Stichting Interplast Holland

General survey3General survey of countries and operationsOperation total = 10815 with 134 teamsUganda 33 teams 2631 patientsYemen 28 teams 2153 patientsNigeria 11 teams 861 patientsRwanda 4 teams 250 patientsGuinea-Bissau 5 teams 340 patientsGuinea-Conakry 1 team 30 patientsBurundi 6 teams 511 patientsZanzibar 5 teams 364 patientsIndonesia 5 teams 498 patientsGhana 18 teams 1362 patientsVietnam 6 teams 976 patientsAnd teams toLebanon, Bhutan, Namibia,Pakistan, India and Burkina Faso.

6 Guinea-BissauGuinea-BissauOfficial nameCapitalLocationSurface areaNumber of inhabitantsClimateRepublic of Guinea-BissauBissauWest Africa36,152 km²1.7 milliontropical27 January - 11 FebruaryTeamPlastic surgeonand team leaderAssistant surgeonAnaesthetistAnaesthetic nurseTheatre nurseLocal teamVisited hospitalRein ZeemanCharlotte LameijerDirk Jan VeldmanMarjo AertsToos BaremanJan and Will van MaanenDelfi m Cabral andCrisologo MendesJohannes MooijHospital Nacional SimãoMendesCharlotte arrived with the team this time, but was unable tostay on longer for the aftercare. Chris and Delfi m wereto take on this task.First week: just one anaesthetic machineIn the process of setting up the operating theatre it turnedout that only one of the anaesthetic machines worked.Luckily, another one could be borrowed at the beginningof the week from the leprosy hospital not far from Bissau.The operating theatre was often very busy, partly becauseof immense media interest in Interplast’s work. Everythingwent well and 43 patients were operated on in the fi rstweek.GUINEA-BISSAU is a small West African country with anestimated population of 1.5 million. It is one of the leastdeveloped countries in the world and among the poorest,ranking 176 out of 187 on the United Nation’s HumanDevelopment Index (2012). The Netherlands, for instance,is number 4. Average life expectancy is 48 years andinfant mortality in the first year is almost 100 in every1,000 children. The country lives primarily from agricultureand has recently become the biggest exporter of cashewnuts worldwide.Fifth mission in a row2012 saw the fi fth Interplast Holland mission to Guinea-Bissau since 2008. The local organising committee, ConsulJan van Maanen, his wife Will and Johannes Mooij hadagain done a marvellous job preparing for the mission.Proper local pre-screening ensures that the team see onlyfew patients who prove ineligible for an operation.Two young doctors, Chris and Delfi m, joined the team attheir own request under the auspices of the Health ministry.‘Chris and Delfi m are enthusiastic workers. They have had abasic training as doctors but they have a lot to learn beforethey can ‘operate’ on their own’, writes Rein Zeeman in hismission report.In contrast, Dr Lassana Intchsso performs all the noma(gangrenous stomatitis) operations together with Rein orunder his guidance. Dr Lassana is due to become director ofthe new Noma hospital which will soon be open. He is wellqualified to carry out operations which are not toocomplicated.A passage from Charlotte’s report on the fi rst week: ‘Thedays fl y by. Toos has developed into a real Jill-of-all-trades.The local staff are constantly calling out ‘Toos, Toos, Toos’to get her attention, but Rein and I don’t lag far behind.She stays calm, makes sure we have the sutures andgauzes we want but occasionally takes an extra stroll roundthe block to be out of earshot of the cries.Marjo is coaching the local anaesthetic staff as if she’s beingdoing it all her life, they are loving it. The job of insertingintravenous lines, and handling the doses of Halothane(an anaesthetic) is becoming more streamlined than ever.

Guinea-ConakryXxxxxxx 9Guinea-ConakryOfficial nameCapitalLocationSurface areaNumber of inhabitantsClimateRepublic of GuineaConakryWest Africa246,000 km²10 milliontropical11 - 24 MarchTeamPlastic surgeonand team leaderPlastic surgeonAnaesthetistAnaesthetic nurseTheatre nurseLocal supportVisited hospitalRein ZeemanEtienne LommenGeert Jan GoekoopEddy HermanusPaula EllenIdrissa CamaraTrusal Friguia (formerPeychine) Hospital, FriaAfter a short visit by Rein Zeeman and Etienne Lommen in2011, the fi rst team was sent out on a fact-fi nding mission.Papingo had travelled earlier from the USA to Guinea-Conakry to prepare for the arrival of the team.When the team arrived it was soon apparent that manyarrangements had unfortunately not been made! The boxesthat had been sent on ahead were still at the airport; theyhad been addressed to the Health Minister, but he was notin the country and could not be reached.Guinea, formerly French Guinea, often called GUINEA-CONAKRY and officially the Republic of Guinea, isconstitutionally a presidential republic in West Africa,situated on the Atlantic Ocean between Guinea-Bissauand Sierra Leone. The capital is Conakry. It is one ofthe least developed countries in the world and has about10 million inhabitants. (It ranks 178 out of 187 on theUnited Nation’s Human Development Index of 2012.)A false start in ConakryThree days and many offi cial bodies later, the boxes wereat last collected at the airport by the team. In Conakry,no hospital to work in had been arranged. Our surgeonProfessor Saadi, who had promised a lot of help, sadlyfailed to show up.The economy thrives mainly on tropical agriculture, fishingand mining. Guinea-Conakry is the second productioncountry for bauxite, with almost half of the world’s bauxitereserves; besides, there is iron ore, and gold anddiamonds are mined. The bauxite production is almostentirely in private hands, 85% of the proceeds go toforeign companies.A new destinationThe initiator of an Interplast programme in Guinea-Conakryis Idrissa Camara (Papingo), Guinean and former Olympicswimmer who has lived in the USA for years but who cameinto contact with Interplast because he was looking for helpfor his nephew Naromba who had a cleft lip and sufferedterribly. Naromba was operated on in 2006 in Ghana byan Interplast Holland team (see 2006 Annual Review).Naromba in 2006 and 2011

Guinea-Conakry11One of only 7 cleft lips! Before and after surgeryA mystery; hardly any cleft lips...On Monday 19th March, Rein wrote; ‘Today we were ableto operate on six patients and screen some new ones.The operating theatre is fine to work in and the local staffcooperate very enthusiastically. Dr Bengoura (the localsurgeon) gave us excellent guidance and helped with theoperations. He also arranged for post-operative care. In theend we operated on 30 patients. We were struck how fewcases of cleft lips and palates we saw. Did all these patientscome from Haute-Guinee perhaps? If so, that would seemto be an excellent location for a future Interplast mission.During this 2012 mission, the number of patients was belowwhat we are used to, but the next time we willsee to it that there are many more.’On the final day of this successful mission, Reins diary read;‘Our farewell reception was heart-warming and we havebeen asked to come back next year. Clearing the equipmentthrough customs can be done through a French agency.We left behind a Watson skin graft knife so that the localdoctors can cut their own skin grafts to treat patients withburns and contractures’.Handing over the Watson skin graft knife

12 Guinea-ConakryPosing with enthusiastic staff in FriaInitiator voor een Interplast-programma in Guinee-Conakry is Idrissa Camara (Papingo), een populaireGuinees en voormalig olympisch zwemmer die al jaren inde VS woont, maar met Interplast in contact kwam doordathij hulp zocht voor zijn neefje Naromba die een lipspleethad en daar erg onder leed. Naromba werd in 2006 inGhana geopereerd door een team van Interplast Holland(zie ook Jaarverslag 2006).Na een kort bezoek van Rein Zeeman en Etienne Lommenin 2011 werd nu een team uitgezonden voor een verkennendemissie. Wat vanuit Nederland allemaal zo goedgeorganiseerd leek bleek bij aankomst niet het geval. Deeerste week kon het team niet veel doen. Er was geenziekenhuis beschikbaar waar geopereerd kon worden ende materialen stonden nog op het vliegveld.Gelukkig maakte de tweede week in Fria alles goed. Hiereen enthousiast en warm welkom, en veel bereidwilligheidom met het team samen te werken.Teaching on the job in FriaYou can read Rein Zeeman’s complete reportat www.interplastholland.nl.Operations Guinea-Conakry7 cleft lips and/or palates18 post burn contracture•• 5 otherL’initiateur du programme Interplast est Idrissa Camar(Papingo), un Guinéen médiatique et ancien championolympique de natation qui vit aux USA. Il est entré encontact avec Interplast pour son neveu Naromba quisouffrait d’un bec de lièvre. Naromba a été opéré par uneéquipe d’Interplast Holland en 2006 au Ghana (voir leRapport Annuel 2006).Après une courte visite de Rein Zeeman et EtienneLommen en 2011, une équipe a été envoyé en missionde reconnaissance. Ce qui semblait bien organisé vu desPays Bas n’a pas été le cas à l’arrivée. Il n’y avait aucunhôpital disponible où les interventions auraient pu prendreplace et le matériel était encore à l’aéroport.Néanmoins la seconde semaine à Fria s’est bien passée.Nous y avons trouvé enthousiasme, chaleureux accueilet volonté de travailler avec l’équipe.

Zanzibar13ZanzibarOfficial nameCapitalLocationSurface areaNumber of inhabitantsZanzibarZanzibar Cityisland in the Indian Ocean,east of Tanzania1554 km²1 millionClimatetropical10 - 24 FebruaryTeamPlastic surgeonEd Hartmanand team leaderPlastic surgeonRuth LesterAnaesthetistGijs WitteAnaesthetic nurse Ingrid Hollander-MusTheatre nurseJolanda Kooijman-EskesVisited hospitalMnazi Mmoja HospitalThe island of ZANZIBAR lies off the east coast of Africaand is a semi-autonomous part of Tanzania. The island ofPemba close by is often considered to be part of Zanzibar.A well-prepared missionThe Zanzibar missions are always prepared well byDr Ramadhan Suleiman at the Mnazi Mmoja Hospital.Dr Rama selects patients in Zanzibar and the nearby islandPemba weeks before the team is due to arrive. Since thiswas the sixth team to visit Zanzibar since 2009 he knowsby now which operations the Interplast surgeons perform.Obviously, the patients have to be healthy and it is theInterplast anaesthetist who has the last word on that.On this mission it was Gijs Witte, an Interplast memberfrom the outset with 20 missions behind him and a wealthof experience.The fi rst (screening) day in the hospital was a Sunday.The reunion of the team and local staff was a warmoccasion. Almost 120 pre-selected patients were waiting.Some of these had to be turned down for the operation,sometimes because they were still too young or becausethey had a low blood count (HB).Many patients waiting for screening

14 ZanzibarBefore and after cleft lip operationIn the end, the team operated on 83 patients, many ofwhom again had urogenital problems in which RuthLester (UK) specialises. Ed operated on the patientswith cleft lips and/or palates, post burn contracturesand tumours. There were remarkably few children withcleft lips and/or palates this time.Sharing knowledgeThe director of the hospital, Dr Jamala, and Dr Rama invitedthe team to give a presentation of the work of InterplastHolland to local staff. Both Ruth and Ed gave a lecture, Ruthspoke about the problems surrounding badly performedcircumcisions and Ed spoke about cleft lips and/or palatesand post burn contractures.The anaesthetic staff Khamis and Mgeni were impressedby Gijs’ techniques, above all the use of a local rather thana general anaesthetic, and they learned a lot.Excellent cooperationThe days were long but the team had excellent support fromthe local staff. They are becoming more and more attunedto each other. Practically everyone could be operated onthanks to the sound pre-selection by Dr Rama. The teamcarried out a total of 83 operations, though anaesthetic wasadministered 90 times in connection with dressing changes.Post burn contracture before and after surgeryOperations Zanzibar•or urethral fistula10 other•4 cleft lips and/or palates46 hypospadia (birth defect of the urethra)23 post burn contracture

Zanzibar15Er waren meer dan 120 patiënten geselecteerd voorde screening. Dr. Rama selecteert van te voren opZanzibar en op het nabijgelegen eiland Pemba in de wekenvoor afgaand aan de missie. Alweer het zesde team datZanzibar bezoekt, en het weerzien met de lokale staf isdan ook altijd heel hartelijk! Voor het eerst ging anesthesioloog,en Interplaster van het eerste uur, Gijs Witte mee.Men was al snel onder de indruk van de technieken (vooralregionale anesthesie, geen narcose nodig) van Gijs en deanesthesie medewerkers hebben veel van hem geleerd.Het team maakte lange dagen maar kreeg voortreffelijkeondersteuning van de lokale staf. Ze raken steeds beterop elkaar ingespeeld!Il y avait plus de 120 patients sélectionnés.Le Dr Rama a sélectionné en avance à Zanzibar età l’ile Pemba dans les semaines précédant la mission.C’est la sixième équipe qui se déplace à Zanzibar etles retrouvailles avec l’équipe locale est toujourschaleureuse ! Pour la première fois l’anesthésiste etmembre d’Interplast de la première heure Gijs Witte étaitprésent. Il a impressionné par les techniques employées(anesthésie locale, pas d’anesthésie générale nécessaire)et les collaborateurs anesthésistes ont beaucoup appris.L’équipe a fait de longues journées mais a reçu unsoutien formidable de l’équipe locale qui s’organise demieux en mieux !The entire team posing together

16 BurundiBurundiOfficial nameCapitalLocationSurface areaNumber of inhabitantsClimateRepublic of BurundiBujumburaCentral Africa27,834 km²9 milliontropical21 September - 6 OctoberTeamPlastic surgeonand team leaderPlastic surgeonAnaesthetistAnaesthetic nurseTheatre nursesChairman IzereVisited hospitalsRein ZeemanEsther MestersRutger van LeersumJan van SteenMarie-Thérèse de BydeBakkerEls GerritsenAndré NkeshimanaCentre Hopitalo Universitairede Kamenge, BujumburaNgozi Hospital, Ngozithe rest of the team. And a good thing, too, becauseInterplast’s medical supplies were still waiting to becollected at the airfi eld and at the fi rst hospital, CHUK(Centre Hopitalo Universitaire de Kamenge) in Bujumburanothing had been arranged.BURUNDI is one of Africa’s smallest and most denselypopulated countries. The civil war lasting from 1994 to2005 has meant that it is also one of the world’s poorest.(It ranks 178 out of 187 (shared with Guinea-Conakry) onthe United Nation’s Human Development Index of 2012.)It is located in the great lakes region of Central Africaand is landlocked. Medical care is accessible to very few.Sixty-five out of 1,000 children die within their first year.There are less than 0.5 physicians per 10,000 inhabitants.Staff in CHUKWonderful local supportIt was fantastic that Brarudi (Heineken) had provideda bus with a driver. The team was really delighted.They were equally happy with a fi nancial contributionfrom the Dutch Embassy in Bujumbura.Only one mission this yearIn early 2012, the deteriorating fi nancial situation of Interplastmeant that it was sadly impossible to organise twomissions to Burundi. The spring mission had to be cancelled.Fortunately, a sponsor was found and the autumn missionto Burundi did take place.The two chairmen, of Interplast and Izere, Rein Zeemanand André Nkeshimana, departed two days earlier thanOn Friday, the day before the rest of the team arrived, theywere allocated the operating theatre for stomatology in theCHUK. Professor Gordien was called out of an operationand was informed on the spot that Interplast Holland wasgoing to be working in his operating theatre.In the end the arrangement worked well and the entire staff,assistants and nurses, as well as professor Gordien himself,enthusiastically cooperated in the team’s work for much ofthe week.

Burundi17Neurofibromatosis (tumour growing from nerve system),partial resectionUnfortunately, there were fewer patients on the screeningday this time, and certainly a lot fewer patients with cleftlips and/or palates. The explanation for this was that medicalteams from India and Kenya had just been to Bujumbura,and they had mainly focussed on helping patients with thesedeformities. There were, however, more than enoughpatients with tumours and post burn contractures.After Dr Jean-Claude (a local doctor engaged by Interplast)had solved the bed problem for our patients, the operatingdays went well. There were approximately ten operationsa day, including a few major operations.Professor Gordien operating on a cleft lipBefore and after bilateral cleft lip operation

18 BurundiA great many patients at NgoziIn contrast to Bujumbura, the number of patients at Ngoziwas overwhelming. More than 150 patients were waiting,and all of them wanted to see the Mzungu (white) doctoras is apparent from Rein Zeeman’s report: ‘It turnedout that everyone had paid around 500 Bfr, which isapproximately 30 euro cents, but it did mean thateverybody wanted attention and advice. It was all ratherhectic, though fortunately we managed to see them allbefore it got dark’.Earlier visits to Ngozi had been memorable because ofthe enthusiasm of the local staff, but now, in the absenceof the only local surgeon Dr Augustin, the organisation inthe operating theatre had suffered. Thankfully, Dr Claudewas very enthusiastic. The anaesthetic team were givenItalian support in the form of Dr Vania, an intensive careanaesthetist from Verona. The operating theatreprogrammes were full, but in the end the team managedto work through them all without any problems and in fourdays they performed almost 50 operations!During the ward round on the first day, the Interplast teamfound that nothing had been arranged for their patients, nochecks had been carried out and none of them were beinggiven anything to eat or drink. Luckily, the team managedto make arrangements for their patients with the hospitalkitchen that same evening.In Ngozi; mother with operated childThe vaporiser that they had brought with them fromThe Netherlands fitted exactly onto the anaestheticapparatus. A stroke of good fortune, for back in 2010, ina different hospital, the Interplast team had had to borrowone because there was no working equipment. Now theycould immediately put the apparatus to good and safeuse.Adult, before and after cleft lip operationThe start of the car trip back to Bujumbura, for the postoperativerounds and flight back home on Friday morning,was difficult because of the scarcity of petrol. In the end,after some haggling, and after having paid a somewhathigher price on the black market to get enough petrol fortheir return trip, the team set off for Bujumbura where theywere to carry out the final dressing changes at CHUK withDr Jean-Claude.Happily, there were few complications and they could besatisfied with the results. After a slow start at CHUK it wasa successful mission, with sincere thanks to their wonderfulhostess Esperence (nobody became ill!), Brarudi and ourembassy in Bujumbura.The next mission will be to Kibimba and Ryuigi in theEastern part of Burundi in March 2013.Operations Burundi18 cleft lips and/or palates18 post burn contracture45 other•

Joining forces in Burundi19In 2012 liet de verslechterde fi nanciële situatievan Interplast het niet toe twee missies naar Burundite organiseren. Gelukkig werd voor de najaarsmissieeen sponsor gevonden!In het Centre Hopitalo Universitaire de Kamenge (CHUK)was niet veel geregeld voor de komst van het team.Professor Gordien van de afdeling Stomatologie kreeg eendag van te voren te horen dat zijn afdeling het Interplastteammoest gaan faciliteren. Uiteindelijk was dit een grootsucces want professor Gordien en zijn hele staf werktenenthousiast mee.De tweede week in Ngozi was het aanbod van patiëntenweer groot. Door het wegvallen van de enige chirurg,dr. Augustin, was de organisatie op de operatiekamerbeduidend minder.De meegebrachte verdamper paste gelukkig preciesop het anesthesieapparaat!Hier kon na wat opstartproblemen weer goed gewerktworden.En 2012 la situation fi nancière d’Interplast n’a paspermis les 2 missions prévues au Burundi. Heureusementun sponsor a été trouve pour la mission d’automne !L’arrivée de l’équipe n’a pas été bien préparée au CentreHopitalo Universitaire de Kamenge (CHUK). Le professeurGordien, unité de stomatologie n’a appris que la veille del’arrivée de l’équipe qu’il devait mettre à disposition sonunité. Mais fi nalement la mission a été un grand succèspuisque le Professeur Gordien et son équipe ont travailléavec enthousiasme.La deuxième semaine à Ngozi les patients étaientnombreux mais l’absence du seul chirurgien Dr Augustina gêné l’organisation dans la salle d’opération.L’évaporateur que nous avions apporté s’adaptait surl’appareil d’anesthésie !Après quelques problèmes de départ nous avons pu bientravailler.Joining forcesin BurundiTheatre nurse Johanna de Vries took part in the Burundimission on behalf of Dokters van de Wereld; this is herpersonal report.‘From 21 September to 5 October 2012 I went on anInterplast mission to Burundi as a representative of Doktersvan de Wereld, the Dutch branch of Médecins du Monde. Myjob was to observe and learn how Interplast worked sinceDokters van de Wereld has the same mission as Interplast,namely reconstructive surgery in developing countries withan emphasis on children with cleft lips, cleft palates andburns contractures.Since 2010, Dokters van de Wereld has been organisingsurgical team missions and has cooperated well withInterplast from the outset, with the Interplast teamsupporting our missions with knowhow and materials.The present joint mission therefore also served to assessto what extent the cooperation could be stepped up.Running a joint mission was the best way to fi nd out.In Burundi we worked in two hospitals, in the capitalBujumbura and to the north in Ngozi. Both missions werea success.Interplast was in Burundi for the sixth time and the prescreeninghas been extremely well-organised partly thanksto this. Rein Zeeman, the team leader, made a detailedselection immediately on arrival in the hospital: patientswith a cleft lip, a cleft palate and/or contractures arisingafter burns were fi rst selected and included in the operatingprogramme. All other patients were also seen by thesurgeons and if possible put down for surgery.The impressive aspect of a mission of this kind is theconclusion that common and additional experience areimportant factors. We see opportunities for setting upand carrying out joint missions in the future.The mission with Interplast was extremely successfuland instructive. The team in which I took part was highlycompetent, open and friendly.A big thank you for the success we had and the pleasantway we worked together.’Johanna de VriesJohanna de VriesMedical Coordinator, Dokters van de Wereld

20 NigeriaNigeriaOfficial nameCapitalLocationSurface areaNumber of inhabitantsClimatethe Federal Republic of NigeriaAbujaWest Africa923,768 km²140 millionfrom tropical to sub-tropical7 - 24 MarchTeamPlastic surgeonand team leaderCees SpronkPlastic surgeonJan HochtrittAssistant plastic surgeon Hanneke TielemansAnaesthetistIna GroustraTheatre nursesFemke AnnemaAnnette BrouwerAnaesthetic nurse Aafke LautenbachVisited hospitalCOCIN Hospital &Rehabilitation Centre, Mangu6 - 21 OctoberTeamPlastic surgeonCees Spronkand team leaderPlastic surgeonJan Willem KortleveAssistant plastic surgeon Marije SmitenbergAnaesthetistRob NiemeijerTheatre nursesFatima van KlaverenGeert WijnsmaAnaesthetic nurse Geke HoeksmaVisited hospitalCOCIN Hospital &Rehabilitation Centre, ManguThe country is located in West Africa and shares landborders with the Republic of Benin in the west, Chad andCameroon in the east, and Niger in the north. Nigeria isroughly divided in half between Muslims, concentratedmostly in the north, and Christians, who mostly live in theSouth. Nigeria is the most populous country in Africa anddespite huge oil revenues there is still great poverty.March mission able to go aheadAgain it was a tense situation beforehand as to whether themission would go ahead or not. In Jos the situation isstrained because of confl icts between Christians andMuslims. Unfortunately, attacks are a daily occurrencethough luckily Mangu is about 80 kilometres away from Jos.Thanks to our people on the ground we know that Manguitself is fairly unaffected by all the unrest.Many patients waiting for the team to arriveAfter 12 missions the arrival of a plastic surgery team fromthe Netherlands is a familiar occurrence in the wider region.There are always a lot of people waiting to see the plasticsurgeons, who this time were Cees Spronk, Jan Hochtrittand assistant Hanneke Tielemans.This time the team stayed for two and half weeks andoperated on almost 100 patients, half of whom had post burncontractures. It is obvious that care for burns patients is nonexistenthere. Cees Spronk hopes that with the aid of theFaridpur Foundation and Interplast Holland, for one thing,this lack can be remedied and a burns centre set up.Courage certificates are highly appreciatedHere is an extract from the report of Hanneke Tielemans whowas on a mission for the fi rst time: ‘The anaesthesia teambrought with them small gifts and a Courage Certifi cate forall the young children who had to be operated on. After thefi rst day, we noticed that the adults were also extremely keento have a certifi cate. In fact, we heard through the nursesthat somebody had failed to be given one. So from day twoonwards every patient was awarded a Courage Certifi cate’.The team worked well together and the atmosphere waspleasant. The operations went well and there was one case

Nigeria21Patients waiting for screeningthat the team will not forget easily; a child of 11 months witha huge tumour on her head. Hanneke; ‘We saw her at thein-patients clinic and had to choose between doing nothing,which meant that we would have to assume that she woulddie in the not too distant future, or operating on her withthe limited means that we had at our disposal. We chosethe latter. In the course of the operation she had to bereanimated, but thanks to the team working together welland excellent directions from Ina, the anaesthetist, all wentwell. When the team visited the wards the next day, the girlwas already being breastfed by her mother.Reanimated child the next morning

22 Nigeriabijna 100 geopereerde patiënten heeft iets meer dan dehelft een brandwondcontractuur. Het is duidelijk dat goedezorg voor brandwondenpatiënten hier nog niet bestaat.Cees Spronk hoopt daar met hulp van o.a. StichtingFaridpur, de Nederlandse Ambassade en Interplast Hollandverandering in te brengen door er een brandwondencentrumop te zetten.Hanneke Tielemans with patientMalgré la situation tendue à Jos concernant lesconflits entre chrétiens et musulmans, la mission a pu avoirlieu. Grace à des contacts locaux nous savons qu’à Mangula situation est relativement calme.L’équipe est restée 2 semaines et demi et plus de la moitiedes 100 patients opérés sont des PBC (contractures postbrûlure). Il est évident qu’il n’existe pas encore de soinspostopératoires adéquats pour les patients brulés. CeesSpronk espère qu’avec l’aide de l’Association Faridpur,l’Ambassade Néerlandaise et Interplast Holland, il serapossible d’apporter un changement et d’ouvrir un centrede soins pour les Grands BrûlésOn the last day we had the prospect of another niceactivity, a teaching session by Annet about hygiene andthe prevention of infection and handing out the certificates.Those who are called forward are visibly proud to receivetheir Interplast certificate.’October mission: tough circumstancesHappily, the second mission to Nigeria went ahead as usual.The fact that Mangu is a remote area is apparent from thefollowing extract from the report on this mission, written byGeke Hoeksma.‘A fantastic mission’Hanneke thoroughly enjoyed taking part in this mission;‘Altogether we have learnt a lot during this mission. On thelast evening we had a farewell dinner with invited guests,and we were extensively thanked for our efforts. We arehappy and satisfied the next morning when we step into thebuses on the way to the airfield. A fantastic mission and wehope that many more will follow.’Operations Nigeria, March6 cleft lips and/or palates53 post burn contracture32 other12 certificates awarded•7 hypospadia or urethral fistulaOndanks de gespannen situatie in Jos vanwegeaanhoudende conflicten tussen Christenen en Moslimskan de missie door gaan. Dankzij de contacten ter plaatseweten we dat er in Mangu niet veel te merken is van alleonlusten.Het team blijft deze keer ruim twee weken, en van de‘After having travelled 17 hours and being warmly receivedby Kefas (manager and head of nursing in Mangu) and thedriver Sati at the airport, we arrive late in the evening at theSisters of Divine Love, a hotel in COCIN (Church of Christin Nigeria) near Abuja. After a sound night’s sleep we leavethe next morning in a truck (borrowed from the leprosyfoundation) and a dilapidated bus belonging to the homefor disabled children, for a long drive to Mangu.The bus breaks down on the way because of a ‘belt’ thathas come loose in part of the engine. The men repair itwith a bit of wood from the bush and we proceed further.A little further on, the wedge has to be fixed again andafter another 6 hours we arrive safely at our guest house.Like the bus the guest house is in a desperate state ofdisrepair, there is no running water and electricity onlyoccasionally. Hotels are nowhere to be seen.’Despite these tough circumstances, both teams, who wereled by Cees Spronk and supported by the FaridpurFoundation and the Dutch Embassy, have brought aboutmany changes in Mangu. After the completion of the newnursing ward a lot of work is being done on building a newoperation theatre complex.

Nigeria23Civil unrest prevents patients from showing upAgain a lot of patients turned up on the screening day.The result after a day’s screening was a full operatingschedule. However, altogether 21 of the registeredpatients failed to turn up. No-shows in such numbershad never occurred before. The riots and unrest in thesurroundings areas were probably responsible. Peoplecould not travel safely or dared not take the risk. Evenso, almost 80 operations were performed covering thefamiliar spectrum of many post burn contractures, cleftlips and palates, occasional hypospadias and a fewkeloid reductions (removal of benign tumours).The medical director, Dr Kuden, and head of nursing andmanager, Mr Kefas Tuwan, went to the burns centre inUganda directly after the mission for a fi ve week trainingcourse. You can read Dr Kuden’s report on page 27 and 28.Operations Nigeria, October5 cleft lips and/or palates41 post burn contracture25 other12 certificates awarded•Before8 hypospadia or urethral fistulaNa de nieuwe verpleegafdelingen wordt er nuhard gewerkt aan de bouw van een nieuw OK-complex,en medisch directeur dr. Kuden en hoofd verpleging enmanager Kefas zijn direct na afl oop van de missie vooreen training van vijf weken naar het brandwondencentrumin Kampala, Oeganda gegaan. Deze training is verzorgddoor Interplast Holland en het Uganda Burns & PlasticSurgery Institute.Young child with post burn contractures; left hand and faceand after cleft lip surgeryAprès la construction du département de soins,la construction du complexe de salle d’opération est enroute. Le directeur médical Dr. Kuden et le Chef infi rmier etle manager Kefas sont allés directement après la missionen formation de 6 semaines au Centre pour grands Brulésde Kampala/Ouganda. Cette formation est offerte parInterplast Holland et le Uganda Burns & Plastic SurgeryInstitute.Mother with child, after cleft lip operation

24 Achieving lasting success in UgandaAchieving lasting success in UgandaInterplast Holland is involved in two long-term projects inUganda; the UBPSI (Uganda Burns and Plastic SurgeryInstitute) and theBurn Prevention Programme. ReinZeeman reports on the current situation.Work continues at the Burns CentreThe Burns Unit is still functioning well under themanagement of Dr Christine and Dr Morgan (supervised byDr Ssentongo). The new steriliser in the operating theatrefunctions well. A Canadian team has worked at the centre,mainly operating in the burns theatre. There didn’t appearto be that many patients.The big ward rounds still take place, and often the plasticsurgeons are present. Our Nigerian colleagues from Mangu(who are in Uganda to train) joined the team on a temporarybasis, working in the operating theatres and changingdressings. They received additional training from Marjoand myself. In any event they have gained enough practicalexperience. They weren’t very keen on Ugandan foodthough!Changes at the BoardDirk ten Brink is retiring as chairman and will besucceeded by the Hon. Tim Lwanga. Astrid de Rooijwill also be stepping down as treasurer because ofother pressing claims on her time.Top talksWe have been in touch with Health Minister Dr ChristineNdoa, whom we met in 2005 when we inspected the AruaHospital for a team mission. She is currently working withadvisor Ben Khingi, and we were able to consult with himon the Burns Unit which we did in depth. Besides talkingabout the contract, we also provided a résumé ofInterplast’s history in Uganda for the minister.Altogether we provided him with enough information tolobby for the cause of UBPSI with the minister. We’ll justhave to wait and see. In any invent it is clear to everyonethat there will no longer be any question of financialsupport from Interplast Holland. Plans for projects cannevertheless be submitted, and we will try to find donorsfor them.Ward round Burns UnitInterview in slum areaFinancial restraintsBandages and gauze are difficult to come by at the moment.In Holland Ward, parts of the ceiling are collapsing hereand there. Some renovation will be needed next year.During a talk with the new Mulago hospital director aboutUBPSI it emerged that he was not really aware of thefinancial difficulties surrounding the institute. These issueswill have to be resolved through the Mulago budget.He was, however, very interested in the results of the BurnPrevention Programme. Mulago will be embarking onrenovations next year, and these will include the BurnsUnit.Burn Prevention ProjectThe seven Burn Prevention Officers worked hard. In totalaround 1200 information sessions were carried out in theslums around Kampala and in major markets. An audienceof 65,000 was reached. Besides, 53 sessions were alsoorganised at 37 schools.Charles (Community Mobilizer) did a second series ofinter views, to follow up on the baseline interviews thatwere held a year ago. We checked the finances andalso the effects on the ground by interviewing a numberof community leaders (12), and by looking around forourselves in the various districts and asking about thesessions and the possibilities for change.

Achieving lasting success in Uganda25The Burn Prevention OfficersProtecting children fromSome sigiris (metal stoves) have now indeed been screenedoff with a piece of corrugated metal, while others have beenput in a safer place.Small children are no longer allowed access to a market inRubaga. The local chairman for Mulago 1 reported that therewere no children with burns in his community this year. Lastyear there had been 15. People watch out for each other andpass the message on if dangerous situations are found.Protected sigiri

26 Achieving lasting success in UgandaInformation session in slum areaWhat’s the next step?Unfortunately, we have had to cancel the burns symposiumplanned for this year because of the financial situation. UnicefUganda and the Uganda Red Cross Society were contactedwith a view to proceeding further with the Burn PreventionProject in Uganda. Both organisations were impressed bythe figures, particularly those for the burns victims agedunder five (60 to 70% of which are caused by hot water).They occur mostly close to cooking stoves, and can thusbe prevented successfully.Both organisations adopted our view that burn preventioncan easily be incorporated into their existing programmes.Marjo gave the Burn Prevention Officers a crash course onhow to train the trainers. They will go on to train Red Crossvolunteers in providing specific information about burnprevention. Burn prevention will also be included in Unicef’sChild Protection and Adult Education programme. Havingheld such positive progress talks, contact will be continuedby email from now on.Continuing the Burn Prevention ProgrammeWe must try and ensure that the projects in the slumareas and in the schools continue for another sixmonths or so for continuity’s sake. No more than 50to 60 sessions per month can take place within thisperiod. A budget for this will need to be found.Unfortunately, we can no longer count on the DutchBurns Foundation for this. We were told that WelslyBhoda had resigned as director in connection withdifferences of opinion with the Board regarding foreignpolicy.Community Based Rehabilitation AllianceWe met Barbara Batesaki, the Executive Directorof Community Based Rehabilitation Alliance, anindigenous NGO dedicated to the empowermentof people with disabilities which cooperates closelywith the Health ministry.She was also very interested in the Burn PreventionProgramme. It would be possible for our dischargedburns patients to be tracked and checked by herorganisation when they return to their villages.All we need to do is give the name of the villageand a short medical record. This would be awelcome solution to the difficult follow-up ofburns victims in Uganda.

Sponsors ‘in the picture’29Thank you!Big or small,your help can make a difference...Top left: KringloopwinkelsSteenwijk-VollenhoveTop right: Hans PleijCentre: Vlietland ZiekenhuisBottom: Distributing clothing(Burns Unit in Uganda) frombiennial second-hand clothingmarket Gouda Noord

30 Interplast Holland information leafletStichting Interplast Holland[ Foundation]A NONPROFIT ORGANISATIONPROVIDING FREE RECONSTRUCTIVESURGERY AROUND THE WORLDInformation leafletInterplast consists of volunteer medical personnel (plasticsurgeons, anaesthesiologists, theatre and anaestheticnurses and other specialists), who work free of chargeduring their holidays. Travel expenses, medical suppliesand instruments are funded by donations raised in Hollandfrom companies as well as the general public.Interplast teams provide reconstructive operations thattransform the lives of children and (young) adults withphysical disabilities and thereby improve the future of thewhole family of those children as well. Interplast has nofi nancial, political, racial or religious interest.The aim is to provide (and teach) reconstructive surgery toimprove function, not to perform cosmetic surgery.Cooperation with local medical staff and working at existinghospitals close to the patients’ home is effi cient and offerseducation in a specialist fi eld for all involved. Apart frommedical staff, local volunteers with social commitment areessential for the preparation and the smooth running ofa successful Interplast mission.If you, your town, your hospital, or a charitable organisationyou know think about hosting an Interplast team, here aresome important issues to consider:•Advance notice for the team should be given at least6 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 ofoperating tables, anaesthetic facilities and local staffavailable. On average, a team will consist of 6 people,2 surgeons, 1 anaesthesiologist, 2 theatre nurses and1 anaesthetic nurse, thus being able to run 2 operatingtables (smaller or larger teams possible on request).•Local staff, i.e. doctors, nurses, interested volunteersare essential for the smooth running of a mission.•Local doctors should perform the patient pre-selectionduring the months before the arrival of an Interplast team.If possible, they should inform the team about the type ofsurgery and special cases beforehand to allow appropriateplanning of instruments and supplies for the trip.•The fi rst day consists of screening and selecting thepatients for the operating lists, unpacking equipment andsetting up the operating room(s).•Types of operation: burns contractures, congenitaldeformities like cleft lip and palate, functional defi cits ordisfi guration from injury, infection (polio, leprosy, Nomaetc.) tumours – in children and (young) adults.•Long working hours have to be anticipated by allinvolved to make an Interplast mission effective.•Apart from operating, ward rounds and change ofdressing 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, sheetsand gowns, if possible oxygen, nitrous oxide, halothane,some dressing material and plaster of Paris.The Interplast team will provide: special instruments andmedical equipment, suture material and special drugsand dressings.•You are requested to provide: (if possible, but if youdon’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 of experience and thousands ofgrateful patients are proof of the successof Interplast activities. YOU can be part of it.

Contact Interplast Holland31Stichting Interplast HollandBoardDrs. Rein J. Zeeman, chairmanDrs. Rutger L. van Leersum, secretaryHenk J.A. Koster, treasurerCorrespondenceStichting Interplast HollandPO Box 21892301 CD LeidenHonorary MemberFrank E.I. SchaafProf. dr. Bert D. de JongEls L. GerritsenNursing CommitteeElles LoenenPaula EllenMarie-Thérèse de By-BakkerMarjo Aerts MPHJan H. van SteenVisitors’ addressStichting Interplast HollandPoortgebouw Zuid, room 468Rijnsburgerweg 102333 AA LeidenThe NetherlandsT +31-(0)71-52 10 165F +31-(0)71-52 14 458E info@interplastholland.nlI http://www.interplastholland.nlPolicy maker (staff)Marjo Aerts MPHOfficeAnnemarie MaasCommittee of RecommendationDrs. Erica TerpstraHerman van VeenINGIBAN NL19 INGB 000 152 07 38BIC INGB NL 2AABN AMROIBAN NL76 ABNA 044 880 09 26BIC ABNA NL 2AThis annual review has largely been sponsoredand created thanks to the cooperation ofediting Annemarie Maasfi nal editing Astrid Nagelhout, Leidendesign Ineke de Graaff, Amsterdamprinting Drukkerij Protocol, Zoetermeer

32 With special thanks to...With special thanks to...All Interplast volunteersNederlandse Brandwonden StichtingStichting LibertyDhr. en mevr. van Velthoven-Leeuwenberg, HeilooDiaconie Gereformeerde Kerk, Nieuw VennepDhr. J.M.G. Huininga, NorgEuro Tissue Bank, BeverwijkKiwanis NederlandEmbassy of the Republic of Uganda, BrusselsStichting Edith Jacoba, RoelofarendsveenJan (Honorary Consul) en Will van Maanen, Bissau, Guinea-BissauJohannes Mooij, Bissau, Guinea-BissauJohan Krijt / One Creation, Den HaagStichting True BlueNetherlands Embassy, Abuja, NigeriaEmdaplast BV, ZoetermeerStichting Bron van Leven, WassenaarLeids Universitair Medisch CentrumStichting Eekhoorn, LeidenDiaconie Protestantse Gemeente, StiensVlietland Ziekenhuis, SchiedamDr. E.J.F. Timmenga, RotterdamJohannes StichtingNetherlands Embassy offi ce, BujumburaDiaconessenhuis LeidenStichting ElsgoedAndrew PosmaIzere, André NkeshimanaStichting PelgrimshoeveDrukkerij Protocol, ZoetermeerBrarudi (Heineken Burundi)Hans Pleij, KatwijkMevr. L.S. Wijnbergen, RotterdamRosalie van Rijn, BeverwijkCliniplast BV, Schilde BE... and many othersBook on cleft lipand palate surgeryin developing countries.Available on requestinfo@interplastholland.nlfor € 25,–

Postbus 21892301 CD LeidenT +31-(0)71-52 10 165F +31-(0)71-52 14 458E info@interplastholland.nlI www.interplastholland.nlINGIBAN NL19 INGB 000 152 07 38BIC INGB NL 2AABN AMROIBAN NL76 ABNA 044 880 09 26BIC ABNA NL 2A