Editor’s note: Roberto De Castro, an Italian doctor affiliated with the Hanoi-based Thien Nhan and Friends (TNF) Fund, established in 2009 to support genital reconstruction for children, recently shared with Tuoi Tre News about his successful mission in Gambia. His letter was edited by Tuoi Tre News for clarity, consistency, and coherence.

The Thien Nhan and Friends (TNF) Fund, after 15 years of intensive and regular surgical activities in Vietnam and Italy, has successfully completed its first volunteer mission in Banjul, Gambia, West Africa.

The invitation to join the English pediatric urologists on their mission in June came to me from London, from the prestigious Evelina Children’s Hospital. 

The super-specialist’s goal was to operate on an unfortunate child who had lost his entire penis and three fingers due to a devastating infection that had spread throughout his body following a squirrel bite (an incredible, yet true, situation!). 

Italian doctor Roberto De Castro (R) and local surgeons during the reconstructive surgery for Ibrahim in Banjul, Gambia. Photo: Supplied

TNF was founded with the specific mission of providing genital reconstruction for male children born without or who have lost their genital organs due to trauma, animal attacks, or illness. While this procedure was considered revolutionary 20 years ago, it is now internationally recognized.

Therefore, I could not refuse the invitation, despite the journey and inconveniences (which were entirely self-financed), to contribute my expertise in this unique reconstructive surgery for the child in need.

Gambia, the smallest nation in Africa, is a narrow former British colony, so nearly everyone speaks English. It stretches approximately 40km wide and 350km long along the course of the great river.

The capital, Banjul, is situated at the mouth of the river leading to the Atlantic Ocean. 

Despite being among the poorest in Africa, the population remains resilient and cheerful.

Local surgeons during the reconstructive surgery for Ibrahim in Banjul, Gambia. Photo: Supplied

Ibrahim, my patient, was nine years old when he was bitten and 11 at the time of surgery. 

The terrifying infection spread throughout his body, leaving scars on his legs and causing necrosis that resulted in the complete loss of three fingers and his penis up to the pubic root. 

Local surgeons and English volunteers skillfully enabled him to resume urination using the salvaged urethral residue. 

They also meticulously followed my instructions during the six-month preparation for the functional phalloplasty operation, which took place on June 20.

I had on my team a consultant pediatric urologist from the Evelina, along with the only two pediatric surgeons in Gambia from Benjul Hospital, along with nurses and a highly skilled Cuban anesthesiologist — all highly competent and dedicated. 

While the local surgical instruments are really at the minimal level, the materials such as sutures and catheters, brought from London, were excellent. 

Surgeons perform the reconstructive surgery for Ibrahim in Banjul, Gambia. Photo: Supplied

We achieved the best possible outcome by incorporating the small remaining penile tissue into the skin reconstruction. 

Ibrahim now has a slightly short and stocky penis, aesthetically pleasing with a circumcised appearance, and the urethra reconstructed up to the tip. 

We “pray” that he does not develop a wound infection, that he can urinate regularly from his new penis, and that the saved corpus cavernosum remnant will provide some degree of swelling in the future. 

I left Gambia with the enduring memory of Ibrahim and his parents’ smiles when I showed them the photos of his newly reconstructed penis (at that moment still covered in bandages) and with the appreciation of the local and English doctors. 

For me, it was a tiring but great pleasure and privilege, which I hope can be counted among the successes of the TNF. 

Thanks everyone, 

Roberto

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