Since 2015, 5 Interplast teams have operated on more than 600 patients in a blood bank in Goma, Congo with the local surgeons and experienced the absolute necessity for the construction of a small hospital for the local Church of the Nazarene.
After 24 years of experience with our Nepal hospital www.nepalhospital.de, the most important prerequisite is the reliability and commitment of the local doctors in a country shaken by corruption. The 4 doctors there have been treating poor patients for 6 years for God's wages.
Goma, a city of 2 million people on the eastern border between the Democratic Republic of Congo and Rwanda, is the headquarters of the UN Refugee Agency and its blue helmets. Under Belgian rule, Goma was the Las Vegas of Africa and is now the safest place in Congo thanks to the UN military stationed there.

The Congo has been embroiled in civil wars for 60 years and large parts are still ruled by rebels. In 2003, 2/3 of the city was flooded by a red-hot lava flow during the eruption of the nearby Volcano. There are practically only 4 functioning hospitals in Goma, all of which only treat emergencies, but only provide treatment or operations for the poor population against payment.
The 4 dedicated doctors at the Nazarene outpatient clinic provide minimal medical care to around 100,000 residents; three of them would like to train as internists, pediatricians or laboratory doctors in crash courses in Uganda; the experienced surgeon Dr. Christophe Kimona, 60, has already operated on the 5 Interplast missions.
On the site of the old Nazarene church there is still a wooden barrack with 5 small outpatient rooms with no light and little medication. My architect son Andreas and I, together with an architect and the doctors, have designed a single-storey surgical outpatient clinic, which can later be extended with 2 more floors if funding is available.

The planned REHEMA-Cntre Medical (the Swahili word REHEMA means mercy) received planning permission from the building authority and the Ministry of Health in July 2020. My other son Martin is financing the exterior construction with 50,000 euros; I will use our mother's inheritance of 120,000 euros for the interior work, beds, surgery and necessary diagnostic equipment.
Two years ago, my former employer in Frankfurt, the multi-billion-euro evangelical Agaplesion gAG, which owns more than 100 hospitals and hospices, offered to pay me 2,000 to 5,000 euros a month for the first five years, but has now withdrawn its support for a hospital near Kumasi in Ghana.
In February 2021, Interplast will submit a 3rd application for $150,000 for the interior design and solar panels to the Ministry of Development in Bonn (BMZ) and insist on sustainability through the visit of future Interplast and other specialist teams for the further training of doctors. A second application for 150,000 euros for equipment is currently being submitted to the Else-Kröner-Fesenius Foundation.

The two German partners “Interplast-Germany” and the “Church-in-Action” in Frankfurt have also pledged financial support. A member of “KiA” and I are monitoring our partner NGO in Goma, “People-in-Action International” (PAI), and the financial and construction management.
The financial support in terms of sustainability of a functioning outpatient clinic with medicines and surgical supplies for the poor, and some salaries, needs to be found urgently. The Church-in-Action in Frankfurt will also participate in the search for a monthly support of $2,000 to $5,000 from its worldwide Nazarene partner congregations. It will be a very important hospital for a population totally neglected by the state.
We therefore invite all Interplast teams to include a visit to the future REHEMA Medical Center in their plans - and to climb the Nyiragongo volcano or visit the mountain gorillas at the weekend.

Thanks to funding from pro Interplast, the second mission to the REHEMA Hospital in Goma, DRC, took place in November '23. Exactly one year earlier, the hospital, which had been planned and built over the last three years thanks to the tireless work and commitment of Gottfried Lemperle, was opened by an INTERPLAST team from Germany.
In November 2022, a single-storey hospital with a reception area, several outpatient clinics and examination rooms, hospital rooms with a total of over 30 beds and a spacious operating wing with two operating tables, corresponding locks, sterile rooms, X-ray and a laundry was already standing on the site of a former infirmary run by the church.
When we arrived in November 2023, we were able to walk through the second floor, which is still under construction, but the roof is already on and the pipes have been laid.

As in previous years, well over 100 patients were already waiting when we arrived, some of whom came from very rural, remote villages. Given the extremely poor and risky infrastructure in the region, this is an immense challenge for those affected. The local church organized the transports with financial support from pro Interplast. And every day, many more patients arrived, hoping for our help. A particularly positive aspect is that surgical colleagues from regions that are sometimes far away have repeatedly come to take part in the mission and learn about plastic surgery.

The team on site consisted mainly of the same team, which made for a nice reunion.
It was the 6th Interplast mission in Goma, the second at REHEMA Hospital. In just under two weeks, the five-strong team of Norbert Grieb, Thiha Aung, Christoph Sachs (all three plastic surgeons) and the two PJ students Anna Friedrich and Nadine Reitberger carried out over 120 surgical procedures.
There were no relevant complications.

The most common procedures included burn contractures, tumor removal, keloid excisions and the correction of congenital malformations.
In summary, the mission was once again a great success for the local people and also for us.
The need is almost limitless. Even if organizing a mission in the Democratic Republic of the Congo is certainly a major hurdle and requires patience and commitment, this should not mean that we do not support this country.

Christoph Sachs, Berlin

Summary

Text Pub_16: As the specialty of plastic surgery does not require complex diagnostics, operations in developing countries are particularly effective. Marking, excision, defect coverage with flaps or free grafts: Aftercare is provided by the local doctors. This means that 100 to 200 patients^* can be operated on in two weeks who would otherwise have no chance. Some external but typical cases of skin tumors are demonstrated below. Keywords: skin tumors, burn contractures, Democratic Republic of Congo, Interplast-Germany

Text Pub_17: Interplast-Germany e.V. is an association of plastic surgeons who spend their free time performing operations in developing countries where people have no access to surgical care in this special field instead of going on vacation. Interplast-Germany was founded 40 years ago in Frankfurt. Today, around 70 teams come together every year to provide surgical care to more than 4,000 patients worldwide.

Lack of medical care and education in Congo

Text Pub_18: The Congo is a neglected country from a medical point of view: six times larger than Germany, but with a similar population of 90 million^*, it is still on a par with Europe 150 years ago. Corruption by those in power and 60 years of civil war have prevented any development or investment from outside. There are only a few doctors (1:10,000 one per 10,000 inhabitants?) and above all hardly any surgeons. Postgraduate assistants have to pay high fees at most African universities in order to be allowed to assist. As a result, it is often the case that benign and malignant tumors in patients in sub-Saharan Africa grow out of control and kill their carriers.

Interplast operations in Goma

Text Pub_19: An Interplast team visited Goma, a city of two million people on the border with Rwanda, six times between 2015 and 2018. As we were not allowed to operate in any of the three large local hospitals, we found a blood bank with a poorly equipped operating room with no running water and frequent power cuts.
Every morning, up to 200 patients and their relatives stood in front of the entrance, of which we were able to relieve 120 to 200 patients of external suffering during the 10 days of our stay, depending on the severity of their condition. Dedicated medical colleagues assisted us in Goma.

Tumors, burn contractures and tropical infections

Text Pub_20: The majority of African patients from Goma have large tumors (bony facial tumors, neck lymphomas, strums, large keloids), burn contractures and terminal conditions of tropical infections. Babies with congenital malformations usually do not make it into life. Our priority tasks include the removal of monstrous tumors with subsequent reconstruction and the resolution of extreme burn contractures.
These contractures occur after third-degree Celsius burns when small children fall into a wood fire or are pushed into it by animals. More commonly, however, second-degree scalds become infected when young children pull themselves up by a kettle of boiling water. Unfortunately, instant cold water therapy is largely unknown worldwide, as any water below 37 degrees will take the heat of a burn above 70 degrees Celsius out of the skin just as quickly. Where children play, there should be a bucket of water next to every fireplace!
Despite the very good aftercare provided by local colleagues, we often lack late surgical results, as many patients return to the bush immediately after surgery. Education and prevention could sometimes prevent burn scars that disfigure for life. Some glaring cases from the Congo are presented below. These require a great deal of intuition, flexibility and improvisation under the inadequate diagnostic and surgical conditions there. However, this is also what makes these interplast operations so interesting and instructive.

Case studies

Patient with typical neurofibroma on the face (Abb. 1 a, b)
Text Pub_21: These tumors are among the most difficult to operate on plastically, as they are permeated by a network of heavily bleeding arteries and must therefore be operated on aggressively and quickly. Unfortunately, the remaining surrounding skin is also inelastically altered, so that the initially satisfactory result requires surgery again after a few years.

Patient with unilateral keloid (Abb. 2a)
Text Pub_22: This patient has a unilateral keloid that has been growing for seven years but has stopped growing two years ago. Clinically, it is “ripe”, i.e. no longer bulging but compressible, and can therefore be surgically removed - with triamcinolone in the backhand. The result after one year without recurrence (Fig. 2b) was predictable, as unilateral keloids on the ear are not caused by a “predisposition”, but by infections - like all keloids! - and can be removed without hesitation in a “mature” or even “burnt out” state.

Patient mutilated lips (Abb. 3a-c)
Text Pub_23: Two private gold miners who were captured by rebels and denied owning gold. The rebels then cut off all eight of their long fingers and both ears. When some gold nuggets were found, the rebels also cut off their lips - so that they could never lie again. We undermined both cheeks and pulled them together towards the middle. The lower lip was created by an inverted visor flap from the neck.

Contract hands with children (Abb. 4a, b)
Text Pub_24: The body responds to third-degree burns or scalds without skin grafting by shrinking the surrounding healthy skin more and more, thereby reducing the burnt area. In children, such contracted hands can be stretched without any problems, as there is no bony stiffening and the extensor tendons are usually not burned. In developing countries, these are usually primarily second-degree scalds, which become infected in the following weeks and convert to third-degree defects.

Patient with unilateral elephantiasis (Abb. 5a-c)
Text Pub_25: Young women with unilateral elephatiasis, probably due to invading filariae that had migrated up the lymph vessels and multiplied. After excision of the entire affected skin, the large defect could be covered with “meshed” split skin, largely from the same lower leg, using the dermatome and a “mesher”.

Conclusion

Text Pub_26: In developing countries, where there are often no experienced surgeons, skin and bone tumors often grow out of control. Interplast teams operating locally can therefore gain a great deal of experience in a short time, including with simple reconstruction after the removal of such tumors.
As further training in plastic surgery is lagging behind there, Africa will continue to be dependent on support in the coming decades.