Surgery in Turkana

TEXT: RAMÓN OLIVER IMAGES: ALBERTO CARRASCO

Carmen Hernández is the director of this wonderful project set up in 2004 (she joined in 2007) by four surgeons at the Ramón y Cajal Hospital (Madrid) after a group of ophthalmologists from the same hospital convinced them to visit this remote northern Kenyan county called Turkana. Since then, the numbers involved have steadily increased in an astonishing manner. So much so that, on their latest trip just a few months ago, a total of 21 volunteers embarked on the venture. Carmen, of course, was one of them: “We are the health system for these people, as there is no other way to access medical services in Turkana.”

She is a general surgeon at the San Carlos Clinical Hospital and the Ruber International Hospital. Her specialty, obesity. “My life switches between fat and thin people. Here, I deal with patients who die from an excess of food. There, I treat patients who die from a lack of food.” In both places, she is driven by the enthusiasm for that place which changed her life. An enthusiasm she transmits to others, passing on her emotion to whoever she is with.

Tell us about the whole process of the trips to Turkana. I believe you go there once a year to operate, don’t you?
Indeed so. A large team of us goes there for two or three weeks, between the months of January and February. But, in Africa, you have to work in a different way to how you would here. Our patients have no access to a hospital, not just because they can’t afford it, but because it’s several kilometers away. Months before we arrive, our local team (nurses and clinical officers) travels around the area seeking out surgical cases. Shortly before we arrive, they use trucks to bring up to 700 people to the hospital. We then see the patients to decide which need an operation, after which they are taken back home. It’s pretty expensive, but really effective.

A tremendous workload!
Yes, indeed. We sometimes get through 25 operations a day, 12 hours’ work. In addition, we do live telemedicine sessions with Madrid. We have incorporated the benefits IT has to offer and can do high quality diagnostics thanks to the help of the radiologist we have in Madrid, a real expert. We have greatly improved the quality of both our treatment and our diagnoses.

How are the cases selected?
The team over there handles that. But it’s easy. They know the profile of patients we treat. Falling sick also depends on where you live. The pathologies there are quite simple: people don’t die of cancer, as they don’t live long enough for that. Cancer is an advanced society’s disease. There, they die of diarrhea, malaria, nodules, traumatisms, burns or childbirth complications. The only problem is that the patients there are very fragile individuals. Surgery must be performed delicately, as any forceful action or bleeding can lead to a patient’s death. That is what sets us apart – we do straightforward surgery on very complicated patients.

On a personal level, what made you get so involved in this project?
I believe everyone strives to be happy in life and each of us does so in their own way. I like exploring the world of others and finding out what lies beneath that first layer… always a surprise. The truth is that I’m not easily surprised, but the reactions of the patients there, with the stories they tell, manage to amaze me. But, in reality, I’m so deeply involved because it makes me tremendously happy.

How do you finance your work?
The vast majority of our funding is private. Donor events, concerts, exhibitions… We get our message across via social media and the campaigns we run. If you are not known, you don’t exist and, if you don’t exist, nobody finances you.

You have grown a lot since you began…
Yes, a lot, but very slowly, which is how it should be done. And we’ve been learning at the same time. That’s why I believe we’ve corrected mistakes and boosted wise moves. We’ve also managed to get more doctors involved. That was essential; with so many patients and such a diverse range of pathologies, we needed more than general surgeons. So we added orthopedic surgeons, maxillofacial surgeons – who deal with children’s mouths, cleft lips, etc. – and gynecologists.

What are the main difficulties you encounter there?
Firstly, the ones determined by nature in Turkana: isolation, drought, climate change, extreme temperatures, lack of roads… Secondly, the characteristics of the area: poverty, endemic diseases, the status of women, lack of education, lack of future and, above all else, shorttermism. Poverty stems from a short-term attitude. Those who have nothing to eat today don’t think about anything else. Tomorrow’s another day. That’s why they’re not afraid, that’s why they smile, that’s why they’re so happy.

How do you see the future for Surgery in Turkana?
We want to keep moving very slowly. Encouraging research; seeing how we can work on diseases really prevalent there, striving to mitigate them and seek solutions. Not just going there to treat patients, but also for prevention. And we’d also like to create schools, a stable core of students and young people who believe in this. Become more aware of the similarities, rather than the differences. That’s the philosophy. And that goes far beyond medicine. Each one of us must seek and discover our own Turkana. Turkana is an excuse to think of others; it’s not just a place, it’s more than that