Left holding the Baby for the 50th Mesh Hernia Repair

My first port of call this morning was to review the young lad with the abdominal pain. Expecting to have to persuade his mother to allow us to take him to theatre, I was surprised to find his bed empty. Just as I was fearing that he had been taken home, he walked through the other door to the ward. Coming in from outside, he spritely walked to his bed with a big, slightly coy, smile on his face. Even in the context of abdominal pain in childhood (it can be a tricky beast at times), this was all very bizarre. I examined his abdomen and it was blameless again. There was only one thing to do, I sent him home.

Today we would reach the landmark of fifty mesh hernia repairs. I am absolutely delighted, not least because the number has a significant feel about it. With the redecoration of the main theatre suite ongoing, we are still located over the way in the obstetric ward theatre. At one point, I found myself left ‘holding the baby’.

Our start to the day’s operating was far from smooth. There was quite a period of delay as the first patient to arrive was very hypertensive and had to be cancelled. He may have genuinely fallen foul of the phenomenon ‘white coat hypertension’ (this means that the blood pressure goes up disproportionately in the presence of medical stress and isn’t actually a problem), given that the previous three readings in clinic and on the ward had been normal. However, I have been very careful to support safe practice here, and was thus very happy to endorse the anaesthetic decision to postpone the surgery. The second patient required quite a lot of ‘pre-optimisation’ as well (an issue not dissimilar to the previous case, but not so severe) and, not unreasonably, the local surgeons had disappeared to use their time productively. However, after a short while I was summoned to the operating theatre from the coffee room. I walked in to be told that the spinal had been put in and the patient was ready on the table. I was the only surgeon present. Hmmm. No-one was answering their phones. Hmmm.

I had had no intention of performing this final mesh procedure myself (it would be the local teams final opportunity to perform this procedure with my supervision), but you really can’t leave a patient waiting on the operating table. I did not rush, but I dutifully scrubbed and prepared the operative field. The local surgeons were still yet to arrive despite my encouragement to locate them. Much to my dissatisfaction, I had to continue. I made the skin incision. However, with the knife barely leaving the patients skin, they bundled through the door much to my relief. They got scrubbed and I welcomed them warmly to the operating table. They took over the case at my request, I de-scrubbed and stepped back to watch them at work. It was a tricky case and would take them a long time (over two hours in the end). But the quality of the operating was very good and I know that speed will come with more experience. I sat in the corner pretending to get on with some admin, all the time slyly watching them work. It was a real delight for me to hear how they coached each other through the procedure, recounting the steps I had taught them. I knew it was going to be a challenge, and it was particularly pleasing to observe how carefully they operated. They recognised the difficulties, each time pausing and slowing until they had made sense of things and knew they could move forward again safely. 

I could not have been more proud. I sat there silently, soaking up those moments, savouring them. There I was, thousands of miles away from home, sitting in an operating theatre in the heart of rural Africa, witness to something very special for me. We really had done it.

In the face of so much challenge, in an environment so far removed from what I would take for granted in the NHS, we had never-the-less established a service that is remarkably close in quality to what you might expect to find in the UK. Whilst I would be leaving in just a few days’ time, I would be going content in the knowledge that the local team are safe, thorough and understand what they are trying to achieve. I felt genuinely confident leaving this new service in their hands. What a great result. What a fantastic step forward in the provision of healthcare for this population.

It also brought me much satisfaction and pleasure to have shared this moment with our visiting friends. Their complimentary comments and approval of the service we had developed was fantastic to hear. Perhaps it was more than that though. Their professional opinion was important to me. It was validation for what we had worked so hard to achieve, feeling almost like a stamp of approval. On what will become a very memorable moment in my time here I am sure, it felt a very fitting way to be ending this chapter of the project.