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Con­ge­ni­tal mal­for­ma­ti­ons of the uri­na­ry and geni­tal tract, kid­ney stone dise­a­se, blad­der dis­or­ders, unde­s­cen­ded tes­tes or mal­for­ma­ti­ons of the penis are the main tasks of the paed­ia­tric uro­lo­gy team. Twice a year, the ARCHEMED team tra­vels to Asma­ra; on avera­ge, almost 200 child­ren are exami­ned per mis­si­on and more than 40 under­go sur­gery.

At the start of their mis­si­ons, the paed­ia­tric uro­lo­gists deter­mi­ne whe­ther a child should be trea­ted con­ser­va­tively or sur­gi­cal­ly. Abo­ve all, they car­ry out pro­ce­du­res that, until now, were not pos­si­ble due to the lack of spe­cia­li­sed spe­cia­lists. Many child­ren have, for exam­p­le, pro­blems with uri­na­ry con­ti­nence, ran­ging all the way to uncon­trol­led uri­ne loss due to an expo­sed blad­der in child­ren. The­se wet and extre­me­ly unp­lea­sant-smel­ling child­ren have no future in Eritrea, becau­se anyo­ne who “stinks” is excluded from atten­ding school. This means, in turn, no chan­ce of fur­ther edu­ca­ti­on, no pos­si­bi­li­ty of lea­ding a nor­mal social and rela­ti­onship life – a life of mere exis­tence on the mar­gins of socie­ty is pre-pro­grammed.   

Archemed paediatric urology patient
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The aim is to distin­gu­ish bet­ween imme­dia­te fea­si­bi­li­ty and long-term pro­ject plan­ning. Essen­ti­al on site is the trai­ning of local sur­ge­ons, ope­ra­ting theat­re nur­sing staff (anaes­the­sia tech­ni­ques, sur­gi­cal assis­tance) and the trai­ning of staff and par­ents on the children’s ward to impro­ve post­ope­ra­ti­ve care (hygie­ne, wound care, dres­sings). Pre­cise IT docu­men­ta­ti­on (a dedi­ca­ted pro­gram­me was deve­lo­ped for ope­ra­ti­ons, pro­gress, fol­low-up care and logi­stics) pro­vi­des the data for mis­si­on plan­ning and out­co­me moni­to­ring. At the end of 2015, ARCHEMED brought a dona­ted litho­tripter (“stone machi­ne”) to Asma­ra. Using shock waves, it can break up and remo­ve all stones in the uro­ge­ni­tal tract – which occur rela­tively fre­quent­ly in Eritrea. So far, around 230 child­ren have been suc­cessful­ly trea­ted with it and freed from their uri­na­ry, kid­ney and blad­der stones. The litho­tripter is inten­ded to be used later by local spe­cia­lists as well.

Pro­ject Manage­ment

Dr Regi­na Str­e­de­le, paed­ia­tric uro­lo­gist, Munich