The 4th mission in Goma, July 2017

Our team from 2016 urged me to accompany them again to Goma in July 2017. The city of millions on Lake Kivu in the east of the Democratic Republic of Congo (DRC) has made a huge leap to an economic center in the last year thanks to extensive road construction by the Chinese and solar lighting of the streets by Germany. Whoever thinks that cities with millions of inhabitants in China are overcrowded should drive through Goma once!
On July 2, 2017, again about 400 patients from all parts of North Kivu stood in front of the small CEDIGO hospital in Goma, among them conspicuously many large face and neck tumors, mostly Burkitt'lymphomas, ameloblastomas and sarcomas, goiters, few burn contractures, and this time no clefts. Unfortunately, we had little influence on the selection of each of the 20 patients, who always sat HIV-tested and changed in front of the operating room during the following 8 days of surgery.
Since I had invited the two young surgeons of the last year Dr. Harmonie Mitila from Kinshasa and Dr. Emilie Amisi from Bukavo again, our team around Christoph Sachs from Berlin, Katja Kassem from Donaueschingen and the anesthesiologist Carsten Schröder could work on 2 operating tables and the two locals could operate on one bed with two patients each on tumors and keloids in local.
In addition, my grandson Johannes Schierle, a medical student in Groningen, was also part of the team. He helped out in the operating room and was supposed to find out for his bachelor thesis which keloids in Africa can be surgically removed without subsequent TRIAM injections. We had brought an inoculation gun with 200 ampoules of TRIAM to the doctor of the Church of the Nazarene in Goma, Dr. Eric Kitoga, and instructed him to photograph all keloids and their postoperative scars and to treat them with TRIAM if necessary.
On Saturday, we operated again at the Red Cross Hospital in Goma, where we covered three boys' decubiti with local flaps, and reconstructed two young men's shot-off anterior mandibles with iliac crests and osteosynthesis plates. Amazingly, I saw six young men in Goma already, all of whom had their mandibles shot through from below-with no other injuries to the face or thorax. None told the truth about this shooting: punishment or extortion? This reminded me of Tanzania, where I once reconstructed a banker's right ear, supposedly severed in an accident, from rib cartilage fairly and poorly (according to Pitanguy) - and three days later five other young men showed up at the hospital with their right ear missing. I learned from a surgical nurse that in some parts of Tanzania this is still the punishment for grand larceny.
In total, five of us freed 207 patients from their more or less burdensome tumors or contractures over eight days of surgery, probably saving the lives of six patients with large sarcomas. Our anesthesiologist, under the most difficult monitoring conditions, tried to teach the local nurse anesthetist the basic concepts of modern anesthesia. Also the two OR nurses Synthia and Colette deserve enormous praise for sterilizing and preparing 20 instrument tables daily, and serving four surgeons at the same time! - as well as the 2 ward nurses and 4 laundresses who cleaned everything overnight. After our departure, Dr. Kimona operated on 20 more patients with huge strumen endemic there, which we could not send back to the rebel areas unoperated. This brings the total number of patients operated on during this mission to 227.
We especially thank the head of the hospital Dr. Jean Maganga for letting us use his rooms and staff for two weeks, Dr. Christophe Kimona, whom Prof. Raimund Horch had invited to Erlangen for six weeks, for operating on the remaining 20 large strumens from North Kivu, where no doctor dares to go at present. And of course Katja, Christoph and Carsten, who did not lose their nerves and the necessary humor during some bloody operations and bad lighting. Many thanks also to Pro-Interplast for financing our flights and hotel costs. And again to the companies Catgut GmbH, Serag-Wiessner GmbH, Paul-Hartmann AG, Combustin GmbH, MIP Pharma GmbH, Novidion GmbH, pfm Medical AG, and the pharmacist Sylvia Pöhlmann in Margetshöchheim and PD.Dr.Dr. Würzler for valuable surgical material.

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Rapidly growing Burkitt's lymphoma recurrence from 2016 - and after resection of orbital floor, maxilla, nasal wall and half palate. The left skull base is infiltrated; there is no radiation or chemotherapy in Goma. We hope for chemo across the border in Rwanda. A year later, the tumor had infiltrated the entire orbit, so we had to remove all the walls down to the exposed brain. The brain was suspended watertight from a wide strip of temporal fascia.

Gottfried Lemperle