Chief Physician from Kaufbeuren on a mission in Benin: “Immense gratitude”

by SRI, 2009/07/17

In June 2009, Professor Heinrich Stiegler, Chief Physician at the hospital Kaufbeuren, went on a one-week mission in the African country of Benin in order to perform surgeries and to offer training measures. Focus was set on:

So-called “shunt” surgeries. Comprehensive expert knowledge and skill, as well as microsurgical instruments are essential in order to perform these medical interventions. Those are preconditions which are hard to meet in Benin. Please continue reading Professor Stiegler’s highly interesting report:

Starting point for the mission in Benin had been a report by Dr Koussemou of the Hospital for Neurology of Kaufbeuren, who mentioned that, although there existed dialysis facilities in his home country, doctors had no means of doing shunt surgeries. In Benin, dialysis for patients suffering from renal insufficiencies was performed by means of placing a catheter.

Professor Heinrich Stiegler provided the medical team both with theoretical and practical training. Photo: humedica

With the help of humedica e.V., a mission was organised with the objective of providing patients in Benin with a so-called “shunt”, as well as providing training to local doctors regarding this surgery in order to enable them to perform shunt surgeries on their own in future.

humedica planned and organised the mission in an exceptionally professional way and all material which was required had been sent to Benin beforehand. Important was in particular provision with the required instruments and here we received a lot of support by German-based companies. These preparations were essential, since in Benin there hardly are any preconditions required for an efficient shunt surgery.

After our arrival in Benin, we started with checking the materials which had been sent and reserved for our use. The material and equipment was then prepared and set up for the following day in a newly created surgery wing. We also had the possibility of examining the patients immediately and explaining them about shunt localisation.

Dr Rofino who was born in Benin and was currently doing his medical training in Bad Mergentheim acted as an interpreter and hence, we were able to talk to the patients also about the details of the complicated topic of follow-up treatments.

Accommodation had been organised on the “African Mercy”, the ship managed by the humedica partner organisation Mercy Ships. This turned out to be a lucky coincidence, since there were a number of persons on board, who could tell me about their experience in the field.

As far as I know, this ship is run by several foundations, she lies at anchor at different shores of Africa for several months each stay and a focus is set on different fields of surgery.

The following day we started performing the surgeries and soon we realised that we were not able to keep up our planned volume of 30 to 40 shunt devices in operation. Even using the shunt devices itself turned out to be technically more difficult, since it was harder to see the patients’ veins due to their dark colour of skin.

We placed the shunts in a whole range of different locations, in order to demonstrate the high potential of variation to the local doctor team and pointed out that this was an advantage, since every patient has individual anatomical preconditions. Except in one patient, we achieved mainly excellent shunt properties. In one case a second surgery was necessary after a shunt failure, which in the end could also be concluded successfully.

Unfortunately, medical standards and facilities at the University Hospital in Cotonou cannot be compared to those in Germany. Photo: humedica

For the purpose of using the recordings as teaching material, the surgeries had partly been filmed; all surgical steps were discussed in detail in order to teach the medical staff as much as possible. Professor Mehento performed a surgery then on his own and was able to successfully place a shunt.

Furthermore, we had a lot of personal conversations, since the Beninese are a very open-minded and sociable people. They are cheerful people who enjoy their lives despite the poor conditions they are living in. Nevertheless, poverty in Benin was depressing, in particular when thinking about the fact that this medical aid could only be offered thanks to external financial support.

When looking back, I draw the conclusion that our work had been more difficult due to the problematic conditions (hygiene, surgery standards, etc.) prevailing at the University Hospital. On the other hand the decision to work under these conditions had been right, since they will still prevail in future and surgery will need to be performed nevertheless. By means of this campaign, we had been able to introduce a whole team to this efficient way of working and hope that most of our advice will be taken into account in future.

A lot of patients in Benin only consult a doctor when their state of health is already very precarious, since they are afraid they will not be able to afford the treatment. We have experienced a series of depressing situations, which again and again made me think of our comfortable life at home and in particular of how fast we are to demand or also to criticise medical services in Germany and how easily we take them for granted.

I have provided Professor Mehento and his team with a complete surgery kit and therefore now they at least dispose of the technical equipment needed for continuing this kind of surgery. A visit of Professor Mehento to Kaufbeuren is being planned for August.

Regarding the maintenance of contact to Benin, I would like to answer an appeal by the Minister for Health and accept to hold a speech about important aspects of vascular surgery at the University Hospital, since vascular surgery does not exist there. When staying in Benin for this purpose, I am also planning to talk about the topic of shunt surgery, since this kind of surgery does require life-long medical treatment. Those patients do definitely not have the possibility of a renal transplantation.

Time flew and the days were filled with numerous surgeries, continuous training and explanations, but also with gaining impressions which moved me deeply. One of these experiences was an encounter with a beggar who sat at the side of the road and was badly handicapped by polio, and whose cheerfulness despite his disability almost caused me to feel ashamed.

The gift I received on this journey was the feeling of immense gratitude: you only had to look into the people’s eyes.

Professor Heinrich Stiegler in summer 2009

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