SAWUBONA Foundation Mission Report 02/2023 - Mombasa, Kenya

We are delighted to present another mission report detailing our recent neurosurgical mission to the County Genereal Teaching and Referral Hospital in Mombasa, Kenya, from the 5th to the 11th of February. The mission was organized and led by Prof. Dr. Joachim Oertel, alongside esteemed participants PD Dr. Christoph Sippl, Dr. Dorothea München, Virginia White, Dr. Julia Szoro, Dr. Andrea Fernandez, Dr. Katharina Donauer, Almud Bansberg, Lionel Ngassam, Anna Oertel, Hannah Spielmann, Eva Oertel and Dr. Fritz Teping.

During our mission, we conducted a successful early outpatient management on Sunday, the 5th of February, with a total of 25 outpatients receiving neurological evaluations. The cases were diverse, ranging from complex hydrocephalus patients to cranial tumor pathologies and traumatic spine injuries.

In total, we performed 16 surgeries, with a focus on providing specialized care to both pediatric and adult patients. Pediatric patients benefited from seven surgical procedures, while nine surgeries were carried out on adult patients. This marked a significant step forward in our ability to treat neurosurgical conditions in the region.

A few exemplary cases shall be presented in more detail:

Exemplary Case Report 1:

M.B.M., a 56-year-old male, presented with a history of falling from a ladder one week before our mission. Radiological evaluation with MRI and CT scans revealed an unstable discoligamentary fracture at the TH11/12 level, with an intraspinal bony fragment compressing the myelon. Preoperative neurology examination indicated lower motor and sensory function. Due to the severity of the injury, surgery was deemed necessary. The surgical approach involved osteoligamentary decompression at the TH11/12 level and dorsal instrumentation spanning from TH10 to L1, which was meticulously performed with intraoperative X-ray control. The postoperative outcome was favorable, with no new neurologic deficits observed. Wound healing progressed as expected during our stay, and there was a noteworthy reduction in postoperative pain. Within the first two postoperative days, assisted mobilization was achieved, showcasing a promising recovery trajectory for the patient.

Exemplary Case Report 2:

S.R.M., a 3-month-old infant, was referred to us for the management of hydrocephalus. Transfontanellar sonography revealed an isolated occipital horn of the right lateral ventricle, which showed progressive enlargement in comparison to previous imaging. Based on the assessment, surgery was deemed necessary. The surgical goal was to perform an endoscopic fenestration of the separating membrane to restore the cerebrospinal fluid (CSF) pathway within the ventricular system. Preoperative planning using sonography facilitated a precise surgical trajectory. The endoscopic procedure was successful, achieving sufficient perforation of the membrane while ensuring clear identification of intraventricular structures, including the choroid plexus and pulsatile CSF flow. Postoperatively, there were no new neurologic deficits, and sonography indicated decreasing diameters of the right lateral ventricle. Wound healing was uneventful, and after just three days of postoperative care, the baby was discharged in good condition, marking a promising recovery from the hydrocephalus condition.

Exemplary Case Report 3:

T.M.M., a 31-year-old male, was referred to the hospital with complaints of increasing headaches. A CT scan revealed a massive space-occupying lesion originating from the falx cerebri between both hemispheres. To facilitate preoperative planning, an MRI scan was performed, considering the complex vascular structures in that area. Due to the severity of the lesion, surgical intervention was proposed. The patient underwent surgery in a supine position, and a bifrontal approach was chosen for the procedure. The surgical team successfully achieved complete removal of the lesion while preserving the venous drainage of the brain. The surgery lasted approximately three hours, and postoperative care in the ICU was necessary. T.M.M.'s neurological outcome was favorable, and as the mission concluded, he was observed on the normal care ward, already mobilized and preparing for discharge to return home. Further treatment would be determined based on the neuropathologic findings, although intraoperatively, the tumor appeared consistent with a benign meningioma. This successful surgery brings hope for a positive outcome and improved quality of life for T.M.M.

One of the key aspects of our mission was the collaboration with colleagues from Nairobi, which allowed us to bring VP-shunt systems for implantation in pediatric cases. This facilitated access to essential medical supplies, contributing to better patient outcomes. Moreover, the intensive care unit was managed with great dedication by Dr. Dorothea München and the three anesthesiologists, Dr. Katharina Donauer, Dr. Andrea Fernandez, and Dr. Julia Szoro. Their expertise and commitment were vital in ensuring the best post-operative care for our patients.

We were privileged to have two medical students, Anna Oertel and Hannah Spielmann, accompany us on this mission. They played an essential role in providing perioperative care to all patients on the regular wards and in the outpatient clinic, contributing significantly to the smooth functioning of the mission.

Throughout our successive visits to Mombasa, we have developed a certain routine that has enabled surgeries to be conducted fluently. We encountered increasingly complex cases, such as craniopharyngeoma and posterior fossa lesions, which presented unique challenges in our surgical approach. In spine surgery cases, we successfully carried out complex instrumentation procedures, thanks to the cooperation and support of medical supply agents from Nairobi. This experience allowed us to expand our expertise and introduce high-level techniques, which will undoubtedly benefit the local medical community.

The warm and heartful welcome from the local staff was heartening, and we enjoyed working with them again. However, during our mission, we received the saddening news of the passing of the head nurse from the local staff. At this moment, we extend our deepest condolences to all our colleagues, acknowledging the great loss for the department. We stand with them in this difficult time.

Amid the challenges, we cherished the opportunity to reconnect with old friends and colleagues, reinforcing the strong bonds we have formed over the years. We were thrilled to revive the tradition of a special dinner at a restaurant by the bay, further solidifying our connection with the local community.

Dr. Ben Okanga, a valued colleague, has been invited to the International Endoscopy Week 2023 in Homburg, and we eagerly anticipate his presence as our special guest in Germany this September. We look forward to fostering even closer ties and potential opportunities for professional exchange and collaboration.

In the heart of our neurosurgical mission to Mombasa, Virginia White, played again a crucial role in connecting us to patients and staff. With her profound understanding of the local culture and language, she facilitated seamless workflows, provided essential translations, and offered compassionate nurse care. Moreover, her infectious laughter and positive spirit uplifted the entire team, creating a supportive and uplifting environment. We extend our heartfelt gratitude to Virginia for her invaluable contributions, which were instrumental in making our mission a success.

In conclusion, our neurosurgical mission to Mombasa was another significant milestone in our ongoing efforts to provide specialized care and expertise to the region. We express our heartfelt gratitude to all the local colleagues and especially to Dr. Ben Okanga for his unwavering support and partnership. The experience has been incredibly rewarding, and as we depart Kenya, we are already eagerly planning the next mission, scheduled for February 2024. Our aim is to upgrade our surgical equipment, bringing high-level techniques and sharing them with our local counterparts.

On behalf of all participants

Dr. Fritz Teping