Hydrocele Healer: A Conversation with Dr. Sunny Mante

By Mary Houghton  - July 22, 2016

During a July visit to the U.S., Ghanaian physician Sunny Doodu Mante talked with us about his love of urology and his longtime work to reinforce hydrocele surgery skills throughout Africa.

Dr. Mante is a preeminent global authority on filarial hydrocele, a debilitating condition marked by an accumulation of fluid in the scrotum. Caused by mosquito-borne worms, hydrocele affects an estimated 25 million men globally.

As a consultant to the USAID-funded MMDP Project, Dr. Mante was in North Carolina conducting final testing on a surgical simulator that will be a core part of the project’s hydrocele surgery training program. (See related story.) He told us he is confident that the simulator, called FASTT (which stands for Filaricele Anatomical Surgical Task Trainer), will reduce complications in patients and ultimately change the way hydrocele surgeons are trained throughout the world.

Our team caught up with Dr. Mante in North Carolina to learn more about his path to becoming a global expert in hydrocele surgery, and his views on what it will take for lymphatic-filariasis-endemic countries to eliminate suffering and disability due to hydrocele.

You studied medicine in Ghana at the University of Science and Technology, School of Medical Sciences. What inspired you to pursue medicine as a young man, and why did you choose urology as your specialty?

I had an uncle who was a doctor. When I was in high school he helped me to prepare for medical school. He encouraged me. Then during my second year of medical school we were sent out to do rotations in the hospitals, and I was given to a urologist who impressed me with his procedures. I watched him do prostatectomy and ureteroplasty. He laid open the whole urinary tract and reconstructed it. For me it was amazing, very amazing. I thought I needed to train and become like him.

Over your career, you’ve continually honed your skills in hospital settings around the world and in challenging field locations. Which experiences were most crucial in shaping the physician you are today?

I would put my urology practice ahead of the field work because it involves varied skills. The field work is purely hydrocele surgery. In my urology practice I see a vast amount of cases: In urology you are dealing with pediatrics, children, mainly congenital anomalies; you are dealing with infertility, cancer, infections; with women, it’s mainly instability of the bladder, pelvic floor abnormalities, because of deliveries. So urology is very broad.

How many patients do you see in a month at your practice in Accra?

It’s a lot! During a day at the clinic I see about 100 patients. I sit in the clinic and they just keep banging on my door. And I run two clinics a week, so that means I see about 200 patients a week. Times four, that’s about 800 patients every month.

And you do surgery the other days?

We do surgeries Mondays and Wednesdays, and we do clinics Tuesdays and Fridays. Thursdays we do our general ward rounds and teaching of residents.

Dr. Mante uses his meticulous surgery skills to test a prototype of the FASTT hydrocele surgical trainer at the Wake Forest Center for Applied Learning in Winston-Salem, North Carolina, in July. (Photo: Mary Houghton)

You are also the surgical coordinator for the African Filariasis Morbidity Project. What is AFMP’s mission, and how did it get started?

Our mission is to harmonize the technique of filarial hydrocele surgery, through training of surgeons. Since our founding in 2004 we have trained more than 500 doctors in 12 African countries how to perform hydrocele surgery. We teach the resection technique, which is the ultimate in filaricele surgery and completely different from the eversion technique I was taught in medical school.

The first funding we got was from the Bill and Melinda Gates Foundation, which funded the first year as a pilot in 2004. After one year everyone was excited. After that we had Health and Development International sponsoring us, with funding from the Norway Agency for International Development, from 2005 to 2010, during which period Dr. Anders Seim and I wrote the LF Hydrocele Surgery Manual. After 2010, Johnson & Johnson took over, from 2011 to now. It’s great to see now that USAID is funding the MMDP Project to further expand access to hydrocele surgeries in Africa.

How has the capacity of African countries to provide surgery for men suffering from hydrocele changed since you began working in this field?

I must say that I feel very impressed when I receive mail from some of my trainees: “Oh, hello doctor, I’m still using your technique.” And I’ve been to several countries where I thought they must have forgotten by now what we did, but they are still using the technique with all seriousness. At the MMDP Project’s recent master trainer workshop in Burkina Faso, the two Burkinabe surgeons who were invited were among the very first the AFMP trained, and they are still very excited. They’ve held onto the technique and they are teaching it to others.

You’ve helped develop the FASTT surgical simulator for the MMDP Project, testing and providing feedback on each prototype. How much of a difference will it make for trainees to practice on the FASTT mannequin?

There’s no doubt that practicing on FASTT will make them much better hydrocele surgeons. Why? Because you make all your mistakes on the mannequin. By the time you get to the human, you will be careful. For example, in your dissections, you need to cut one layer at a time. With the mannequin, you realize sometimes you cut two or three layers all at once and you cause a lot of bleeding. The mannequin helps you learn how firmly you have to cut. You learn the feel.

In the past, you just moved from your clinic and went straight to the operating theatre for your first surgeries. That era has changed. Now training in surgery has become more of a simulation.

Beyond the MMDP Project, many other countries could benefit from using the FASTT mannequin. What will it take to spread this new tool everywhere?

Other NGOs that are involved with hydrocele surgery training will have to be encouraged to use it. We need to spread the message. I will be speaking at the annual meeting of the American Society of Tropical Medicine and Hygiene in Atlanta in November 2016. And we are getting ready also to speak at the Global Alliance to Eliminate Lymphatic Filariasis meeting, which will be organized sometime next year. Wherever scientists are gathered, we must let them know where we have reached with hydrocele surgery training.

Meeting the World Health Organization’s goal of eliminating lymphatic filariasis as a public health problem by 2020 requires reducing hydrocele morbidity. What do you see as the greatest challenge for countries in achieving this?

I think the main problem will be finance, and it has been a problem for a long time. We need governments to own projects instead of leaving it for NGOs to do. So, if countries are able to imbibe that idea -- that the project is for them, and ending lymphatic filariasis by 2020 is a must for all countries -- and to put in money and have budgets for hydrocele surgery, it’s going to make a big difference.

What does it take to get a country to feel that ownership?

Usually the director of the health service must be able to push government to do that. Because the NTD community in every country works directly under the director general, and the director general has all the contacts with the Minister of Health. So it’s something that has to be pushed along.

Is there anything that we in the NTD community can do to better support countries in taking ownership?

Yes. You know, the FASTT mannequins provide a great opportunity to build upon. The mannequins are made up of a solid base and disposable scrotal cartridges. The bases don’t change and they don’t expire. You can use them forever. So if the MMDP Project goes to a country and purchases four bases and several cartridges, after the training workshop, the country will still have the bases, and they could easily buy the cartridges for continued training. It’s just like getting a piece of equipment and its consumables. It’s very simple. It can be done.

And of course, continued use of the FASTT tool will permanently strengthen the health system, so that the country is prepared to provide high-quality hydrocele surgery long into the future. But hopefully, not too long into the future, because we’re going to eliminate lymphatic filariasis and millions of men will be spared this debilitating and stigmatizing disease.

Mary Houghton is the Communications Specialist for the MMDP Project.