Saturday, January 31, 2015

Saturday, January 17, 2015

Thursday, January 1, 2015

Sweeping leaves on a windy day

The baggage compartments do not line up with the seating arrangements on Singapore Airlines flight SQ0246. At least not on this aircraft, and not in coach class. They would line up if the arrangement was 2/4/2 (where / = aisle). But the arrangement is 3/3/3. Maybe there’s been a refit to squeeze an extra seat into each row.

India. She welcomes me with a familiar indifference. As usual, she is busy. She's always busy. She attends to her people as they move about in a kaleidoscope of colour and sound. There is much to do. I step into the noise and feel her warmth against my breast. I kiss her gently on the cheek. 

She turns to me and smiles.

Samrat calls out. We greet each other. Samrat is quick to inform me that I need to "freshen up" and eat something at his place before travelling onwards. I meet his wife, his two sons, and his parents and have some masala chai. I'm not exactly sure what I ate at Samrat's place but it was both sweet and savoury. And delicious. India delights my senses. Although we are in a rush I have enough time to sip through another cup of hot, spiced tea.

We travel to Amravati to meet up with Dilip and his team. They arrived a couple of days earlier and have made good use of the time.

Road trippin’.

Children’s orphanage, Nagpur.

Justine makes some splints.

Justine, Penny, Kath.


Visit to an animal shelter.

Avinash and friends, Amravati.

We leave for the camp in the early morning. The sun hides behind a low lying haze and lights up a contrail as a brilliant gash in a cloudless sky. A pig snuffles through some trash. Dogs stretch out lazily beside the road. People are everywhere. Cows and buffalo roam freely. 

As we approach the camp the traffic thins and the din of horns (used to indicate a vehicle’s presence and intention for road markings play a negligible role in India) die down. A cacophony of noise that disorientates a newcomer becomes recognisable as a conversation between individual vehicles. An enormous number of small trucks ply the roads of India. Narendra Modi may have chosen a good time to put an end to fuel subsidies but he clearly has his work cut out.

Road trippin’ 2.

The camp is set in a tiger reserve. As usual we do not see any tigers. As usual the girls are disappointed (incomprehensible given the smallness of the transport vehicles and the conspicuous absence of brawn or weaponry on their male companions). But we do see monkeys. Lots of monkeys.

We arrive at the camp by midday. We are met by Ashish and Kavita. There is significant building work in progress. Smack bang in the middle of the hospital complex rises a concrete structure that will house an ICU and gynaecological unit. Just five hundred meters down the road a large university hospital (where Ashish works as a professor) is being constructed. Six kilometers in the opposite direction yet another hospital is being built by Ravi. The region is losing its rural charm: trading up for infrastructure with the capacity to do much good. 

The clinic has already started to fill. 

There are many post-burn contractures (PBC) at this camp.

Right hand released last year. Left hand to do this year.

Most PBC cases are not quite as challenging.

PBC chest and neck.

Minor PBC of the axilla.

PBC leg.

 PBC foot.

Remember this girl from last year?

Still some work to do to achieve a functioning hand.

Blast injury from a firecracker.

Missing thumb, amputated index, fixed contracture of the middle finger. Although similar in appearance to a PBC this is altogether a different beast. We elect to release the contracture first (which is difficult enough). Some might argue that a pollicisation of the index would have been a better option. But the length of the amputated index would have meant a web reconstruction. And the lack of intra-operative screening would make a challenging procedure even more so. As it turns out the middle finger only has a radial neurovascular bundle (the ulnar side presumably blown off). Must remember this should this boy come back for more surgery.

Incomplete syndactyly.


Club feet for Ponseti casting.

Osteomyelitis following a fracture. Not suitable for surgery at this camp.

Femoral torsion. Not suitable for surgery at this camp.

Poorly demarcated lesion (inflammatory or neoplastic) on the lateral aspect of the arm with radial nerve involvement.

I argue whether it is safe to proceed without better imaging. 
Turns out to be one of the most grateful patients at the camp.

Epigastric hernia.

Cancer of the oral cavity with involvement of the mandible.

Many villagers are illiterate. Consent for surgery can still be given. 

Cleft lip.

A multitude of lumps and bumps.

Keloid scarring.

Justine has set up a splint table just outside theatres. It is regularly dismantled whenever she leaves to attend to patients.

The next morning is Christmas day. We have some time before the anaesthetists arrive from Pune, Amravati, and Nagpur. 

Athang has built his own batteries (charged by solar panels) and attached them to a hub motor on his bicycle.
It can do 30km at a decent speed with the two batteries fully charged.

Dilip has a go. The bike must weigh 50kg and the left crankarm is loose.

Pedalling is like so yesterday..

Christmas Melghat style.

The team from the Gold Coast.

Time for theatres to start. We have enough work to keep us busy for three days. 

The girls sneak out with Dilip to visit Ravi and check out his cotton farm and new hospital.

Dilip and Smita.

Dilip and Ravi.

Ok. That’s quite enough girls.

Back at the camp.

Gopal (specialist oncology surgeon) takes out an oral cancer involving the mandible.

Hemi-mandilectomy with a near bloodless field. 
I ask Gopal how he feels about doing such a large procedure within the constraints of a camp hospital with no facilities for a blood transfusion. He tells me he has brought along his own cautery machine. Holy shit. It takes more than just a good cautery machine my friend. It takes experience, good hands and balls of steel. 
You, sir, have my utmost respect.


Another hemi-mandibulectomy. This one with a lymph node dissection.

A pec major flap is needed to close the wound. Sheilesh is up for it.

The other tables (thankfully) carry smaller cases.

The girls get back to it.

The next morning we take a walk to the river.

So this is where our food comes from.

Hey Sheilesh! I bet you a $100 that you can’t climb that pillar.

Dilip and Sheilesh.

Ashish tells us that we have completed 101 cases.

An extraordinary collection of human beings.

Ward round.

Ceremony round 1. Sheilesh.

Samrat sustained a nasty left ankle fracture five months before the camp. He was limping from the start and, despite his obvious discomfort, refused to return to Nagpur until the camp was complete. Respect. And gratitude.



Ceremony round 2.

The case with radial nerve involvement that I didn’t want to do.

We return to Amravati and spend the night at Avinash's new headquarters. Dilip talks deep into the night with Ravi. Four medical students came to this area many years ago and promised to serve those that could otherwise not afford such care. Three of them slept under the same roof that night. The fourth (Prem) was here a little earlier.

The camp takes its toll and, for a second year in a row, I leave with a nasty head cold that goes to my chest. I think about the new hospitals being built and imagine a bright and sustainable future for the local community. I think I would like to tell a different story next year. 


I board my plane at the newly renovated international terminal in Mumbai. With red eyes and a snuffly nose I take one last look at India. She gives me a wave and turns away. For she has other things to attend to.

The seating arrangement on Singapore Airlines flight SQ0423 is 2/4/2 (where / = aisle). The luggage compartments line up with the gaps in the row of seats. 

A pretty Indian hostess hands me a warm towel. 

I wipe my face and settle in.