, case-discussions between MDs and RNs. Butterfly Ultrasound technology was donated in coordination with Francis., in addition to numerous surgical and medical supplies in accordance with the WHO Guidelines for Safe Donation.

Drs. Ryan Benson and Julia Riccardi, and Erica Regoe MS4 remained at TQMH after the mission for follow up, and reported no major issues and high levels of satisfaction amongst the patients. 

 SURGICAL CARE

We are happy to report that the ISHI team completed  safe operations and all patients are recovering well. The mission included patients from various towns throughout the region. With our strong operative team, we performed hysterectomies for massive fibroids and ovarian masses, multiple hernia repairs, hydrocele repairs, mass excisions, hand surgeries, burn scar contracture surgeries, skin grafts, and prostatectomies. Drs. Ryan Benson, Julia Riccardi, and Erica Rego MS4 remained at TQMH after the mission to follow up, reporting no major issues and high levels of satisfaction amongst the patients. 

KNOWLEDGE AND SKILL EXCHANGE

Education continued to be a major focus of the mission.  Our Emergency Medicine team led by Dr. Harsh Sule  (NJMS-Rutgers ), hosted structured lectures for a group of family medicine residents and physician assistants and taught a three-day ultrasound course.

ISHI VOLUNTEERS AND RESPONSIBILITIES:

Surgical Team: Vladislav Bargman MD, Edward Lee MD, Ziad Sifri MD, Alaine Sharpe MD, Ryan Benson MD, Julia Riccardi MD, Erica Rego MS4

Anesthesia: Zoulfira Nisnevitch MD, Jose Chu Luo MD, Joy Quitiquit CRNA, Phil Knowles CRNA, Nicholas Choi SRNA

Respiratory Tech: Marie Mondesir RT

Nurses: Hannah Asare-Boateng RN, Tracey Bradley RN, Kristin Knowles RN, Esmeralda Da Costa RN, Destiny Dominique RN

Medical/Ultrasound: Harsh Sule MD, Amtul Mansoor

Logistics Tea: Amanda Schaufele, Maya Nisnevitch, Daniel Acquah,

Mission Team Leader: Ziad Sifri MD

SPECIAL THANKS TO: 

Thank you to all 2023 volunteers who went above and beyond to make this mission a success - and to our donors that make our missions possible.A big thank you and so much appreciation to  Amanda for  leading and taking care of the mission preparation  and logistic support remotely 

The Hon. Nana Otoobour Djan Kwasi II and Queen Mother Awo Adwoa Amenei and their representatives for allowing us to provide services in the Aburi region.

The Hon. Nana Nellie Kemevor: Local champion coordinating the local logistics with the ISHI team to support our effort in Mampong.

Dr. Albert Benneh, Medical Superintendent at the TQMH.

Dr. Mawuli Gyakobo, Ghanaian College of Physicians and Surgeons

SPECIAL ACKNOWLEDGEMENTS

A special thank you to those who donated medical supplies, which allowed us to complete this mission successfully: AFYA, NY-Presbyterian Queens Hospital, Newark Beth Israel Medical Center, Ethicon, Americares, COVIDIEN, Hospital Sisters Mission Outreach, Henry Schein