•IPH JOZ 2015 omslag DEF 160309.indd 1 17-05-16 12:36 · Vietnam, Rwanda, Pakistan, India, Bhutan and Lebanon. Four missions in 2015 There were four regular missions in 2015: one

•IPH_JOZ_2015_omslag_DEF_160309.indd 1 17-05-16 12:36


Table of contents

General survey of countries and operations

From the chairman

Introduction

Mission to Zanzibar

Mission to Burundi

Mission to Nigeria

Mission to South Sudan

UBPSI in 2015Rein Zeeman revisits the Burns Unit.

Burn Prevention Programme, Uganda Marjo Aerts reports on this successful Interplast initiative.

Some results of 25 years

Interplast Holland information leaflet

Contact Interplast Holland

Special thanks to …

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24

27

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32

S T I C H T I N G I N T E R P LA S T H O L L A N D

a n n u a l r e v i e w 2 0 1 5

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2 G e n e r a l s u r v e y


General survey of countries and operations

Operation total = 11930 = with 148 teams

Uganda 33 teams 2631 patients

Yemen 28 teams 2153 patients

Nigeria 15 teams 1197 patients

Rwanda 4 teams 250 patients

Guinea-Bissau 7 teams 477 patients

Burundi 10 teams 919 patients

Zanzibar 8 teams 630 patients

South Sudan 1 team 49 patients

Indonesia 5 teams 498 patients

Ghana 18 teams 1362 patients

Vietnam 6 teams 976 patients

and teams to Guinea-Conakry, Lebanon, Bhutan, Namibia, Pakistan, India and Burkina Faso

3G e n e r a l s u r v e y


This annual review for 2015 has largely been created and sponsored by volunteers.

From the chairman

We are pleased to present you with the 2015 Annual Review of Stichting Interplast Holland.The overview contains concise summaries of our missions and other activities during 2015. Detailed mission and fi nancial reports can be found on our new website: www.interplastholland.nl. This year we celebrated our 25th anniversary, a milestone in our history. As a small NGO we are still very active helping children in low-income countries to give them a better life and future.

The team missions in 2015 were all successful and we operated on over 300 children and (young) adults during the various missions. We organized our fi rst mission to South Sudan and hopefully we can follow this up in 2016. South Sudan is a very poor country with hardly any health infrastructure. We also visited Bukoba in the north west of Tanzania having been invited by Stichting de Vaste Burcht (a Christian charity), and we are planning a mission there next year.Unfortunately we had to cancel two missions, one to Nigeria in March because of postponed elections and one to Burundi in November because of post-election violence. I really hope the confl ict in Burundi can be settled peacefully so we can continue our work there.

In Uganda, since July, the Burns Unit should have been feeling the benefi t of the ring-fenced fi nance from the government. However the signatory director of Mulago Hospital and the head of clinical services were unable to provide a fi nancial report for the fi rst quarter (July, August and September) which led to the withholding of the second quarter funds. Interplast has no insight into the ring-fenced account.

The Mulago Hospital will be undergoing renovation next year so the Burns Unit will have to move to another, temporary, location. Guiding the Uganda Burns & Plastic Surgery Institute towards independence with its own approved government budget still remains a challenge which is why I’ve spent several months in Uganda this year.The Burn Prevention Programme is still being fi nanced by Interplast Holland and is doing very well. A fi eld offi ce was opened in Nansana, a local initiative that we are happily supporting. You can read more about this on page 24 to 26.

Again one of our volunteers, Paula Ellen, was honoured with a decoration by our king, His Royal Highness King Willem Alexander of the Netherlands, in April this year for all the excellent voluntary work she has done.

Finding the necessary funding for all our activities is still a major task, even after 25 years. We were grateful for the legacies we received last year but that source has now been exhausted. Revenue in 2015 was signifi cantly less and we will have to extend our fund-raising activities in 2016. A new website with a donation section is a fi rst step in this direction.

It only remains for me to give warm thanks to all the volunteers of the nursing committee and the teams for their continuing efforts to help the needy children. Of course we are also extremely grateful to all our donors, great or small, for without their support we would not be able to continue our work.

Veel dank, thank you, merci beaucoup, vielen dank, shukran djazilan, asante sana, webalenyo, obrigado!

Rein J. ZeemanChairman, Interplast Holland

44 F r o m t h e c h a i r m a n


Introduction

Stichting (Foundation) Interplast Holland is a charitable organisation that performs reconstructive surgery on children, young people and adults in developing countries. Each year the organisation sends teams of experienced plastic and reconstructive surgeons, anaesthetists and theatre assistants on a number of missions to developing countries.

The doctors and assistants, who are assisted by local doctors and nurses, work during their holidays and provide their services free of charge. Their assistance includes:

• performing reconstructive operations free of charge for children and adults with cleft lips and palates, disfigurements caused by burns, tumours and other congenital deformities

• training local medical personnel in reconstructive surgery, anaesthesia and nursing techniques

• helping to set up burns and reconstructive surgery units in hospitals and assist in setting up burn prevention programmes

To secure lasting results Interplast Holland works intensively with local hospitals, doctors, nurses, universities and NGOs. In order not to burden local hospitals unduly, almost all materials required to perform around 100-120 operations are brought from the Netherlands or bought locally if available.

Interplast is an international organisation which was founded in the United States in 1969. Stichting Interplast Holland was founded in 1990. By now Interplast is represented in many other Western countries. As a foundation, Interplast Holland is fully independent from its fellow Interplast organisations. They are regarded as sister organisations.

Interplast Holland currently concentrates its activities in Burundi, Nigeria, Zanzibar, Uganda and Guinea-Bissau. Missions to these countries take place every year. In the past teams have also been sent to Indonesia, Yemen, Vietnam, Rwanda, Pakistan, India, Bhutan and Lebanon.

Four missions in 2015There were four regular missions in 2015: one to Nigeria, one to Zanzibar, one to Burundi and one to South Sudan. Also several individual programmes were carried out in Uganda (Burns Unit and Burn Prevention programme), and an assessment was done in two hospitals in the northern part of Tanzania. The outcome of this assessment

was positive and an Interplast team will go to Tanzania for a fact-finding mission in 2016.

Visionary goalInterplast Holland has a vision of a society in developing countries in which children and adults with physical disabilities are given medical treatment so that they can fully participate physically, mentally and socially in their community.

MissionInterplast Holland is a charitable organisation that seeks to give help in developments in the field of reconstructive surgery and treatment in developing countries by participating to achieve the self-reliance of local doctors, nurses and other staff. The organisation works towards this goal by carrying out operations and providing training and courses during team missions, by founding and supporting plastic and reconstructive surgery units and burn centres, and by setting up burn prevention programmes. Cooperation with other organisations in the Netherlands and abroad is high on the agenda of Interplast Holland. In the Netherlands the organisation aims to run its office with the structured, administrative and policy support of mainly volunteers.

Our volunteer, Paula Ellen, was honoured with a decoration by our king for all the excellent voluntary work she has done

55I n t r o d u c t i o n


Zanzibar

Official name Zanzibar

Capital Zanzibar City

Location island in the Indian Ocean, east of Tanzania

Surface area 1554 km²

Number of inhabitants 1,2 million

Climate tropical

20 February - 6 March

TeamPlastic surgeon Esther Mesters

Paediatric Urologist Liam McCarthy (UK)

Anaesthetist Gijs Witte

Anaesthetic nurse Elly Hofstede-Lagerberg

Theatre nurse Jolanda Eskes

Visited hospital Mnazi Mmoja Hospital

The island of ZANZIBAR l ies off the east coast of Africa and is a semi-autonomous part of Tanzania. The island of Pemba close by is often considered to be part of Zanzibar.

As in the greater part of the African continent there is no plastic reconstructive surgery here. Before the arrival of Interplast Holland patients were sometimes referred to a clinic for reconstructive surgery in Dar es Salaam on the mainland, which was a very expensive exercise. So the Interplast teams are very welcome on Zanzibar, where they have been working since 2008 in the Mnazi Mmoja Hospital, a government hospital with 430 beds.

The Zanzibar 2015 team with the local theatre staff

6 Z a n z i b a r


Patients and family waiting for the theatre

Mission report on FacebookInterplast’s eighth mission to Zanzibar involved the usual round of operations but this time anaesthetic nurse Elly Hofstede was also compiling an almost daily look behind the scenes report complete with photographs for Interplast’s new Facebook page. The response was very enthusiastic and the idea is certainly worth repeating.

Excellent preparationThe screening of patients by the surgeons and the anaesthetist took place on Sunday after the team’s arrival. As usual our local partner Dr Ramadhan Suleiman, Dr Rama for short, had made an excellent preselection of patients with lists for the two surgeons; plastic surgeon Esther Mesters and paediatric urologist Liam McCarthy (Birmingham / UK). During the final screening only a few patients were turned down, either because they were still too young or were not entirely in good health. One hundred patients were seen and 87 were placed on the operating theatre list. More than half of the operations involved plastic surgery including children with cleft lips and/or palates and children and adults with burn contractures. More and more patients were added in the subsequent days.

International cooperationBecause of the huge problem with urogenital cases in Zanzibar (certainly by comparison with the other host countries we visit), the Interplast team has since 2010 been accompanied by a surgeon who specializes in this field. Initially, this was Ruth Lester from Birmingham and in the past two years paediatric urologist Liam McCarthy has also joined the team. This cooperative venture is still working extremely well. In 2014 a workshop was organised on the problem, which is mainly caused by the excessive removal of the foreskin during circumcisions which gives rise to 50% of the fistulas. The workshop in 2014 was greeted with great enthusiasm and will be followed up in 2016.

Monday was the first operating day. You can read in the various reports how full the programme was with up to 11 operations a day being performed. The atmosphere was excellent and everyone became more attuned to each other as time went on. Dr Rama assisted in the operations almost every day, or operated himself under guidance from plastic surgeon Esther Mesters and learned a lot.

7Z a n z i b a r


Rein Zeeman’s Field guide for cleft surgery was a welcome aid on this mission as well

Teaching on the job

Ward round with Dr Rama

8 Z a n z i b a r


Jolanda busy with the instruments

Equipment challengesWard rounds were conducted every morning first thing in the children’s ward and each child who had been operated on was seen. Sterilising the instruments which the teams always bring with them went less well this year, as can be read in Jolanda’s report. The ‘dry heat system’ was broken so steam had to be used for sterilising. That takes more time and the instrument bags get wet.

It is remarkable how many improvements have been made in the hospital in recent years, but unfortunately not in the operating complex. The operating theatre tables were in even worse condition than in the past. Even so the count after 10 days operating was 95 and that does not include dressing changes of children that were performed under anaesthetic.

O p e r a t i o n s Z a n z i b a r

• 6 cleft lip and/or palate

• 48 hypospadia or urethral fistula

• 26 post burn contractures

• 15 other

Deze alweer achtste Interplast missie naar Zanzibar stond naast het gebruikelijke opereren ook voor het eerst in het teken van een ‘kijkje in de keuken’ door het bijna dagelijks plaatsen van berichtjes en foto’s door anesthesie-medewerkster Elly Hofstede op de nieuwe Facebookpagina van Interplast. De reacties hierop waren erg positief en zeker voor herhaling vatbaar.

De missie was zoals gewoonlijk weer heel goed voor- bereid door dr. Ramadhan Suleiman (Dr. Rama), onze vaste partner ter plaatse. Tijdens de screening werden 87 patiënten op het programma gezet. Gedurende de volgende dagen kwamen er steeds nog patiënten bij.Omdat de urogenitale problematiek op Zanzibar zo groot is (zeker ook in vergelijking met onze andere gastlanden) gaat er sinds 2010 een chirurg mee die daarin is gespecialiseerd. Dit was eerst plastisch chirurg Ruth Lester uit Birmingham, en sinds 2 jaar is dit kinderuroloog

Liam McCarthy, ook uit Birmingham. Deze samenwerking verloopt nog steeds uitstekend.

Het is opmerkelijk hoeveel verbeteringen er zijn aan-gebracht de afgelopen jaren in het ziekenhuis maar niet in het operatiecomplex. Ook de ok-tafels verkeerden in een slechtere staat dan voorheen. Toch stond de teller na 10 operatiedagen op 95, en dat is zonder alle anesthesie die gegeven is aan kinderen tijdens een verband wissel.

9Z a n z i b a r


the team members had arrived at Schiphol. The fl ight was rebooked for the following morning and everyone was informed. Those who were already at Schiphol spent the night there in a hotel.

A warm welcome in KibimbaAfter a relatively long journey and a short night at the guesthouse in Bujumbura the team set off for the fi rst destination. Brarudi (Heineken Burundi) had again arranged for a bus and driver. The director of Kibimba Hospital, Dr Elisee, was happy with the team’s arrival and cooperation with the other disciplines in the hospital went well during the week that followed. The team felt more than welcome.

It was noticeable during the screening that there were relatively few cleft lip and palate patients and, sadly, a great many other patients with a range of conditions that Interplast was unable to remedy.

Burundi

Official name Republic of Burundi

Capital Bujumbura

Location Central Africa

Surface area 27,834 km²

Number of inhabitants 10.5 million

Climate tropical

10 - 23 April

TeamPlastic surgeonand team leader

Adriaan de Blécourt

Plastic surgeon Andrew Posma

Anaesthetist Floortje de Kempenaer-Ulrich

Anaesthetic nurses Arend Verbaan Vincent van Weerle

Theatre nurses Elles LoenenIngrid van Ginkel-van der Knaap

Chairman Izere André Nkeshimana

Local partner Dr Jean Claude Bizimana, MD

Visited hospitals District Hospital de Kibimba, KibimbaNgozi Hospital, Ngozi

Burundi is one of Africa’s most densely populated countries and the smallest. The civil war lasting from 1994 to 2005 has meant that it is also one of the world’s poorest. (184 out of 188 on the United Nation’s Human Development Index of 2014).

It is located in the great lakes region of Central Africa and is landlocked. Medical care is accessible to very few. Around 55 out of 1,000 children die in their f irst year.

A delay of one dayThe tenth mission to the small green country of Burundi was due to begin on Friday evening at Schiphol. Unfortunately it quickly became apparent when Offi ce Manager Annemarie Maas arrived to hand out WakaWaka lights as a present to the team members that the fl ight to Nairobi had been cancelled without any reason being given. Luckily not all

April 12th, celebrating the 25th anniversary of Interplast in Burundi!.

10 B u r u n d i


No matter how the visit of a team is announced, everybody wants to see the Mzungo doctor (white doctor). After the screening around 30 patients were put on the list for an operation.

A little improvisationFor the anaesthetic team it is always a bit of tense moment waiting to see what state the anaesthesia equipment will be in and whether the halothane ordered beforehand has arrived. Luckily Arend’s and Vincent’s talent for improvising is unparalleled so they always succeed in creating a safe and sound system.All the reports and certainly the one written by the anaesthetist Floortje, who was on a mission for the first time, speak of Arend’s huge added value at the recovery stage and in arranging all the logistics in cooperation of course with a tremendous local staff member Remi!

Ingrid and Elles busy planning the operation days

Remi and Arend

Aline with her mother

Extra attention for AlineOperating in the first week went more or less without too many difficulties, and new patients still kept arriving in small numbers daily. At the end of the week 36 operations had been performed. The team operated on Friday morning as well but it was decided, as you can read in the report of the team leader, Adriaan de Blécourt, that a small child (Aline) with a large burn on her head should go to Ngozi. Aline was suffering from severe malnutrition and it later emerged that she’d been burned as long ago as 2012. The team hoped for the best and gave Aline’s mother the money for the trip to Ngozi. A farewell party was held on Friday afternoon attended by about twenty people.

Assistance from ItalyThe team arrived in Ngozi after a good journey lasting about two hours on an excellent road. The team met the hospital director and started screening in the afternoon. There, too, were a lot of patients that Interplast would be unable to operate. It’s always difficult to send so many people away. In the end there were 20 patients on the list, most of them for general surgery.

The next day the operating theatre was made ready and the team met Dr Vanya Traversi Montani, an anaesthetist trained in Verona who had been working in Ngozi for three years. She mainly concentrates on intensive care.

On Monday the team began the operation programme in Ngozi. The local surgeon was unaware of the team’s arrival and was not exactly pleased. Fortunately, the chairman of Interplast partner, Izere, André Nkeshimana was present and things were quickly smoothed over. André also arranged for a ward with beds for the patients. No new patients turned up during the week but after a round of the hospital more patients were found who needed attention. Local interest and help were minimal. Dr Traversi by contrast was a big help and assisted the team enormously. She was to take charge of the aftercare as well.

11B u r u n d i


Deze tiende uitzending naar het kleine en groene Burundi zou vrijdagavond 10 april op Schiphol aanvangen. Helaas bleek al snel dat de vlucht naar Nairobi zonder opgaaf van reden was gecanceld. Gelukkig waren nog niet alle teamleden op Schiphol gearriveerd. De vlucht kon worden omgezet naar de volgende ochtend en alle betrokkenen werden geïnformeerd. Het deel van het team dat er al was bleef overnachten in een hotel op Schiphol.

Na een redelijk lange reis en een korte nacht in het guesthouse in Bujumbura ging het team zondag op weg naar de eerste locatie, Kibimba Hospital. Brarudi (Heineken Burundi) had weer voor een busje met chauffeur gezorgd. In Kibimba was de samenwerking met de lokale staf uitstekend. Er werden hier 36 patiënten geopereerd. In alle verslagen, en zeker in die van anesthesioloog Floortje die voor het eerst mee was, is te lezen dat Arend voor het verkoeveren en zorgen voor de logistiek van grote toegevoegde waarde was. Wel samen met een geweldige lokale kracht, Remi!

De tweede locatie is het Ngozi Hospital. Op zaterdag is de screening en de volgende dag werd de operatiekamer ingericht en maakte het team kennis met dr. Vanya Traversi Montani, een in Verona opgeleide anesthesioloog die al drie jaar in Ngozi werkt. Ze houdt zich voornamelijk ook bezig met de ‘Intensive Care’.Maandag is de eerste operatiedag in Ngozi. De lokale interesse c.q. hulp gedurende de week was minimaal. Dr. Traversi daarentegen was van grote waarde en heeft het team enorm geholpen.

Aline (on the right) with her twin sister, November 2015

An early flight homeThe team returned to the Netherlands two days early since there were fewer patients than anticipated and the team had really worked hard. Petrol was hard to come by and the team ended up having to buy petrol from someone else’s tank to get to Bujumbura. The return flight was fine after the team had passed an Ebola check in Nairobi. A few days after they had returned, disturbances in Bujumbura caused two fatalities and several injuries.

AlineThe team saw this young girl, who was nearly five, at

the screening in Kibimba. She had a large burn wound on her head and was in a very poor state of health becauseof malnutrition.Later it turned out that the burn dated from 2012 and that she had been in various hospitals in Burundi. Sadly, as in many other developing countries, in Burundi burns treatment is barely developed if at all.The team performed a skin transplant on Aline in Ngozi, but later the graft proved not to have taken. Thanks to our doctor on the spot Dr Jean Claude Bizimana it was possible to transfer Aline to the Burns Unit in Kampala, Uganda. After six weeks with the right nutrition and various treatments the wound had healed to such an extent that she was able to go home.A few weeks later Interplast received this photograph of her.

O p e r a t i o n s B u r u n d i



• 34 other

• 2 hypospadia

12 B u r u n d i


Happily most of the team members were able to shift their weeks so were available to join the mission in October.

Visas just in time… or just too lateOrganising the mission this time was a laborious process. Acquiring visas is always diffi cult, but this time tightening of the rules meant a lot of extra time and money were involved. Moreover the fast-track procedure had to be used for everyone to ensure that the visas were ready on time. Despite this, most of the team members, with three exceptions, only had their passports returned to them on the morning of their departure at Schiphol. The other three passports had gone missing and the Interplast team was informed about this the evening before departure. So Fatima, Geesje and Marthe were unable to leave the following day. Naturally they were terribly disappointed.

After a lot of manoeuvring and with the cooperation of the Nigerian embassy, the Royal Marechaussee at Schiphol and CIBTvisas the emergency passports had been stamped with a visa by late Tuesday afternoon and, having spent a night at Schiphol, the remaining three were fi nally able to leave on Wednesday morning.

Nigeria

Official name the Federal Republic of Nigeria

Capital Abuja

Location West Africa


Number of inhabitants 178 million

Climate tropical to sub-tropical

10-25 October

TeamPlastic surgeon NPand team leader

Cees Spronk

Plastic surgeon Peter Houpt

Assistant plastic surgeon Ellen Meerman

Anaesthetist Robbin Thieme Groen

Anaesthetic nurses Geke HoeksmaGeesje Bonhof-Boer

Theatre nurses Fatima van KlaverenSandra van der Broek

Stichting Faridpur Neeltje Spronk-Mulder

Communications advisor Marthe Houpt

Visited hospital COCIN Hospital & Rehabilitation Centre, Mangu

Nigeria is located in West Africa and shares land borders with the Republic of Benin in the west, Chad and Cameroon in the east and Niger in the north. Nigeria is roughly divided in half between Muslims, concentrated mostly in the north, and Christians, who mostly l ive in the south. Nigeria is the most populous country in Africa and despite huge oil revenues there is sti l l great poverty.The country is far behind others in terms of health care. The COCIN Hospital & Rehabilitation Centre is situated in Mangu on the Jos Plateau in Northern Nigeria. This hospital, formerly belonging to the Nederlandse Leprastichting or Netherlands Leprosy Relief (NLR), has been visited twice a year since 2007 by a team mainly comprising plastic surgeons from the north of the Netherlands.

Mission postponed to the autumnThe March mission failed to go ahead because the elections in Nigeria were postponed. The elections would have exactly coincided with the team’s arrival which could have been unsafe.

Happy faces after the CIBTvisas driver delivered the passports

13N i g e r i a


Many burn contracturesMeanwhile the rest of the team was already hard at work in Mangu. The screening took place on Monday and there were queues of people patiently waiting their turn. Again, the team saw dozens of children with burn contractures. Plastic surgeon in training Ellen Meerman related her experiences in her report: ‘I weigh the small patients, take photos and I am amazed at what I see. I was deeply affected by so many small children with burn contractures of all possible degrees of severity. You cannot imagine how much pain these small children must have suffered. We see different kinds of cleft lips and palates among patients of different ages. This also takes a bit of getting used to. In the Netherlands cleft lips are routinely operated on in the first year of a baby’s life.’

A busy programmePatients who had been given a green light by the surgeons and the anaesthetist were put on the operating programme and given a date for their return. Cees Spronk and Interplast Holland have been working in the hospital since 2007 and the programme is widely known. People come from far and wide.

Operating began the next day. It is always a bit nerve-wrecking to see whether everything will function as it should, whether cooperation goes well with the new members of the team. But everything ran smoothly and despite an electricity cut all the operations that were due to take place were completed. In the evening the good news arrived that the three team members who had been left behind could fly on Wednesday! By Thursday the team was complete. And not a moment too soon because a lot of hard work had to be done and the days were long. Operations were performed on two operating tables at the same time and on average eleven patients a day were operated on.

Great local interestLastly another extract from Ellen’s report: ‘It is busy in the operating theatre. Besides our own team, the local operating theatre team are also hard at work. Instruments are autoclaved, the tables are prepared, instruments handed over and patients collected and brought. The local doctors show great interest and regularly look on, make photographs or even scrub up so that they themselves can help. Nurses and the physiotherapist are also keen to take a look in the operating theatre and regularly drop by.’

Operating on two tables in the new OR for the first time

Cees Spronk examines one of the many children with burn contractures

14 N i g e r i a


O p e r a t i o n s N i g e r i a


• 14 hypospadia or urethral fistula


• 23 other

Popular presents‘We operate patients with wonderful names like Happy Jerry, Friday Justice, Marvellous Monday, Ambitions Rehop and Ponfa Goodness. All the patients are given a small present. For the children there are small cuddly bears or toy cars, while the adults are given a pen or a key cord. While we are doing the ward rounds we see how proud the little patients are of their presents. One little girl is carrying her new cuddly bear in a sling on her back just as a mother carries her baby. A lot of the mothers want to pose for a photograph with us, but the patients themselves find the white doctors a little overwhelming. Changing dressings is accompanied by a lot of tears. As a reward for their courage we give them balloons which again are cherished dearly.’

Still holding on to his balloon while fast asleep

Little girl before and after cleft lip surgery

Door het uitstellen van de verkiezingen in Nigeria werd het niet veilig genoeg geacht om de missie van maart door te laten gaan. Gelukkig konden de meeste teamleden hun weken verzetten zodat ze in oktober mee konden! De organisatie wat betreft het verkrijgen van de benodigde visa voor Nigeria verliep deze keer moeizaam en de paspoorten van Fatima, Geesje en Marthe zijn zelfs zoek geraakt. Zij konden na veel kunst- en vliegwerk pas een paar dagen later met een noodpaspoort de andere teamleden nareizen. De rest van het team was intussen al hard aan het werk. Donderdag was het team gelukkig compleet.

Het programma in Mangu staat wijd en zijd goed bekend en patiënten kwamen dan ook van heinde en verre. Er worden gemiddeld 11 patiënten per dag geopereerd. De samenwerking met de lokale enthousiaste staf was uitstekend en aan het eind van de twee weken zijn er 105 operaties verricht. Hiervan waren er maar liefst 59 patiëntjes met een brandwondcontractuur. Dit geeft maar weer eens het belang van een juiste behandeling van brandwonden en de preventie er van aan. Speciaal voor de preventie van brandwonden is Marthe Houpt mee gegaan. Zij heeft samen met manager Kefas Tuwan presentaties gegeven op scholen en aan ouders van brandwond-patiëntjes over hoe brandwonden te voorkomen.

At the end of two weeks the Interplast team had carried out 105 operations. No less than 59 of these were on small patients with burn contractures. Again it is an indication of how important it is to treat burns properly and how crucial it is to prevent burns occurring.

15N i g e r i a


2 5 y e a r s c o v e r A n n u a l r e v i e w16


2 5 y e a r s c o v e r A n n u a l r e v i e w 17


Ellen Meerman reports that school children and patients’ parents were all enthusiastic about the presentations. A few particularly creative women fashioned clay ovens which could be used for cooking on without being exposed to an open fire.

New clay ovens protect children from the flames

So the programme has made a start in attempting to prevent burns and the resulting contractures that are often so disabling. With Interplast’s help the programme will be expanded in the coming years.

The October mission to Nigeria included working on the burn prevention programme as well as the usual round of operations in Mangu. Marthe Houpt had specifically joined the team for this purpose. Here, as in so many African countries, women cook in pans on open fires.

Unprotected open fire

Children play in the cooking area and fall into the fire, or are burned by scalding liquid if a pan overturns. Marthe and manager Kefas Tuwan gave presentations and information to school children, patients and parents of patients in the hospital ward to warn them of the dangers. Posters and pocket cards were made and distributed giving tips for preventing burns and what to do straight away if a child or anyone else is burned.

Kefas and Marthe giving a presentation to the parents of the burn patients in the hospital

Burn Prevention Programme, Mangu, Nigeria October 2015

18 N i g e r i a


South Sudan

Official name the republic of South Sudan

Capital Juba

Location east-central Africa


Number of inhabitants 11.7 million

Climate tropical

25 October - 6 November

TeamPlastic surgeon NPand team leader

Rein Zeeman

Anaesthetist Gijs Witte

Theatre nurse Greta Hesseling

Local partners Tatjana Gerber (Germany)Arkangelo Ali Association

Visited hospital Gordhim Hospital, Gordhim

Basic comfortsDespite reports that South Sudan was unsafe Interplast received information at fi rst hand, namely from Tatjana herself. There was unrest and violence 600 kilometres away but Gordhim and the surrounding area were quiet.

Only a small team was despatched comprising three highly experienced Interplast volunteers. The trip went well and having arrived at the airfi eld in the capital of Juba, the team found a member of staff of AAA, Moses, waiting for them. The fl ight to Aweil was due the next day so the team spent the night in the AAA guesthouse in Juba. Conditions were Spartan to say the least, since there was no water or electricity.

Dinka father with child with cleft lip

Burn Prevention Programme, Mangu, Nigeria October 2015

South Sudan (officially the Republic of South Sudan) is a landlocked country in north eastern Africa that gained its independence from Sudan in 2011 after a civil war that lasted for a decade. Its current capital is Juba, which is also its largest city. South Sudan is bordered by Sudan to the north, Ethiopia to the east, Kenya to the southeast, Uganda to the south, the Democratic Republic of the Congo to the southwest, and the Central African Republic to the west. Since October 2015 South Sudan consists of 28 states instead of 10.

First mission for Interplast HollandThe very fi rst mission to South Sudan came about through Greta Hesseling, an operating theatre assistant and an Interplast volunteer for many years. Greta also works for Interplast Germany and through this met Tatjana Gerber who heads a small hospital in Gordhim, South Sudan. Tatjana works for the Arkangelo Ali Association (AAA), a South Sudanese NGO operating under the umbrella of the Verona Fathers (Catholic missionaries).

Gordhim is located in the north of South Sudan in the state of Northern Bahr el Ghazal where 95% of the population belong to the Dinka, the largest ethnic group in South Sudan. The group’s means of existence is cattle herding. The closest largish town is Aweil.

19S o u t h S u d a n


20 S o u t h S u d a n

The following morning the team returned to the airfield to fly to Aweil with the United Nations Humanitarian Air Services UNHAS. The aircraft, a Fokker 50, had a full Dutch crew. The airfield in Aweil was an unpaved landing strip, the luggage collection area was a mango tree.

The team was picked up by Tatjana and driver Deng. After an hour and a half driving on a very bad road the team arrived in Gordhim. The hospital comprises a few simple buildings and is really not much more than a rural clinic, but the wards were clean and the operating theatre well-equipped. There were no doctors or medical officers present. Tatjana is the ‘matron’ and runs the whole show. A German team of general surgeons had visited a year before and had donated anaesthesia equipment that had just arrived. Gijs managed to put it together!

Sound local supportOn the same afternoon at four the team began screening the patients that Tatjana had pre-selected. Team leader Rein Zeeman reported that here, too, there were patients with all kinds of abnormalities as well as quite a number of cleft lips and burn contractures. After the screening the programme was drawn up.As Rein writes: ‘the team members were all extremely experienced, so the programme went smoothly with the help of local staff who prepared the patients for surgery. The team worked from eight in the morning to five in the afternoon but not everyone could be operated on. Some were too frightened, and in another instance

the husband of one woman with significant burn contractures refused to give his consent.’

The days spent operating (seven instead of the usual ten) passed without incident, thanks to the sound support of the local nurses Gabriel and Angelo. The days were fewer since there were no flights to and from Juba at the weekend because of works on the runway.

Treatment Unit with theatre

Greta and Angelo working closely together


21

Adult man before and after cleft lip surgery. Always surprised to see the ‘new‘ face in the mirror for the first time

S o u t h S u d a n

VIP treatmentDuring the week various dignitaries dropped by to see exactly what Interplast was doing. The District Commissioner and the new Minister of State (in October 2015 the ten districts of South Sudan were subdivided into twenty eight states) were impressed and could see for themselves how happy the patients were when they visited the wards.

The team with some of their patients and with Tatjana

On Thursday morning before the flight back to Juba the team visited the Minister of Health of the new district in Aweil and discussed ways of improving health care. Afterwards a visit was made to the district hospital in Aweil which has 300 beds. Doctors without Borders also works in this hospital. The head nurse of the operating theatre would also like to receive an Interplast team. Here, too, there are a lot of patients with burn contractures.

Deze eerste missie naar Zuid-Soedan kwam tot stand via OK-assistente Greta Hesseling, sinds jaar en dag vrijwilliger bij Interplast. Greta werkt ook voor Interplast Duitsland en kwam via dit werk in contact met de Duitse Tatjana Gerber die een ziekenhuisje leidt in Gordhim in Zuid-Soedan. Tatjana werkt voor de Arkangelo Ali Association (AAA), een Zuid Soedanese NGO die onder de paraplu van de Verona Fathers opereert.

Gordhim ligt in het noorden waar 95% van de bevolking behoort tot de Dinka’s, de grootste etnische groep in Zuid Soedan. Zij leven voornamelijk van de veeteelt.

O p e r a t i o n s S o u t h S u d a n



• 10 other


Landing strip at Aweil Airport

De dichtstbijzijnde grotere plaats is Aweil. Ondanks berichten dat het niet veilig zou zijn in Zuid-Soedan kreeg Interplast de informatie hierover uit eerste hand, namelijk van Tatjana zelf. De onrust en geweld dadig heden vonden 600 kilometer verderop plaats en in Gordhim en omgeving was het rustig.

Er ging maar een klein team bestaande uit 3 zeer ervaren Interplasters. Het ziekenhuis bestond uit een paar simpele gebouwtjes en is eigenlijk meer een platte landskliniek maar de afdelingen waren schoon en de operatiekamer goed geoutilleerd. De operatie -dagen verliepen zonder problemen, ook zeker dank-zij de goede onder steuning van de lokale verpleeg-kundigen Gabriel en Angelo. En van matron Tatjana natuurlijk.Young woman before and after cleft lip surgery

22 S o u t h S u d a n


Two young burn victims being treated at Holland Ward

A young patient is prepared for surgery at the burns theatre

Prevention Programme. They will have to be discussed with the Permanent Secretary of the Ministry of Health in Uganda. Interplast hopes to see Rein Zeeman go back in 2016 to assist in the next phase towards independence.

UBPSI in 2015

A lot happened in 2015 at the Uganda Burns & Plastic Surgery Institute. The biggest milestone occurred on 1 July, the start of the new administrative year in Uganda, when financial support for the Burns Unit was promised by the government. This meant that food, medication, dressings etc. could be purchased through the government buying procedure at the National Medical Store (NMS). A separate account was opened specifically for this purpose. The account is managed by the CEO of Mulago Hospital. The money in the account has been earmarked and is intended solely for the Burns Unit. Nobody can touch it. However, the money was transferred to the account late and to ensure that care was nevertheless provided Interplast stepped in to bridge the gap.

Marjo Aerts had already drawn up the budgets for the Burns Unit in the previous year but it was not clear which budget had been submitted to the Ministry and what lists had been used for the NMS. Regrettably, Interplast still has no insight into the spending from this account. An audit will be needed to counteract the rumours that are doing the rounds. The contract that Rein Zeeman was promised for 2015 failed initially to materialise, but after staying several months in Uganda it was finally forthcoming shortly before his departure to the Netherlands at the end of the year. With some amendments it is acceptable.

Marjo Aerts had drawn up working plans for the new year with the accompanying budget (July 2016 - July 2017). These plans relate both to the Burns Unit and to the Burn

23U B P S I i n 2 0 1 5


Village in Karamoja burned down by fire

Playing with fire is common among young children in Karamoja

Burn Prevention Programme, Uganda

Marjo Aerts is serving as programme manager of the Burn Prevention Programme which has been set up by Interplast to reduce the number of burns victims in Kampala, Uganda’s capital. Here is her report on the programme’s activities and achievements in 2015.

A year of transitionIn 2015 I went to Uganda several times to visit the Uganda Burns and Plastic Surgery Institute UBPSI in Kampala. It was a year of changes. The government was due to take over the funding of UBPSI from Stichting Interplast Holland. In 2014 Rein Zeeman had visited President Museveni on different occasions at the president’s invitation. The UBPSI was to become an independent institute directly funded by the Ministry of Finance. The first year was to be a transition year.

A visit to KaramojaIn February, at the invitation of Mrs Janet Museveni, the First Lady of Uganda, I paid a four- day visit to Karamoja in North East Uganda. The main goal was to make an analysis of what was happening in the field of burns in this region. Planning had to be tight because I wanted to visit at least two hospitals, one a government hospital and the other a mission hospital. Most hospitals have a good idea of the main causes of burns. In addition I wanted to visit a Health Care Centre, the District Health Office in Moroto and three villages in Moroto. Michael Angel, an former operating theatre nurse from Karamojo, accompanied me as a translator. The State House took care of the car and driver.

A detailed report of the visit can be requested from Stichting Interplast Holland. The conclusion was that the causes of burns are the same as in other parts of Uganda which I have visited in the past. Most victims are young children below six years old. The culprits are hot fluids from unsafe cooking places, accidents arising from playing with fires or unsafe candles. There are ample opportunities for a burn prevention programme here.

24 B u r n P r e v e n t i o n P r o g r a m m e , U g a n d a


A woman in Nansana fenced off her cooking place and children are not allowed in

Another example of a fenced off cooking place

Enthusiastic teaching about burnsThe burn prevention programme team is very enthusiastic. Richard Chaddy Amadro, fellow manager, accompanied me to Bweyale, about 350 kilometres to the north of Kampala. Here we visited a school. Richard is co-founder of the school and still closely associated with its organisation. He has written a poem about burns, their causes and prevention. The Star Schools has converted this into music and drama – called magic theatre in Uganda – of which the Ugandans are extremely fond. The children are invited to recite and sing these texts at events.

There are also monthly sessions that are organised and implemented with a great deal of enthusiasm. The Community in Nansana has asked whether we would like to organise an intensive programme in six villages. An office, donated by one of the Community Leaders, was opened in Katooke B. During my stay in November and December the office has been much visited by people, who wanted to help as volunteers in this programme. The Community Leaders joined us in implementing sessions or gave their full support.

High level support of burn preventionAt the end of 2015 I took three and a half months unpaid leave to support the Burns Unit and the Burns Prevention Programme.

25B u r n P r e v e n t i o n P r o g r a m m e , U g a n d a


The Permanent Secretary, Dr Lukwago, was very pleased with the burn prevention programme and said he himself was prepared to supervise it. He saw the importance of burn prevention. Richard Chaddy Amadro will remain the manager of the programme. Two board members of the UBPSI, Joy Batusa and Joy Asiimwe, will give him support with this. Both of them are highly trained and motivated, and have experience with Community Based Programmes.

Together with Richard Chaddy Amadro I wrote a three-year Strategic Plan and a Draft Working Plan and Budget for the 2016-17 financial year. Dr Lukwago and Dr Amandua were highly appreciative of the work I did through Stichting Interplast Holland. Interplast Holland offered to continue help on the side-lines on request.

Coordinator of the burn prevention programme Charles is sensitizing people in Nansana

Together

we can

prevent

burns

in

Uganda

26 B u r n P r e v e n t i o n P r o g r a m m e , U g a n d a


27S o m e r e s u l t s o f 2 5 y e a r s


Een succesvol partnership op financieel gebied vraagt om twee grondbeginselen: een persoonlijke benadering en grote betrokkenheid. Dat klinkt logisch, maar steeds meer organisaties beschouwen de wereld als hun speelveld en richten de focus op het groter geheel. Kennis van de klant, écht kennis en persoonlijke betrokkenheid raken daarmee nog wel eens op de achtergrond. Dat overkomt u niet bij RSM Tempelman Registeraccountants en Belastingadviseurs.

Voor meer informatie over de dienstverlening van RSM Tempelman kunt u contact opnemen met Pim van Batenburg, 010 - 455 41 00 of per e-mail [email protected].

www.rsmtempelman.nl

RSM Tempelman I Jacques Dutilhweg 471a I Postbus 8028 I 3009 AA Rotterdam

Regionaal betrokken, wereldwijd verbonden

RSM Tempelman - Interplast_Rotterdam.indd 1 30-1-2014 15:12:44

A D V E R T I S E M E N T S | A D V E R T E N T I E S

28 A D V E R T I S E M E N T S

www.interplastholland.nl


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Interplast consists of volunteer medical personnel (plastic surgeons, anaesthetists, theatre and anaesthetic nurses and other specialists), who work free of charge during their holidays. Travel expenses, medical supplies and instruments are funded by donations raised in Holland from companies as well as the general public.

Interplast teams provide reconstructive operations that transform the lives of children and (young) adults with physical disabilities and thereby improve the future of the whole family of those children as well. Interplast has no fi nancial, political, racial or religious interest.

The aim is to provide (and teach) reconstructive surgery to improve function, not to perform cosmetic surgery. Cooperation with local medical staff and working at existing hospitals close to the patients’ home is effi cient and offers education in a specialist fi eld for all involved. Apart from medical staff, local volunteers with social commitment are essential for the preparation and the smooth running of a successful Interplast mission.

If you, your town, your hospital, or a charitable organisation you know think about hosting an Interplast team, here are some important issues to consider:

• Advance notice for the team should be given at least 6 months before the intended date.

• Duration of the mission is usually 2 weeks, i.e. 10 operating days. Depending on the severity of cases, about 100 patients can be operated during that time.

• Size of the team varies depending on the number of operating tables, anaesthetic facilities and local staff available. On average, a team will consist of 6 people, 2 surgeons, 1 anaesthetist, 2 theatre nurses and 1 anaesthetic nurse, thus being able to run 2 operating tables (smaller or larger teams possible on request).

• Local staff, i.e. doctors, nurses, interested volunteers are essential for the smooth running of a mission.

• Local doctors should perform the patient pre-selection during the months before the arrival of an Interplast team. If possible, they should inform the team about the type of surgery and special cases beforehand to allow appropriate planning of instruments and supplies for the trip.

• The fi rst day consists of screening and selecting the patients for the operating lists, unpacking equipment and setting up the operating room(s).

• Types of operation: burns contractures, congenital deformities like cleft lip and palate, functional defi cits or disfi guration from injury, infection (polio, leprosy, Noma etc.) tumours – in children and (young) adults.

• Long working hours have to be anticipated by all involved to make an Interplast mission effective.

• Apart from operating, ward rounds and change of dressing sessions take place every day.

• The hospital should offer: two operating tables, anaesthetic machines, a recovery room, enough beds, electricity supply, water, normal saline for infusion, sterile sheets and gowns, oxygen, halothane and some dressing material and plaster of Paris. The Interplast team will provide: special instruments and medical equipment, suture material and special drugs and dressings.

• You are requested to provide: (if possible, but if you don’t have the means, other arrangements can be discussed) basic, clean accommodation, food and transport for the team. Government / Ministry of Health permission for the mission; assistance with customs, excess baggage clearance etc.

Many years o f exper ience and thousands o f g ra te fu l pa t ien ts a re proof o f the success o f In te rp las t ac t iv i t i es . YOU can be par t o f i t .

S t i c h t i n g I n t e r p l a s t H o l l a n d [ F o u n d a t i o n]

A NONPROFIT ORGANISATION

PROVIDING FREE RECONSTRUCTIVE

SURGERY AROUND THE WORLD

Information leaflet

30 I n t e r p l a s t H o l l a n d i n f o r m a t i o n l e a f l e t


This annual review has largely been sponsored and created thanks to the cooperation ofediting Annemarie Maas translation Wordsmiths Translations, Den Haagfi nal editing Astrid Nagelhout, Leidendesign Ineke de Graaff, Amsterdam printing Ray Kruithof Kremer, Delta Print BV, Zoetermeer

Stichting Interplast Holland

BoardDrs. Rein J. Zeeman, chairmanDrs. Rutger L. van Leersum, secretaryHenk J.A. Koster, treasurer

Honorary MemberFrank E.I. SchaafProf. dr. Bert D. de JongEls L. Gerritsen

Nursing CommitteeElles LoenenPaula EllenMarie-Thérèse de By-de BakkerMarjo Aerts MPHJan H. van SteenLesley Monfi ls

Policy maker (staff)Marjo Aerts MPH

OfficeAnnemarie Maas

Committee of RecommendationDrs. Erica TerpstraHerman van Veen

Interplast is also active on Facebook

CorrespondenceStichting Interplast HollandPO Box 21892301 CD Leiden

Visitors’ addressStichting Interplast HollandPoortgebouw Zuid, room 468Rijnsburgerweg 102333 AA LeidenThe Netherlands

T +31-(0)71-52 10 165F +31-(0)71-52 14 458E [email protected] I http://www.interplastholland.nl

INGIBAN NL19 INGB 000 152 06 38BIC INGB NL 2A

ABN AMRO IBAN NL76 ABNA 044 880 09 26BIC ABNA NL 2A

31C o n t a c t I n t e r p l a s t H o l l a n d


Book on cleft lipand palate surgery in developing countries.

Available on request [email protected] for € 25,–

With special thanks to...

ALL INTERPLAST VOLUNTEERSStichting Elise Mathilde FondsDiaconie Gereformeerde Kerk, Nieuw VennepEuro Tissue Bank, BeverwijkEmbassy of the Republic of Uganda, BrusselsJan (Honorary Consul) and Will van Maanen, Bissau, Guinea-BissauJohannes Mooij, Bissau, Guinea-BissauJohan Krijt / Goedemiddag! online, Den HaagStichting True BlueLions Club LeiderdorpBergman ClinicsDr Jean Claude Bizimana, BurundiDiaconie Protestantse Gemeente H-Z-B, AvenhoornStichting Bron van Leven, WassenaarLeids Universitair Medisch Centrum

Stichting Eekhoorn, LeidenTatjana Gerber, South SudanSavannah Koomen, Webstudent LeidenDr. E.J.F. Timmenga, RotterdamJohannes StichtingDana Petroleum Netherlands B.V., Den HaagFam. S. van der Meij, RijnsburgNetherlands Embassy, Bujumbura, BurundiStichting S. Robert & Denise Zeilstra Foundation, Den HaagAlrijne Ziekenhuis Leiden Izere, André NkeshimanaDokters van de Wereld, AmsterdamBrarudi (Heineken Burundi)Mevr. L.S. Wijnbergen, RotterdamArkangelo Ali Association, South Sudan... and many others

32 S p e c i a l t h a n k s t o . . .



E v e n i n U g a n d a t h e y c e l e b r a t e d t h e j u b i l e e o f I n t e r p l a s t !

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