15 October 2013

Uganda: Mosquito Nets Now Ridding Ugandans of Hernia


Hassan Waiswa (not real names) first discovered he had a herniated condition when he had gone for a simple checkup at Mulago hospital.

Waiswa had experienced persistent stomach and groin pains and a swelling that had made his life intolerable.

"I had problems bending, working out... it was pain all through," he says.

Later that day, Waiswa had his groin hernia surgery at a tune of Shs 280,000. Waiswa was lucky that he had a good job which enabled him to afford that surgery only hours after he was diagnosed. Many rural area dwellers cannot afford such privileges.

Groin hernia is a common surgical condition that causes significant pain, morbidity and even mortality if not attended to appropriately, and is the most commonly-performed general surgery worldwide.

In this case, the intestines push themselves through the walls of the muscles around them, which results into a mass or bump in one's groin. This mass usually develops gradually but can occasionally occur with a single forceful muscular event, such as lifting a heavy object.

"Often the mass in the groin will cause you some discomfort. It is usually worse at the end of the day and is relieved when you lie down," says Waiswa.

According to an earlier study carried out in rural Uganda by Makerere University's Bio-ethics department, in conjunction with the Karolinska Institute and Umea University, Sweden, Uganda's eastern region was found as the most hit part; almost 10 per cent of adult males had or had had groin hernias.

Yet less than one per cent of the estimated number of people with groin hernias was operated in the health facilities in the region annually.

"For a part this rural area, hernia surgeries go for about Shs 200,000 which can't be afforded by the locals. They thus decide to substitute surgery for local herbs which have not been helpful," says Dr Alphosus Matovu, the general surgeon at Kamuli Missionary hospital.

In high-income countries, a tension-free repair using a commercially-produced, synthetic mesh, polypropylene, is the most commonly used method in groin hernia surgery. It has proven to be superior to the previously used sutured techniques.

Though, with the financial constraints that are usually faced by the locals in rural areas of developing countries, the commercial mesh is not affordable.

It is because of this that Makerere University is partnering with the Swedish institute to provide cheaper hernia surgeries for the less privileged. In the procedure, a mosquito mesh, which comes at a cost of less than one per cent of the commercial mesh and structurally similar to the commercial mesh, is already used.

Jenny Lofgren, one of the Swedish medics, says the mesh is indeed a mosquito net although it is thoroughly prepared, conserved and sterilised to get it ready for such surgeries.

The sterilised mosquito netting is used to fill the hole that is created when the intestinal organs penetrate the muscles and as time goes on after the surgery, the mesh is absorbed into the flesh.

Matovu, with the help of two Swedish surgeons, has operated on 300 men in Mayuge, Iganga and Kamuli. He also notes that there are no apparent causes of hernia besides old age, lifting of heavy loads and, in some cases, smoking.

After surgery, the doctors will follow up on the patients' welfare and if all the signs are positive, Uganda will lead the world in providing hernia surgeries at less than five dollars.

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