Hélène Le Hors is a pediatric surgeon at Marseille’s Saint Joseph Hospital and president of HumaniTerra, a humanitarian NGO created 20 years ago to remedy the lack of surgical services in the world’s poorest regions. One of her missions is to operate on children aboard a hospital ship in Bangladesh.
MedicalExpo e-magazine: Does your organization offer surgical care around the world?
Hélène Le Hors: Yes. Over the past two decades, world health efforts have focused on diseases like AIDS, tuberculosis, and malaria. Surgery in the poorest areas had very low priority. Simple things like Cesarean deliveries, appendicitis, and compound fractures can turn into life-threatening problems. According to The Lancet, there’s a need for 143 million additional surgical procedures per year in the poorest countries. It’s absolutely necessary to offer this kind of care. It’s vital but completely ignored.
There’s a need for 143 million additional surgical procedures per year in the poorest countries.
HumaniTerra’s first activity was to perform surgery in Cambodia. Nearly all the doctors had been killed during the Khmer Rouge period. We next went to Afghanistan, setting up a burn center in Herat. Then we started going to Bangladesh to work on a hospital ship. We’ve been working for 11 years now with Friendship, a local NGO started by a Frenchman and his Bangladeshi wife. He sailed from France to Bangladesh in a canal boat. They converted the boat to a hospital ship.
ME e-mag: How many vessels do you have now, and how do they function?
Hélène Le Hors: Two other boats have been built since. The Emirates Friendship Hospital is much more modern than the canal boat, with six beds and two operating rooms. The former Greenpeace ship Rainbow Warrior also has been converted and is now known as the Rongdhonu, rainbow in Bangladeshi.
The idea behind these boats is to offer services to isolated populations that have no access to care. Bangladesh is dominated by water. The vessels we work on are in an area honeycombed by islands that appear and disappear with changes in water level. People move in, build a house, plant crops and then move elsewhere when the island disappears.
Our idea is to train a nurse to perform three or four operations. That would save a bundle of lives.
The boats spend four months in one place, then move to another area. Each is set up as a dispensary open to patients every day. There’s a dentist, an ophthalmologist, a general practitioner and lots of paramedics. They’re all locals. Each vessel sends small outboards to the neighboring islands. In each location, a village woman in charge of watching over pregnant women, children, etc., reports on the situation. Once a month, these small boats take medicine to the islands. They also note any surgical problems. That way, when our NGO announces the dates our surgical teams will be there, appointments are made. When I arrive, I already have 70 appointments scheduled. In general, I operate on 60 people a week.
ME e-mag: What kind of surgery do you perform on the ship?
Hélène Le Hors: We have many specialties: gynecology, orthopedics, ophthalmology, pediatric surgery, plastic surgery. I mostly do inguinal hernias. There’s an enormous number of them. Since these children didn’t receive early care, the size of the hernias is significant. For the same reasons, the gynecologists see a lot of uterine prolapses at a very advanced stage. The women marry and give birth very young. They have numerous pregnancies and spend their lives in a squatting position. We also see problems linked to delivery complications.
The ophthalmologists see very advanced-stage cataracts. It’s astonishing. There are bunches of mostly older people squatting along the corridors, waiting with a piece of tape over the eye requiring surgery. In orthopedics, we can’t do very complicated procedures because we lack sophisticated sterilization equipment. For example, we can’t insert pins, but we can treat clubfoot.
ME e-mag: What kind of material do you have and how do you sterilize it?
Hélène Le Hors: There’s a real operating room aboard. As for the material, I go with my own instruments—scalpels, needles, sutures, compresses, scissors, etc.—to be autonomous. When you buy products there, it’s expensive and of poor quality. There’s no magic formula for sterilization. We use the old Poupinel system, a sort of big pressure cooker for the instruments. But we don’t do major surgery. For instance, we don’t open the stomach area because of inadequate antisepsis. We often have flies in the operating room…
ME e-mag: Have you encountered problems because of that?
Hélène Le Hors: Surprisingly, no. If we operated in the same conditions in France, we’d probably have an abscess in half the cases. People over there have a much stronger immune system than ours. They heal extremely fast. It’s impressive. That made me worry much less about scar healing, even here. The children are in terrific shape because they’re always running around and are constantly outdoors. They’re thin because there’s no overeating. Despite their poverty, they’re mostly in good health.
ME e-mag: What are your projects for the future?
Hélène Le Hors: Given that there are very few local surgeons, our idea is to encourage task assignment projects. For example, this could mean training a nurse to perform three or four operations—appendectomy, strangulated hernia, Cesarean section. That would save a bundle of lives. There are African countries where this works very well.