The 5th mission in Goma, June 2018

Participants were, as in the 2016 and 2017 missions, Gottfried Lemperle, Katja Kassem, Carsten Schröder and Christoph Sachs. We operated again in the operating room of the private blood bank CEDIGO of Dr. Jean Maganga, as we did not find entrance in any of the 5 larger hospitals of the city of millions.
The security situation still seems good, as a lot of local and international military is stationed in Goma. The political situation in Congo is unchanged, with new elections scheduled for December: Joseph Kabila, who is not eligible to run again, is likely to be elected a 4th time because he has made opposition politicians disappear or keep them in prison. Allegedly he has moved $50 billion to Switzerland. All African dictators bleed their people dry and only manage to get re-elected again and again with their military.
The infrastructural situation in Goma continues to improve, albeit slowly. The increase in street lighting and paved roads is striking. Our outreach was again announced by Dr. Maganga and the local Church of the Nazarene via radio and the local media, so that about 400 patients found their way to Goma even from the remote villages in the rebel areas, some more than 100 kilometers away.
In this year's mission, too, considerable attention was paid to the involvement and training of the two former colleagues Harmonie Mitila from Kinshasa and Emilie Amisi from Bukavu, as well as the four local assistants. The latter were engaged operating on about 120 patients with keloids, lipomas, atheromas and ganglia on a shared bed at the window. Harmonie and Emilie also operated largely independently on about 50 major skin tumors and contracted scars, leaving our team with about 80 major facial tumors and extensive burn contractures under anesthesia, plexus, or spinal anesthesia. A total of 303 were largely relieved of their suffering in 10 days of surgery at the 4 surgical sites. As reported by our follow-up physician, Dr. Eric Kitoga, there were only two secondary recoveries: after excision of a large keloid and on Z-plasty on a burned arm.
Again, on Sunday 1, all 400 patients stood in the hospital's front yard, this time with a strikingly large proportion of grotesque head and neck tumors. Since there is no surgical care in Kivu North Province, benign and malignant tumors grow to infinity. In Goma itself, there are no X-rays or CT scans for the poor, nor any functioning pathology or chemotherapy, so that we could only assume the tumor diagnosis on the basis of the medical history and the clinical and intra-operative findings - and had to operate radically accordingly. However, Katja Kassem took 30 tumor samples in formalin to Germany for her pathologist. After our return flight, Dr. Kimona operated on 30 more patients with huge strumen; he hospitated at the invitation of Prof. Horch and his Rotary Club Erlangen for 6 weeks in March in the plastic surgery department of the University of Erlangen.
It is striking that due to the constancy of the annual missions with the same medical staff, the cooperation with the colleagues on site is getting better and better. One has come to look forward to each other, understands each other partly blindly, knows the circumstances and possibilities, and communicates largely non-verbally. The structure in the clinic also increases from deployment to deployment, in that our medical equipment and instruments remain on site every year, which noticeably improves the organization and patient care, but especially the aftercare. Thus, this year a defibrillator with the possibility of monitoring, several oxygen saturation clips, and an electric dermatome were brought and left there.
The need for plastic surgical care in the Eastern Congo is still immense, so that also this year numerous patients had to be postponed until next year. In cooperation with the University of Goma, local colleagues founded "Interplast-Goma" during our stay to continue the Interplast idea (www.interplast-germany.de). With the status of a Non-Governmental Organization (NGO), they hope to acquire public funds and donations locally.
Since capacity limits are inevitable due to the increase in local colleagues accompanying our missions and the private sector use of the CEDIGO Hospital, the existing outpatient clinic of the Church of the Nazarene is to be expanded with an operating room and beds in order to establish a dedicated surgery center in Goma. An application to this effect has been submitted to the BMZ in Bonn - which in spring 2018 had rejected our application for a 2-story hospital in Goma on the grounds of a lack of sustainability.
During the next mission in April 2019, a new treatment facility in Bukavu, at the southern end of Lake Kivu, is also to be explored. In a university hospital there, preoperative diagnostics and postoperative care for patients could be significantly improved. Gottfried Lemperle will fly to the capital Kinshasa in October at the invitation of the Congolese Minister of Health, where Harmonie will organize a first Interplast camp in their university hospital.
We would like to thank again Pro-Interplast Seligenstadt e.V. for the financial support of our efforts, and the companies Catgut GmbH, Combustin GmbH, Paul Hartmann AG, MIP-Pharma, Novidion GmbH, and Serag-Wiesner AG for unbelievable amounts of surgical materials for the far more than 300 operations in Goma.

Christoph Sachs, Berlin