Sweeping leaves on a windy day

Him: “By necessity I live a very efficient life.”

Her: “.. Well, that’s very sad.”

I rather like train rides. I sit and stare out the window at a world that passes by. Newtonian physics determines that an object cocooned at a constant speed does not feel the push and pull of motion. I open the window. A rush of wind on my face reminds me that I am in motion. I smile and breathe deeply. After a while I close the window. Time metronomes with a clackity-clack as steel wheels meet jointed track. I feel comforted. And safe. I lean back in my chair. Everything is in its place.

A tug tells me that I am arriving at a station. Dilip steps in with four young, enthusiastic girls. The train moves on a we greet each other. We discuss our journey ahead. We settle in. Suddenly the train jolts to a stop. This is India. She welcomes us with a rush of humidity. The doors open and the carriage fills with commotion and colour.

This is our stop.

India beckons. 

There is something about India that draws us to her. May be it’s her heat. Or her humidity. Or her noise, her smell, her colour, the immediacy of mingling humanity, her people. Her rawness. Her spirituality. Her unpredictability. The camp we attend deep within her bosom has an intensity that has a way of grinding through layers of established social norms. India shows us another way of seeing the world. We need India. Or rather, I need India. She informs me of where I am.

Chris, Sarah, Renee, Joy. The girls arrive. And they don’t travel lightly.

We fly 8 hours to Singapore. Then another 4 1/2 hours to Mumbai. We take over two hours to transit from the international to the domestic terminal then spend the next ten hours trapped within its walls. The girls make the most of it. Chris, Joy and Sarah have been here before and are familiar with the way things are done in India. This is Renee’s first time. If they are frustrated they show no signs of it. Sadly it is “dry day” and there is no alcohol to numb our fatigue. 

It is a short flight to Nagpur. Dilip has decided that we should travel straight to the camp to allow us some time to recuperate on proper beds. It is a couple hours drive to Amravati.

We meet up with Dilip in Amravati. It is 2330.

It’s another 4 hours drive to the camp. Dilip gives us a little red pill and we sleep along the way. He tells us they are for nausea. I reckon they’re roofies. We arrive just before 0400.

Athang, Sarah & Joy outside the girls accommodation (bottom floor of the building on the right).

All is quiet at the camp.

Some water boils.

And so the clinic starts.

Downstairs the theatre is being prepared.

The team unpack gear and set up before joining us.

This year we are better prepared for taking photos. 

As usual there are plenty of contractures. Most are post-burn contractures (PBC).

Neck, chest & both axillae. 

One year old with severe burns sustained at 3 months. How she ever survived is a mystery.

Here’s one we prepared earlier.

Released and skin grafted from a previous camp.

A few tight bands that are easily dealt with.

Otherwise not doing too bad.

Bilateral PBC of the hands.

The left hand is worse.

There are fingers and a thumb somewhere in there.

We’ll come back for the right hand.

Axillary PBC.

A particularly nasty PBC.

Skin quality is terrible and reconstruction requires a groin flap.

Despite the severity of the contracture she never turns up for her scheduled operation.

Thankfully not all contractures are that bad.

Dilip’s vast exposure to plastic, hand, reconstructive and general surgery makes him particularly adaptable to a camp like this.

Cleft lip and palate.

Parotid tumour.

And an assortment of lumps and bumps.

Malignant change in a large neurofibroma. Sadly metastases are evident on CXR.

A massive lipoma.

And so the clinic rolls on.

Plenty of polydactyly in this region of India.

Correcting this will also mean stabilising the MCPJ & deepening the 1st web.

Wassal-schmassal. Dilip wants a corrective osteotomy as well..

Thumb and index syndactyly.

 Macrodactyly.

Amniotic band and syndactyly of hands and feet.

Osteochondroma arising from the distal ulna.

Ashish screens the patients prior to the clinic. There remains a small number of patients with problems beyond the scope of what we are able to offer.

Fixed club foot.

7 month old calcaneal fracture with dislocated calcaneocuboid joint. 

Large, poorly-defined arteriovenous malformation.

Facioscapulohumeral dystrophy.

The clinic finishes late.

A list of patients is made and theatre plans drawn up.

Kavita and Dilip draw up battle plans. Samrat looks after his orthopaedic cases.

Theatres start the following day. All hands are required on deck over the next couple of days. 

Somewhere in the bustle of running four tables simultaneously someone manages to snap a shot here and there. Some are even in focus.

Athang (Ashish’ and Kavita’s son) is just 11 but has been here many times.

Dilip and Renee tackle one of the many cleft lips and palates.

Another cleft.

And another one.

Hand contracture.

Nitin & Chris.

Sarah joins in.

Fibroma arising from the medial head of triceps.

Outside theatres. The splint table is tucked away in a tiny corner.

Joy.

Ashish organises and reorganises the theatre list as surgeons, anaesthetists and equipment become available.
Standing in the doorway is our computer and electronics expert.

And so it continues.

Shailesh arrives late in the night and immediately joins Dilip on a complex excision of a lower lip squamous cell carcinoma with neck dissection.

Theatres close in the wee hours of the morning. One anaesthetist stays up with the neck dissection until 0500. Theatre staff clean and restock throughout the night. Kavita is the last to leave the hospital.

We go to a nearby lake in the morning. Chris, Joy and Dilip muster the energy to go for a run.

Wrist examination session with Samrat and Joy.

Dilip shows passing interest.

Sarah, Chris and Renee have more interesting things to talk about.

One of many back rooms where much work is done.

Standard fare during the camp. 
Awesome.

And then it’s back to theatres.

Another cleft lip and palate.

PBC release.

Thumb-index syndactyly release.

Samrat angry eyes.

Samrat angry eyes 2.

Another PBC.

We tackle the one year old with significant PBC.

Schlippery little schuckers..

Splint applied.

Theatres finish late.

Shailesh. Charming and cheerful as always.

Washing done and hung up overnight so they are dry for the morning.

Morning ward round..

.. Then back to theatres.

Parotid tumour.

Polydactyly.

Samrat examines a club foot.

PBC chest and axillae.

Splinting of an axillary release (different patient).

Fockun tourist.

Volar wrist ganglion.

Polydactyly.

And we are done.

“I’m taller than you Samrat”

Samrat: “No sir”

Sarah: “.. this is what you call a photobomb”

We finish the camp after five days. Ashish tells us that we have done 97 cases.

We walk slowly back to the station. There is no rush to leave.

Awesome foursome. Mumbai international terminal.

The train pulls in. Our time in India has come to an end. We say our goodbyes with hugs and kisses. A song is sung. A couple of girls shed a tear. But India does not allow herself the luxury of romanticism and sentimentality. She bids us farewell. We board. India moves on.

I settle in and quietly smile to myself. 

I know I will meet her again.

If only India could capitalise on her vast potential. 

Her: “Watcha thinking?”

Him: (holding her hand) “Oh, I dunno... May be just savouring what could be some of the best days of my life..”

...

Her: (smiling, but releasing her hand) “That was terrible.”

Him: “Yeah, wasn’t it?”