Sunday, December 30, 2012

Sweeping leaves on a windy day

So long suckers! I'm off to India.

One of my little secrets is that I actually get paid to do something I would happily do for free. But a busy year ending with a pre-Christmas rush of 70+ hour weeks and I’m ready for a break. India excites me. India has a sense of unfocussed energy that infuriates and enchants. Seemingly detached from the comforts of structure, predictability, reliability and routine. I need India. I need Ashish and Kavita and their little hospital at the northern end of the Amravati district of Maharashtra. I probably need them even more than they need me.

This time we have two therapists and a theatre nurse in the team from Australia.

Certified hand therapists and splint queens Chris and Joy at an orphanage in Nagpur

Joy applies a foot-drop splint

The girls fly in with Dilip a couple of days before me. They start work almost immediately visiting an orphanage in Nagpur, making splints, teaching the local therapists, and doing presentations. They mingle in the mayhem and immerse themselves in the explosion of colour and noise that that so typifies India. They lap up the local cuisine, shop for saris, and buy bangles. They too fall in love with the magic of India.

Joy, Chris, Sarah and Samrat ready for the drive to the camp 

It’s a six hour drive from Nagpur to the camp. Samrat, a junior orthopaedic surgeon from Nagpur, joins us. He expects he will be needed for a day, maybe two. He brings enthusiasm as well as drills, K wires, and other assorted tools. At this time he does not know that he will stay the full four days and operate 12-16 hours every day.

We squeeze into the car. It is a privilege to be surrounded by good people.

Dilip arrived a day earlier at the camp and has already seen over a hundred patients. There are breast cancers, parotid tumours, cleft lips, goiters, hernias, keloids/ scars and assorted lumps and bumps, and post burn contractures. He decides what we can do within the limitations of this small hospital. I start to appreciate that the camp is a lot bigger than the previous two. Four general surgeons will also attend on the first day of this camp. Dilip leaves Samrat and myself to decide what we have on offer for the small number of orthopaedic cases.

There are a lot of post burn contractures (PBC) in this part of India

Remnant fingers somewhere in there

Fully functioning opposable thumb if we can get a better position

PBC patient treated last year is back for surgery to his other hand

Nice result here

Plentiful cases of polydactyly as well

Amniotic band syndrome

We finish the clinic at a very reasonable 8pm. The girls unpack the equipment they have brought from Australia and sort out the instruments and disposables already at the hospital. We are ready. At 11pm we settle in and get acquainted.

A storm of activity is about to start.

The girls are ready 

Theatres are ready

Theatres roar into action with organisation and efficiency that takes me by surprise. The general surgeons take two tables, the pods have one, and Dilip has one. Dilip and Sarah makes sure that the general surgeons don’t steal our table during the turnaround of patients. Sarah quickly comes to terms with the way theatres run and the equipment available (and, crucially, where they are located within the theatre complex). Within an hour or so she is running the floor.

Super nurse Sarah

With four cases happening at once, limited time, and a relatively small complement of staff it is hard to find a spare hand to take a photo record of the unfolding events. 


121 cases, four beds, four days

First major PBC case

Ketamine and a brachial plexus block

Ok I'm stuck. What do I do now Dilip?

Split skin graft (SSG) harvested from the thigh

Wires transfix the wrist and rudimentary digits (wound closure and skin graft still to do)

Dilip returns to his work on a PBC of the neck and chest (thick scar holds the chin to the chest in this patient)

Super therapist Joy applies a thermoplastic neck splint (note the position of the chin after release and skin grafting allowing a full hand span between chin and chest)

Another PBC of the hand

After release and before skin grafting

Full thickness skin graft (FTSG) harvested from the groin

Same patient had a good result after a similar operation on his other hand one year ago

One day and over sixteen hours later and we have completed 57 cases (most of them under simple local infiltration). The general surgeons leave but a couple more will arrive over the next three days. 

Morning ward round

PBC patient with release of elbow/wrist/hand appears to be doing well 
(all PBC releases were splinted by the therapists providing comfort and maintaining the corrected position)

Then it’s back to theatre.

Another PBC

Vijay and Nitin weave their magic

Over two hours operating and no tubes


SSG needed for this one

Applying SSG

Look, fingers!

We finish late enough to see Christmas arrive. I joke with the girls about who will be the first to crack under the pressure. They remain excited and enthusiastic and the throw the challenge back. I don't tell them that I had already cracked over 12 hours ago. I smile and allow their passion to lift my spirits.

 Christmas breakfast by a river near Ravi's place

 Dilip and Ravi

 Christmas Melghat style

 And so it continues for another two more days

 Post-traumatic contracture requiring a radial forearm flap

 Fixed hyperextension of the knuckle joints

Radial forearm flap delivered to the defect (note the corrected finger position) 

Super therapist Chris has got this theatre thing all happening

Skin markings for another PBC correction

Calcified mass being removed from a knee

 Samrat working on another knee

Dilip working on a particularly nasty parotid cancer

Surgery finishes after four days. And yet there is so much left to do. Many of the patients have to stay at the hospital for a few days. Some have to stay a few weeks. Their families also stay over this time and they too need to be fed and sheltered. Ashish and Kavita have worked hard running the hospital over the four days of the camp. And they and their devoted staff will continue to do so long after we are gone.

Chris and Joy have been busy making template splints for the hospital in addition to splinting and arranging rehabilitation protocols for the existing patients

So much work is done during the camp that the limited opportunity to take pictures and post them here (and excluding the many that were unfortunately way out of focus) cannot do any justice to the contributions of so many individuals.

It is one thing to be aware of the world around us.

It is a privilege to have the opportunity to be engaged and to be surrounded by good people.