Surgeon César Ramírez with some of the people of Bopolu. / SUR

From Malaga to Liberia: 152 humanitarian operations

Dr César Ramírez has just led an eight-day mission to Bopolu in Liberia, where his team operated on patients who would have gone untreated


The somewhat idyllic image of Africa which is so often portrayed by films and literature is far from reality, especially when it comes to health care. The vast majority of inhabitants of African countries have no access to medical treatment, and this is something which means they are condemned to death or permanent disability from illnesses which are cured easily in Europe.

One person who knows more about the lack of medical resources than most is César Ramírez Plaza, a surgeon from Malaga who is the founder and president of the Bisturí Solidario Foundation; he is the head of general and digestive surgery at the Quirónsalud Málaga hospital.

That knowledge is the reason he often leaves behind the facilities that we have here and travels to Africa, to operate on patients there who cannot afford to pay for surgery.

“What seems very little to us is a great deal to them, and at the same time the professionals who go there receive so much from these people,” Dr Ramírez says.

The most recent humanitarian mission coordinated from Malaga was to the town of Bopolu, the capital of Gbarpolu county, which is about 100 kilometres north of the Liberian capital, Monrovia. The population suffers from severe poverty, and this was the first time César Ramírez and his team had been there.

They left Spain on 20 January and returned on 1 February. Working long, hard days, they saved lives and opened a door to hope for patients who would not otherwise have been treated.

The team consisted of three general and digestive surgeons, two anaesthetists and three nurses. Five of them are from Malaga: César Ramírez, surgeon Saray Ayllón and nurses Paco Gómez, Rebeca Sanabria and Julia Cánceres. They were going to be accompanied by surgeon Marta Roldón, but she had to remain at home because she tested positive for Covid the day before they set off for Liberia. The other members of the team were anaesthetists Beatriz Fort and Sandra Casares and surgeon Pablo Muriel.

This act of solidarity was the first for Cirujanos en Acción, a group which collaborates with the Bisturí Solidario Foundation, since they went to Uganda in December 2019. The coronavirus pandemic meant that they had to suspend the missions they had planned in 2020 and 2021.

“After two years and three months we have been the first to be able to take up humanitarian surgery again,” says Dr Ramírez. It takes a great deal of planning for these trips to take place. The Bisturí Solidario Foundation has funded the campaign and paid for the material they took to Liberia, and also handled the logistics and the infrastructure.

Before they were able to do the trip, they had to postpone it twice due to Covid, in February and September last year.

“In these African countries, which have very little access to the vaccine, they are very protectionist about allowing people in if they are from countries where there is a high incidence of coronavirus,” says Dr Ramírez, who has carried out operations in Liberia twice before, in 2018 and 2019.

12 to 14 hours a day

During the eight days the Spanish medical team was in Bopolu, they operated on 152 patients, working marathon days of 12 to 14 hours to treat as many patients as they could. Most of the operations were for inguinal and umbilical hernias (120 people in total, including children over the age of six).

They also operated on 11 patients with gigantic goitres and three who needed to have their spleens removed. They carried out emergency surgery to remove a kidney from a young woman and they saved her life, because she was seriously ill with an infection. Another patient was a woman with an ovarian tumour and the team also operated on young boys for hydrocele (inflammation of the scrotum which occurs when fluid accumulates in the thin lining surrounding the testicle) and undescended testicles.

This was their ninth mission to operate on poor people in third world countries. César Ramírez says it involves huge responsibility in coordinating and managing a team of professionals from the time they set off from Malaga and their stay in the country to their safe return, and that it is very satisfying when everything goes well. In addition, there is what he calls the parable of one times a hundred: in other words everything they take from Malaga is multiplied by 100 in Africa.

“That is the most satisfying thing of all, because we have the feeling that we receive much more than we give. The very little we give them is a great deal to them, and at the same time we gain so much from doing this,” he says.

He makes it clear that in Liberia the team worked from early morning until late at night, and in very hard conditions.

“It’s not a country to go to for tourism or holidays,” he says. As an example, he explains that the capital city, Monrovia, only has two sets of traffic lights in its main street, which is where the government headquarters and the ministries are located in very old buildings.

Dr Ramírez says the Malaga team stayed in a place with no running water for showers or for the toilet. There was only a bucket of water and a basin with which to scoop some out to wash with.

“We have experienced first-hand what the African continent is like. We have been in two or three villages to see patients, where 2,000 people live with no electricity. The children get up at 6.30 in the morning to go to school, when it gets light, and they go to bed at seven or eight at night when it is dark,” he says.

“That is what we adapted to, and we worked exhausting days when we sweated so much, with a minimum temperature of 30 degrees,” says Dr Ramírez. He adds that the local population mainly lives on rice, pineapple and papaya, which those on this solidarity mission also ate to recover their strength after very long days operating non-stop, aware that they were the only way these patients could ever be treated.

Some of these patients would have died if they had not undergone surgery, while others would have faced permanent disability and some would have been repudiated because of their illness as they live in very tribal societies.

“People in Malaga suffer from goiter just as they do in Liberia, but the difference is that in Africa it can cause them to die from drowning. These people cannot lie down; the thyroid compresses their trachea,” explains Dr Ramírez.

He also says that some of the inguinal hernias they have seen had reached the patient’s knees, causing disability and deformation which stopped them carrying out any type of activity.

Helping by healing

When asked if it is a source of pride that they are giving a second chance to people with no money for medical treatment, Dr Ramírez says it is the only reason that they go to Africa to operate.

“The only thing we want to do is help these people become healthy again. Although most of them are suffering from benign conditions, they are tremendously disabling. That is our reward, helping them to get better. That’s why we go and operate on them. And we are all constantly thinking about what our next campaign should be,” he says.

For the eight days that the Spanish health care professionals were in Bopolu they worked out of a consulting room in a medical centre where, after removing a desk and some chairs they placed two stretchers, similar to the ones used in Malaga to move patients into an ambulance. These stretchers can be fixed to the floor so they do not move; the patients lie on them and that is where the surgery is carried out. They were also able to use an operating theatre, which is the one the Liberian doctors use for carrying out Caesarean deliveries.

All the surgical material, anaesthesia medication and analgesics were brought from Spain by César Ramírez and his team because of the lack of resources in Liberia. When they left the country to return home, they left a large supply of medications for the patients during their post-operative period.