Hernia is considered a non-complex surgery, although it can be in specific cases. “In Europe we don’t give it the importance it can have in a country with few resources. A strangulated hernia can lead to the death of a patient. If you can solve it before, you can save a life”, emphasizes Francesc (Kiko) Marsal. Retired surgeon from Tarragona, with a long career at the Santa Tecla hospital, dedicates part of his time to a cooperation project to offer abdominal wall surgery to patients without resources in Africa; they also train local doctors.
Every year, when winter passes, a group of Spanish doctors, with seven female surgeons, three anesthetists and two nurses, travel to Uganda (Africa) to concentrate in one week half a hundred abdominal wall surgery interventions.
In countries with resources, they are simple operations, in most cases taking around 30 minutes. “But in African countries like Uganda, with scarce resources and long distances to get to hospitals, hernias get so big that, if they get strangled, they don’t have time to heal,” he says.
With this aim, they have traveled the world to solve this type of pathology. They also do an educational task to train African doctors. “We save lives, because we avoid problems in the future”, insists Marsal, enthusiastic about the project.
When hernias are not operated on in time, they also cause the physical inability to work, a vital necessity in such poor communities. In Africa alone there are 6.3 million untreated inguinal hernias.
It is not at all easy to execute in five days between 40 and 50 operations, previously scheduled, with the patients waiting with their families. They travel to the Ugandan hospital involved for years in the project with the participation of Spanish doctors, from Barcelona, ​​Tarragona or Seville. There is no electricity or running water in the hospital. Surgeons operate with headlamps, in marathon days, from early in the morning until dark.
We work from sun to sun, with previously selected patients. The rhythm is supported because it lasts five days. “If you had to do it for a whole month, it would be impossible because you have to avoid complications if you work too many hours”, reasons Marsal. This year he traveled with the Spanish team, but he did not operate, after retiring, to pave the way for surgeons who, since they are active, have more rhythm. “It’s an overwork for the doctors, but it pays off”, he adds.
The surgeon began collaborating in 2011 with the project, which has multiple missions on a global scale. “It’s nice to see that they are young doctors. We provide the resources, the money comes from our own pockets, and the doctors take vacation time,” he explains. The budget for such a trip does not fall below 2,500 euros per person. “It’s fun and rewarding to see the faces of patients and families when you solve their problem, it’s impactful.”
Holy Innocents Hospital is located in Kamutur, a rural area of ​​Uganda, near the border with Kenya, at the epicenter of the Ugandan civil war (1980-1993), an eight-hour drive from the airport plus close. “There is nothing around, you are in a rural hospital complex that we have seen born, since 2014”, remembers Marsal. Three years later they traveled for the first time to operate, they returned in 2019, but the pandemic interrupted the interventions until this year. Each time the Ugandan hospital, open all year, has more space and above all more resources, now with the installation of electric light thanks to another charity project, and will have running water.
“It is a satisfaction to see how Moses Aisia, a social worker in the country, takes the hospital forward”.
The support of Hernia International, an NGO led by the prestigious English surgeon Andrew Kingsnorth, is key; Enrique Navarrete, the team leader in Spain, and Teresa Butrón, from Cirujanos en Acción, promote the trips to carry out the interventions and transmit the knowledge. The cooperation project does not only take place in Africa, where it began in 2005, it also reaches countries in Latin America and Asia. Hernia International assists communities in 23 countries and operates inguinal and abdominal hernias.
When they travel, they also bring medical supplies on the plane and then transport them in jeeps, a logistical challenge that Marsal oversees. The group of Spanish doctors, which joined the international project in 2011, has also operated in Nigeria, Tanzania, Ecuador, Cambodia and Mongolia.
