Twenty operations in six days

February 2013

Neurochirurgie-Team

Travel report of neurosurgery team to Asmara

The journey

8 February what time again, since 2005, we are now flying for the twelfth time in Asmara.
Unfortunately, we have our operations always plan so that there is no overlap with other surgical teams, we’d love to get to know other times ARCHEMED members.
We, that is Barbara Luedtke (Anaesthesieschwester), Elisabeth Poenitz-Pohl (anesthetist), Siji Mulamoottil (surgical assistant) and Dieter Hellwig (neurosurgeon) (see photo at the end of the report). Ariane Harbor (Anaesthesieschwester) stayed at home this time as scheduled.
Painfully we miss Klaus junk that has built up from the beginning to the neurosurgical operating room and with the orthopedist Peter Griss, who then made us familiar with the situation in Asmara and in IOCCA. Both have unfortunately died last year too early. We have Peter honored with a portrait in IOCCA.
At 46 kg of luggage as it was always going on in Frankfurt. This consisted primarily of Op. material and textiles, which we gave away the spot. We must emphasize that we are but overall a fairly “inexpensive” team. To use our costs 10,000 euros, included here are the expensive shunts. This time we had 12 of 500, – Euros here, two were provided to us free of charge from the company Codman.
In further use, we will again be able to take the financial support, which was founded by Dieter Foundation “Help for Children hydrocephaluskranke” period, so that the financial burden on ArRCHEMED is lower.
We were naturally excited about the changes that had occurred in the past year in Asmara. Especially on the political situation after the events of the last few weeks.
Arrived in Asmara, we were buses from the tarmac to the airport main building transports (innovation) and also the check-in at the counters went relatively quickly (surprisingly).
Siji for the entry and exit is because of his dark skin usually something difficult because it is held again for indigenous, but on the other hand does not speak the local language.

Arrival

Dr. Habteab us as always personally gone through the dimly lit streets in Embassoria’s (for the next team – do not forget flashlights). After checking into the lobby to eat Zibib brought homemade meatballs, this is pure romance.

The medical life

The next morning we caught up with us again of medical life in Eritrea. From 09.00 clock was (a terrible word, actually we mean patient presentation and selection) for Elisabeth and Dieter “screening” is announced, while Barbara and Siji prepared the pending operations logistically.
We have seen 60 children on the first day, in total there were then about 80 young patients, including follow-up visits were 30 studies, 21 new hydrocephalus and 36 MC (MMC) – patients. Unfortunately, we could only operate on 19 children (10 and 10 Hydrozephali MC / MMC). Many parents insist to put the fate of her paraplegic, incontinent, psychomotor retarded by a hypoxic brain damage, vegetative state children in the absence of other opportunities in our hands. These children are not only sick, they are not presentable, a stigma for some a punishment from God. Basically they are undesired. We can make the problem but in most cases not solved surgically, share this with a heavy heart.

This annoying folate topic

Shortly after we were back in Germany, we have already ARCHEMED with the recurring problem of folic acid prophylaxis addressed. This application has everything visually that which we have seen before, is exceeded. In some children, we were shocked by the physiognomy. We should really get together and consider what we can all do. It so rich from just a few grams of folic acid and vitamins to avoid this misery. That is, it must be initiated a comprehensive education program.

The sudan

We were surprised to note on the request of parents, in the medical record that treatment abroad is possible. Later we learn that he who stay for diagnosis and treatment in Sudan is possible for a few who can afford it. There, the health system has become privatized and there are good medical conditions.

What to do without diagnostic imaging?

Of course we must also now note again that CT scans and MRI scans in Asmara still are not available due to the lack of functionality of the equipment, which actually is a “no-go” for us neurosurgeon. Neurologic / neurosurgical diseases that go beyond a visual diagnosis can not be determined and therefore not treated expertly.
Digitized radiographic images so there is not, what can currently appear rather unrealistic to build a teleradiology.
Particularly affected has made ​​us the fate of a two-year-old girl with unclear consequences of craniocerebral trauma. The attending physician at the pediatric intensive care unit had asked us to case conference. We found a comatose child who took over CPAP. The right pupil was a little unrounded. The question epidural hematoma, subdural hematoma, intracerebral hemorrhage, cerebral edema was right or left? The colleagues had already begun with the anti-edema therapy. Exploratory craniotomies are obsolete today. Two days later we went voluntarily to re-case conference, the bed was empty.
At least with a CT diagnosis, the child would have had a chance to survive.

Neurosurgical care – Africa 100

In our operations, a new young colleague Dr. Abdul Reza has supported us. A skilled general surgeon in the third year of training. He wonders if he is training as a neurosurgeon.
And here we need to address another issue that makes us very thoughtful. In Eritrea, a country with about 4.5 million inhabitants there is a single Chinese neurosurgeons of adult patients operated on now and again. According to our research, this number corresponds to the situation in Africa.
Based on the data, the World Society for Neurosurgery start a training program for African doctors who want to be trained as a neurosurgeon. The name of the program is “Africa 100”, ie 100 neurosurgeons for Africa.
This is the responsibility former world president of the WFNS, Professor Madjid Samii from International Neuroscience Institute in Hanover.
The training will take place in selected African countries and are supported financially by “godfathers”. You should take as in European countries 6 years.
And that’s the sticking point, which neurosurgeon returns after 6 years back to his impoverished homeland?
Dr. Abdul will probably not get a chance to have qualified overseas trained as a neurosurgeon. Dr Habteab takes the position for half a year in their own country might suffice. But here the question arises, which neurosurgeon is ready to go for a long time to Eritrea to train students there. So we go around in circles.

Fazit

Nevertheless, we remain optimistic every child that we can save counts, regardless of the medical, social and political conditions that prevail in Eritrea and barely noticeable changes it .. Hope dies last known.
The week went by way too fast, bought on Friday afternoon shortly before departure or spices and souvenirs on the market and in the evening at 24.00 clock we went back to Germany’s cold.

In the next application we are looking forward!

 

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