The most common surgery in the world still costs lives. Two doctors hope to change that.
Dr. Michael Ohene-Yeboah can still recall the seemingly mysterious ailment that afflicted so many people in his Ghanaian village.
He'd often see the local Catholic priest as he ran around trying to treat those who'd fallen victim to this strange abdominal sickness.
He remembers the howls of pain, how the protrusions in their bodies swelled to the point where they could no longer work, and how, all the while, herbalists and other healers warned them that surgery was too expensive and wouldn't help them even if they could afford it.
[rebelmouse-image 19533079 dam="1" original_size="1024x768" caption="Photo by oneVillage Initiative/Flickr." expand=1]Photo by oneVillage Initiative/Flickr.
He never had a name for it until he became a district medical officer: inguinal hernia. And cases of it kept him busy day and night.
More than 200 million people across the world suffer from inguinal hernias — a condition where an organ or other piece of tissue breaches the muscle wall in the groin, causing swelling, infection, and blockages. The bulge that results can sometimes descend as far down as the knees, causing even more discomfort. Often, the sufferer is unable to work or even move around.
The mortality rate from hernias is particularly high in Africa, where it's estimated that only 30 out of every 100,000 cases get repaired. The surgery is a simple outpatient procedure, but it still requires more money and surgical skill than most West Africans can afford.
"Non-surgeon physicians already perform the repair of inguinal hernias in the rural district hospitals," Ohene-Yeboah says via email.
"However ... the outcomes were not very satisfactory," he continues. "Now, if the skills of these non-surgeons can be improved then we could expect better outcomes."
Ohene-Yeboah has been teaching the easy-to-learn mesh repair technique to non-surgeon doctors for years. It requires just a few supplies, such as sutures and anesthetics, along with standard surgical monitoring equipment. But the mesh itself, which holds the breached organs back until the muscle wall heals, can often be too expensive for some rural hospitals.
Ohene-Yeboah and his fellow surgeons must also contend with the lack of education around treatment for inguinal hernia, especially in remote areas. "Many patients with long-standing inguinal hernia have been told by the herbalists and other traditional healers that an operation will lead to death," he says.
Some of them will eventually accept the surgery, after much convincing, but not all.
[rebelmouse-image 19533080 dam="1" original_size="1280x834" caption="Photo by Shane T. McCoy/Wikimedia Commons." expand=1]Photo by Shane T. McCoy/Wikimedia Commons.
Ohene-Yeboah was still committed to saving as many lives as possible, but he always knew there had to be a better way. Then, one day, it found him.
In 2011, Ohene-Yeboah published a paper in the West African Journal of Medicine about the hernia epidemic in Ghana, explaining how low-cost mesh and basic training for non-surgeons could make a massive difference for the country. It attracted the attention of Dr. Jessica Beard.
A U.S.-born surgeon, Beard had spent time in Ghana as part of a high-school exchange program and continued to return to the African continent because she was interested in the intersections of surgery and public health.
In an email, she explains that "in Ghana, we have hernia surgeons interested in training doctors to perform hernia surgery and doctors who want to learn. But physicians in low- and middle-income countries (LMICs) face many competing interests and need to be compensated for the training and care they provide."
[rebelmouse-image 19533081 dam="1" original_size="1280x960" caption="Photo by Nora Morgan/Flickr." expand=1]Photo by Nora Morgan/Flickr.
So Ohene-Yeboah and Beard worked together to create a "toolkit" to help non-surgeon doctors in Ghana address the hernia problem themselves.
The toolkit includes a series of step-by-step instructions and pre-recorded lectures to help prepare doctors for the very basic hernial repair procedure called the Lichtenstein technique. It also provides a breakdown of the necessary surgical supplies, incentives, and guidance for how to fund and provide the training (like transportation, food, accommodations, and a small honorarium for trainers).
Beard handles research and logistics in the U.S., including gathering financial support from their partner organizations such as the Americas Hernia Society and the Swedish Research Council.
But other than that, she says, "It's all locally driven by Michael's leadership, vision, and tenacity."
And that's how the Ghana Hernia Society was born, with the mission to "reduce the burden of disease from inguinal hernia through increasing access to high quality care."
The inaugural class of 12 non-surgeon doctors trained in the mesh repair procedure "graduated" in 2013. The society has continued to expand and grow since then.
But there's still a lot of work to do — and not enough funding.
In addition to toolkits and training programs, Ohene-Yeboah and Beard also use the Ghana Hernia Society as a vessel to secure surgery funding and low-cost supplies. "We hope to use data from the study on our program to show the Ghanaian government that investing in surgery can be effective and cost-effective," Beard explains. "Our training program and toolkit implementation are the first step in this process."
Over the next 5 to 10 years, they hope to triple the number of Ghanians treated for hernias. And if their dataset is large enough to prove the value of the program, Ohene-Yeboah hopes to eventually build a factory where they can produce their own commercial mesh, making this simple surgical process easily available in hospitals across West Africa, including Ghana.
[rebelmouse-image 19533082 dam="1" original_size="1280x850" caption="Photo by USAID Africa/Flickr." expand=1]Photo by USAID Africa/Flickr.
In 2018, the Ghana Hernia Society received a $50,000 Gen H Challenge grant. It's a huge step forward — but they still need more support as they move into the future.
You can help them out as well by donating cash or supplies to the Ghana Hernia Society.
As Sir Cecil Wakeley of the Royal College of Surgeons once said, "A surgeon can do more for the community by operating on hernia cases and seeing that his recurrence rate is low than he can by operating on cases of malignant disease."
That was 70 years ago, and it remains true today.
It's people like Ohene-Yeboah and Beard who are doing the work to keep those recurrence rates low, helping communities across Ghana and the rest of West Africa.