So No Child Must Wait

Dr. Chandini Perera on National Public Radio

  Dr. Chandini Perera on National Public Radio 
  Photo by: Phil Borges

Dr. Chandini Perera, one of only six plastic surgeons in Sri Lanka and Interplast's surgical outreach director, was interviewed by National Public Radio’s Michel Martin, host of “Tell Me More”. During this interview, Dr. Perera discusses the impact of disabling burns and how she heals and empowers women burn survivors.

Click here to listen to the interview and view photos of some of Dr. Perera’s patients.

Working Together

  Working Together 
  Originally uploaded by interplast

Dhaka, Bangladesh-- Dr. Steve Garner, Interplast visiting educator.

We just finished a long operating and clinic day.  After finishing two wound debridement/skin graft cases, we tackled one of the primary cases Dr. Shafquat Khundkar asked me to help with as a Visiting Educator. The patient had a large wound from a pressure sore/post radiation injury.   I offered Dr. Shafquat my input and together we did a split gluteus muscle flap on the patient. I've never seen quite so many people gathered around an operating room table observing! It was a great day. At the end of the day, after long hot hours I remembered how good a cold glass of Coke can taste.

Big Need, Small World

Dhaka, Bangladesh-- Dr. Steve Garner, Interplast visiting educator.

Last night I had dinner with a young Bengali plastic surgeon named Tarek who trained with Interplast’s Surgical Outreach Director, Dr. Shafquat  Khundkar.  We had a lengthy and lively conversation about burn care in Bangladesh.  He works at a 50-bed burn unit which sees 250 patients a day.  Many of his patients are forced to lay in the hallways due to lack of space. 

Yesterday at the clinic, we saw a young child with leg burns caused by accidentally walking on burning embers. In discussing her case, I emphasized the importance of grafting her leg carefully while monitoring blood loss. Dr. Tarek shared with me that they had a patient pass away due to not only 20% burns on his body but also excessive grafting. If my whole trip does nothing more than prevent such incidents from happening again, I will be soul satisfied.

Other than my attempts at humor during lectures going over like lead balloons, all is well.  I am confident that it is the language barrier and has nothing to do with my delivery. My favorite funny yesterday was the young Bengali strolling past me with a t-shirt saying "Save Ferris".  World sure is small.

Able to Help

  Able to Help 
  Originally uploaded by interplast

Dhaka, Bangladesh-- Dr. Steve Garner, Interplast visiting educator.

Another great day in Bangladesh!  Again, I gave two lectures and spoke on Dressings/ Drains and Angiosomes/ Foot Flaps. We saw several patients and prepared a tentative surgery schedule for tomorrow.  So far all our exchanges have been lively, interesting and, most importantly, well received. The lectures will hopefully help my colleagues provide improved care to their patients. There are so many chronic burn and injury wounds, they are heartbreaking.  I feel very fortunate to be able to help.

Arriving in Bangladesh

  Arriving in Bangladesh 
  Originally uploaded by interplast

Dhaka, Bangladesh-- Dr. Steve Garner, Interplast visiting educator.

Hello, my name is Steve Garner, M.D., and I’m a volunteer plastic surgeon participating in Interplast’s Visiting Educator program. My first day here in Dhaka was excellent. I gave two lectures to a group of 25 physicians and residents from hospitals all over the city. The weather is warm but not beastly.  All of the Bengali people have been quite gracious and friendly. I look forward to another productive day tomorrow.

Our Time In Nicaragua

  Our Time In Nicaragua 
  Originally uploaded by interplast

Managua, Nicaragua —Liliana Vazquez, Interplast Communications Technology Coordinator.

Our visit to Nicaragua was a memorable one. The hospitality we experienced only comes second to the valuable lessons we learned during our time at the hospital. Each child we met and story we heard helped reinforce in our hearts and minds the importance that these life-changing surgeries have. As we return home, Dr. Chandini and Asha Karunathilake to Sri Lanka and I to the United States, we return with newfound inspiration and knowledge that will be applied in our daily work.  This was my first trip with Interplast, and being able to write these blogs myself has proven to be a unique experience. As the Communications and Technology Coordinator at Interplast, I constantly receive blog entries from our volunteers abroad. However, having the opportunity to witness firsthand the work being done by our international partners and to meet the patients we serve has given me a new appreciation for the powerful human impact of all that we do.

Edwing

  Edwing 
  Originally uploaded by interplast

Managua, Nicaragua —Liliana Vazquez, Interplast Communications Technology Coordinator.

Edwing is 9 years old. Like many boys his age he enjoys exploring the outdoors with his friends. One day he and his friends found a small bomb out in the fields. As they tossed it away from them, the bomb exploded, leaving Edwing's hand badly damaged. He lost the index finger of his left hand, which left him with a hand contracture that prevented him from opening his hand freely. This picture was taken after the surgery to release his hand contracture. Edwing is old enough to understand the impact this surgery will have in his life, but young enough to still smile enthusiastically at my camera.

Shared Commitment

  Shared Commitment 
  Originally uploaded by interplast

Managua, Nicaragua —Liliana Vazquez, Interplast Communications Technology Coordinator.

During my time in Nicaragua, I was constantly inspired by the level of commitment shared by the local staff as well as Dr. Chandini Perera and Physical Therapist Asha Karunathilake. Despite working for burn units on the other side of the world from each other, their deep passion for the work they do is identical. This dedication was apparent as we watched Nicaraguan therapist, Socorro, and Sri Lankan therapist, Asha, rush into the OR and work collectively to create a leg splint for a young baby who had just been operated. The leg splint is essential as it keeps the patient's leg from contracting after a burn. At that moment there were no language barriers or cultural differences, just the patient's well being in both their minds.

Some Things Don't Change

  Some Things Don't Change 
  Originally uploaded by interplast

Managua, Nicaragua —Liliana Vazquez, Interplast Communications Technology Coordinator.

Joseph is an energetic 4-year-old who suffered a severe water burn while playing in the kitchen of his home. At his young age he is constantly exploring the world around him; which led to him accidentally pouring boiling water over his body. Despite having a neck contracture that prevented him from turning his head, Joseph is always playing and keeping the hospital staff smiling. Dr. Chandini Perera and local plastic surgeon Dr. Mario Perez performed the surgery which released his neck contracture. The next day we visited Joseph to see his progress. Here he is pictured a day after his surgery. He now has greater mobility of his neck but has kept the same tireless energy and playful silliness which no surgery could ever change.

The Importance Of Therapy

  The Importance Of Therapy 
  Originally uploaded by interplast

Managua, Nicaragua —Liliana Vazquez, Interplast Communications Technology Coordinator.

This is 16-year-old Marilyn as she awaited her weekly therapy session. Just like many impoverished burn victims around the world, her burn injuries were caused by a lantern used to provide light for her home. After spending a month in intensive care, both she and her mother are very committed to following the therapist’s advice to help Marilyn heal correctly from her injuries. Without a proper therapy routine, burn patients’ wounds become contracted, leaving a person unable to move their limbs freely.

Katherine

  Katherine
  Originally uploaded by interplast

Managua, Nicaragua —Liliana Vazquez, Interplast Communications Technology Coordinator.

Katherine is only 11 months old. As we walked into her room, she carefully watched each one of us arrive. Her attentive eyes and still nature captured all of us immediately. Referred to at the burn unit as the "miracle baby," Katherine was resurrected by doctors after suffering burns covering over 35% of her body. Katherine is from the town of Dario, which is named after Nicaragua's famous poet Ruben Dario. One day the lantern that provided light for her family exploded, engulfing their home in flames. Sadly, her mother died after the fire. Now her father sits by her bedside everyday, making sure to keep her company through her treatment. Later in the day Dr. Chandini Perera, Interplast's Surgical Outreach Director in Sri Lanka, helped the local staff change Katherine's dressings to keep them free from infection. I look forward to visiting Katherine again tomorrow, and watching her eyes widen as her doctors walk in announcing their presence with an enthusiastic "Buenos Dias, Katherine!"

From Sri Lanka to Managua

  From Sri Lanka to Managua 
  Originally uploaded by interplast

Managua, Nicaragua —Liliana Vazquez, Interplast Communications Technology Coordinator.

I arrived in Nicaragua on Sunday evening accompanying Dr. Chandini Perera (pictured on left) and occupational therapist Asha Karunathilake (pictured on right) from Sri Lanka. They are participating in Interplast's Visiting Educator program, with the goal to exchange ideas with their colleagues across the world and learn from the local burn unit here in Managua. As we arrived today, promptly at 8 am, we were warmly greeted by the staff of Asociacion Pro Ninos Quemados de Nicaragua (APROQUEN.) After a few welcoming words, we were off to start morning rounds and consultations, which quickly introduced us to the children we'll be working with the rest of our visit. Each child we met has his or her own story which I hope to share with you in the following days.

Joy Needs No Translator

  Joy Needs No Translator 
  Originally uploaded by interplast

Quy Nhon, Vietnam—Mary Beth Yosses PACU RN, Interplast volunteer nurse

This is Pham Quynh  with her 6-month-old daughter Anh Thu, who was born with a unilateral cleft lip. Dr. Rui Pereira meticulously repaired her cleft. Upon entering the recovery room, Thu’s mother broke down into tears. She was overcome with joy at the transformation that had just occurred to her precious chubby-cheeked child. Instantly, Thu’s mother reached for my hands to shake them, stroked my arms and repeatedly uttered her appreciation as I watched her daughter emerge from her anesthesia. I called Dr. Pereira over, who also received the mother’s appreciation. To his credit, Dr. Pereira let her know, through our fabulous, endlessly energetic interpreter, Lan, that his work was not done alone. He praised his Vietnamese counterpart, as well as the rest of the international team.
Despite the oppressive heat here in Quy Nhon, we all had a little extra spring in our step as we strolled home along the waterfront that evening.  Pham Quaynh’s joy lifted our spirits like the breeze off of the South China Sea.

Farmer's Market in Vietnam

  Farmer's Market in Vietnam 
  Originally uploaded by interplast

Cao Lanh, Vietnam--Dr. Janet Volpe, Interplast volunteer pediatrician

Cao Lanh is a bustling city in southern Vietnam with a population of 150,000.  It was carved from the jungles and swamps of the Mekong Delta region.  The surrounding waters make fresh seafood readily available, and the hot and humid climate is perfect for cultivating many tropical fruits and produce.  Many of our patients reside in the surrounding rural farming communities, located within a three-hour drive of the city.  On weekends, a lively farmer's market takes place just a few blocks from our hotel, selling everything from fish to fresh cut flowers, ripe fruits and bright green veggies. This photo was taken at about 6:30 am on a Saturday morning, at the peak of the market; many of the sellers drove into the city hours earlier to prepare their goods for sale.

A Kind and Grateful Family

  A Kind and Grateful Family 
  Originally uploaded by interplast

Cao Lanh, Vietnam--Dr. Janet Volpe, Interplast volunteer pediatrician

This is Van Canh with his wife and 9-month-old daughter, Thi Sang Sang.  Thi Sang Sang was born with a cleft lip, like her father. When Van Canh heard that Interplast was coming to Cao Lanh, he and his wife decided, despite financial hardship, to leave their family store for the day and make the two-hour bus journey to our clinic day to have their daughter evaluated.  Fourteen years ago, Interplast operated on clefts on both sides of Van Canh's mouth. He had been told he would need a revision in the future but because of work and family commitments, he had never been able to make it back for the revision.  As our team evaluated Thi Sang Sang, we asked Van Canh if he'd like to have his clefts revised during our stay.  He and his wife were overjoyed that we would consider this for him.  At the age of 26 years, he told us he thought he was too old for Interplast to want to perform another surgery on him, and had no money to have the revision performed locally.  We scheduled the surgeries one day apart, and this photo was taken at the time of discharge from the hospital.  Van Canh had brought chewing gum from his store; just before going home, he gave each member of our team a stick as a token of appreciation. I taped my Wrigley's Doublemint wrapper in my journal and will always remember this kind and grateful family.

Our Time in Cao Lanh

  Our Time in Cao Lanh 
  Originally uploaded by interplast

Cao Lanh, Vietnam--Dr. Lauren Jefferis, Interplast volunteer pediatrician

Our Cao Lanh team consisted of three surgeons, three anesthesiologists, two pediatricians, two OR nurses, one head nurse, two PACU nurses, one nurse educator, and two coordinators/translators.  In just under two weeks, we screened more than 250 children and operated on 59 of them, performing a total of 84 procedures.  After their operations, the children sometimes needed some TLC as their anesthesia wore off.  They stayed an average of 2-3 days on the wards following their surgeries, under the care of the Vietnamese nurses.  Many children returned a week after their surgeries to have their wounds checked and re-dressed.

A Very Important Visitor

  A Very Important Visitor 
  Originally uploaded by interplast

Cao Lanh, Vietnam--Dr. Lauren Jefferis, Interplast volunteer pediatrician

This is Thi, who had a large birthmark removed from her face.  Her younger brother clearly adored her.  He rushed into the post-operative ward as soon as possible to see how she was doing.  He was covered in Canada stickers from one of our Canadian PACU nurses. We used the stickers to entertain the kids pre-operatively.

Witnessing Hope

   
  Originally uploaded by interplast

Cao Lanh, Vietnam--Dr. Lauren Jefferis, Interplast volunteer pediatrician

One of the most rewarding parts of this experience is being able to witness the look on parents' faces when they see their children for the first time after they have had surgery.  This is Thao, who had ptosis, a congenital deformity that didn't allow her to open her eyelids fully.  This picture was taken immediately after surgery, when Thao's mother saw her daughter's new and improved eyelids for the first time. 

An International Team

  International Team 
  Originally uploaded by interplast

Cao Lanh, Vietnam--Dr. Ian Wilson, Interplast volunteer plastic surgeon

These three Interplast plastic surgeons bring surgical experiences from around the world to Cao Lanh, Vietnam.

Dr. Percy Rossell (pictured on left) has been one of Interplast’s long standing international partners in Lima, Peru. He brings a wealth of reconstructive experience as he regularly offers these types of surgical interventions both in Lima and on many local outreach trips in his home country.

Dr. Michelle Spring (pictured in middle) is the current Interplast Webster Fellow. She has gained tremendous experience working with many different surgeons from around the world over the last year. She is a vital source of continuity through all the team trips and provides insights from one team to another.

Dr. Ian Wilson (pictured on right), originally from Ireland, was Interplast’s 2007 Webster Fellow. Now based in Florida, this is his second visit to Cao Lanh, and he is thrilled to recognize many patients from last year's trip.

Kia's Pain

   
  Originally uploaded by interplast

Cao Lanh, Vietnam--Dr. Percy Rossell, Interplast Surgical Outreach director in Peru

This is Kia, a 50-year-old woman who suffered terrible burns on her body and neck after a gas explosion 10 years ago. The severe skin contracture that formed around her neck caused her great pain every time she attempted to move her head. She is pictured here with Dr. Percy Rossell, Interplast's Surgical Outreach Director in Peru. With others on the Interplast team, Dr. Rossell successfully operated on Kia, offering her greater mobility for her neck and minimizing her pain.

Nguyen

  Nguyen 
  Originally uploaded by interplast

Cao Lanh, Vietnam--Dr. Ian Wilson, Interplast volunteer plastic surgeon

Nguyen has had the first of four hand operations he needs. This 4-year-old boy was born with three of his fingers fused on each hand. His mom will bring him next year for the procedure that follows. Interplast frequently visits the local community of Cao Lanh and provides this surgical trip roughly the same time each year. It is very fulfilling to see and help these patients on a yearly basis when possible. This type of hand surgery is still considered a luxury in Vietnam for those who can afford it, as the deformity—despite being debilitating—is not life threatening. Nguyen will now have the opportunity to be more like other children his age and eventually have full function of all his fingers.

Starting a New Life

  Starting a New Life 
  Originally uploaded by interplast

Cao Lanh, Vietnam--Dr. Ian Wilson, Interplast volunteer plastic surgeon

This is 32-year-old Le, who was born with a condition known as congenital ptosis. She was never able to open both her upper eyelids fully. In order for her to see she had to tilt her head backward every time. This has really impaired her life up to now.
Today, she underwent surgery where a spare tendon was used to suspend her eyelids to her brow muscle. Now, Le can open her eyelids by raising her eyebrows. Her mother is delighted that her daughter has a normal appearance and can begin to enjoy the things that she missed out on so far.

Recovering Comfortably

  Comfortably Recovering 
  Originally uploaded by interplast

Cao Lanh, Vietnam--Dr. Ian Wilson, Interplast volunteer plastic surgeon

Thao is a healthy 4-month-old boy born with a cleft lip deformity. He is our youngest patient to whom we could safely offer surgery. Thanks to his mother’s careful attention, he has done very well after his operation, and his mother makes sure he gets all the attention he deserves. His hammock is very practical and comfortable as he recovers from his surgery.

Cahn and His Father

  Cahn and His Father 
  Originally uploaded by interplast

Cao Lanh, Vietnam--Dr. Ian Wilson, Interplast volunteer plastic surgeon 

Nguyen Huu Cahn is an 8-year-old boy who was born with his fingers fused together, a condition known as syndactyly. Last year the Interplast team successfully operated on him to release his little and ring finger of his left hand. This year the same fingers were released on his right hand. Nguyen’s father looked after him well after his first surgery and will do the same this year. He will need one final surgery next year to complete the process and have normal appearing and functioning hands for the rest of his life.

Burns and Clefts Keeping Us Busy

My Tho, Vietnam -- Michelle Springer, Webster Fellow  My Tho is very nice, especially with our hotel right on the Mekong River. The people have been friendly and hospitable.

We operated on a young Cambodian woman who was burned by acid in "drive-by" incident; it was apparently a case of mistaken identity. The kids who did it were never identified or caught. The patient had severe contractures of her eyelids and neck, which we operated on. She is very grateful and recovering well. Her cousin speaks perfect English (he lived in Oakland, California for a while), and he is staying with her night and day. He has an interesting story: he was a gang member in California and now lives in Southeast Asia helping drug addicts. He says that his mother helped him realize that the life he was living in a gang was wrong.

Next week we have mostly clefts on the schedule, a mixture of lips and palates. We saw an unexpected number of virgin clefts during clinic. There are a couple of patients (one with a cleft palate and one with a neck burn contracture) who are going to meet me and the next Interplast team in Cao Lanh next week. We will prioritize them and make sure to fit them in the schedule.

The Road Well Traveled

   
  Originally uploaded by interplast

My Tho, Vietnam -- Michelle Springer, Webster Fellow  This is one of my favorite photos of the trip to Vietnam so far--taken from the van window on the way to Saigon. The traffic here almost compares to India, except I don't fear for my life while driving (like I did in India, due to the number of vehicles bigger than us on the road).  I fear, instead, for the "scooter-ists'" lives.   Walking across the street is a different matter, of course. The biggest object on the road usually wins, I guess.  I have seen five people on one scooter, usually two adults and children of varying ages. It almost hurts just to see the babies and toddlers balancing on someone's leg, weaving in and out of traffic precariously.

Grace and Beauty

  Grace and Beauty 
  Originally uploaded by interplast

Dehradun, India -- Sheila Wolfson, Interplast Coordinator 

After a long day of surgery, our hosts took our team to visit “Cheshire Homes,” a residential facility in Dehradun that cares for the permanently disabled in the community.  This home was one of several founded by Lord Leonard Cheshire, Britain’s ace bomber pilot in the Second World War.  After noting the devastation of war, he decided to devote his life to establishing homes for the upkeep and care of people with disabilities who had no place to live and no one to look after them.

The home we visited was home to 50 people.  It was immaculate and organized.  The impeccable hygiene of the residents and lack of odor in the home stood out to us all.   The team was treated to tea and snacks and a dance performance by two of the residents, one being Kamala, a teenage girl who had been operated on by the Interplast team the previous year.  Her story was dramatic and moving, as Kamala had been attacked by a leopard on her way home from school.  As a result, she lost her leg and her face and eye were badly mauled.

After this devastating accident, Kamala left her village to go through her rehabilitation at the Cheshire Home.  It was there that she learned to use her new prosthesis. She eventually returned to her home, but less than two weeks after her return, Kamala asked to go back to the Cheshire Home to live, as she felt she received better care and had more opportunities there. She is a lovely girl and now attends high school in the area.  She amazed us all with her grace and agility during her dance performance, prosthesis and all.  Above, are photos of Kamala before her surgery last year and in her dance attire a year later.

Noma Patient's Face Reconstructed

  Michelle Spring, Webster Fellow, with Noma patient 
  Originally uploaded by interplast

Dehradun, India -- Michelle Spring, Webster Fellow   Here I am with a patient and a mold of his face. He had Noma (an infection that attacks the face) and lost much of the bone on the left side.  We placed an implant, based on that plaster mold, to reconstruct the left side of his face.

This trip will remain imprinted in my memory forever.  I hope to come back again. The need is absolutely incredible.

Chaotic and Colorful

  Namaste 
  Originally uploaded by interplast

Dehradun, India -- Michelle Spring, Webster Fellow  Driving in India is probably one of the most dangerous things I have ever consciously done. The stream of cars almost dance around each other---the drivers are definitely skilled.  There are absolutely no traffic rules, and there are no lanes.  Sometimes 5 or 6 trucks, cars, horses, motorcycles and bicycles cram into what should be one lane.  There are so many "near misses" and "almosts," that, eventually, my adrenaline has stopped rising each time and it becomes sort of mundane to think "Wow, I think we scraped our car with that truck," or "Hmmm, we almost had a head-on collision again...."

I learned last night to never give a begging child money; it took 30 minutes to shake off the hordes of kids who followed me around afterwards, begging and pulling at my jacket.  My heart breaks, though, thinking of them.

Laughter and Hardship

  Newspaper seller with polio 
  Originally uploaded by interplast

Dehradun, India -- Michelle Spring, Webster Fellow  While out walking one night, we saw a man who looked as though he had suffered from polio in the past.  His legs were deformed and he now lives about two feet off the ground.  He lifted each foot with his hands, and waded right into traffic before our eyes.  A woman standing nearby saw us staring and told us that he is self-employed.  We watched him cross 2 (or 3 or 5) lanes of traffic and deliver a newspaper that was in the back of his pants. 

Stories like this make me somewhat ashamed to think of my own country and some of the people relying on welfare or disability payments to survive.  Of course no place is perfect and no people are perfect, but I think that everyone living in "wealthy" countries should visit a place like India some time in their lives.The suffering is incredible.  Yet, children and adults living without health care, electricity, clean water, shoes....seem to be smiling and laughing everywhere.

A Burn's Lasting Mark

  Newlywed following burn 
  Originally uploaded by interplast

Dehradun, India -- Michelle Spring, Webster Fellow

This is our 26-year-old newlywed after cooking-fire accident.  She will need surgery to protect her eyes, to keep her from going blind.  Below is a picture of her before the accident.

Newlyweds

  Newlyweds 
  Originally uploaded by interplast

Dehradun, India -- Michelle Spring, Webster Fellow   

I found this interesting:  in clinic we saw a woman with a burned hand, which is very common.  Her left hand had a small, non-functional index finger.  In the US, we would amputate it as it serves little functional purpose to have a fused digit in that position.  Yogi told us that here, that is not an option.  Her marriage value will drop horrendously if she does not possess all five fingers.   It reminded me how important it is to learn about different cultures, as it can really impact compassionate health care delivery. 

The woman pictured here with her husband (a different woman than the one with the burned hand) was perhaps lucky that she was already married before she was burned in a cooking fire.

A Better Man

  Boy with disabling burns 
  Originally uploaded by interplast

Dehradun, India -- Michelle Spring, Webster Fellow   Well, we're one week into the Dehradun trip. This is an amazing trip.  India is such an overwhelming, chaotic place that seems to be so full of heart.  We have seen many, many severe burns. 

Drs. Yogi and Kush Aeron are amazing hosts.  Anything we ask for, they will find for us.   Yogi is involved with the care of every patient we see, and he and Kush already know most of them.  It is overwhelming to watch them work.  They are actually housing the post-op patients in their own living room right now.  The facilities are the most meager that I have worked in so far, yet the hosts and the care that is given to the patients by them are unparalleled. 

I hope Yogi doesn't mind, but I want to share something he said to us on the first day at clinic.  He told us that before he met the volunteers of Interplast, he did not know about all the profoundly poor, needy people in his own country who had such terrible burns.  He told us that Interplast has made him, first, a better man, and second, a better surgeon.  I was so touched by his emotions and that he shared them with us.  I think he is a wonderful man who is giving so much to humanity.

Doing Rounds

  Tim Sproule with Mamta 
  Originally uploaded by interplast

Dehradun, India -- Tim Sproule, volunteer plastic surgeon   

On rounds, I reviewed Mamta, who had smiles for us all despite having her arm tied to her nose!  The quality of care she is getting from Dr. Yogi and the local nursing staff has been tremendous.

A Poignant Case

  Lakpat's repaired nose 
  Originally uploaded by interplast

Dehradun, India -- Tim Sproule, volunteer plastic surgeon 
February 11: It is now Monday afternoon.  The trip is half over, and we have gelled together as a group quite well.  There have been a few minor GI upsets amongst the team, but nothing that has impaired our ability to perform.

Today we operated on one of the most poignant cases of the trip, Lakpat, who had been attacked by a rat virtually while suckling at his mother's breast when he was just five days old.  He lost a large part of his nose.  He is only one month old.

We performed yet another unique operation for him: a midline forehead flap, which seems to have reconstructed the defect well. He is the youngest patient I have ever performed surgery on during a trip, and by far the youngest for whom I have ever utilized a forehead flap.

A Tagilacozzi Flap

  Mamta, post-op.jpg 
  Originally uploaded by interplast

Dehradun, India - Tim Sproule, Volunteer plastic surgeon 

We have had a unique opportunity to perform a classic plastic surgical operation on young Mamta, who suffered disabling burns several years ago.  The procedure, call the Tagilacozzi flap, was first described in the west in the 1400's by Gaspare Tagliacozzi.  Dr. Yogi has informed us that the same operation has been performed in India for literally thousands of years; in their literature, it is described by Susrutta. 

Mamta has severe facial burns, and has lost her entire nose as a result. After discussing the options, we decided to utilize her unburned inner arm as a donor site and "pedicle" the tissue to her nose without detaching it from her arm.  She now will remain with arm draped over her head for the next two weeks, before having the connection detached by Yogi after we have gone.  It is only with an experienced burn surgeon like Yogi that Interplast would ever take on such a complex procedure.  We are confident that she is in the best of hands and we are proud to be able to help her with her problem.

Burn Patient Working in Hospital

  Burn Patient Working in Hospital 
  Originally uploaded by interplast

From Sheila Wolfson, Interplast coordinator: 

Mamta has been an indispensable help to us while we’ve been working at the New Disha Hospital and Interplast Surgical Outreach Center here in Dehradun. Whenever we need just about anything, Mamta is there for us. She actually lives at the hospital and has practically become a part of our hosts’ (Dr. Yogi Aeron and Dr. Kush Aeron) family.

In addition to being our host and working with our surgeons on many of our cases, Dr. Yogi runs his own private clinic and is one or Interplast’s Surgical Outreach Center directors. He is an extremely caring man who wants to provide medical attention to the poor people in his country. He is supported by Interplast to perform free surgeries for the poor during the year, when our team is not here.

Mamta is one of his outreach center patients and he has performed several reconstructive facial surgeries on her. Dr. Kush told me her story. When Mamta was just an infant, she fell off her bed and rolled into a “chula” (a clay pot filled with burning wood). She was burned and blistered all over her face and did not receive proper care at the hospital where she first received treatment. She continued to suffer from her burns and never had the resources to receive more care. Although the timing of everything isn’t quite clear, Mamta and her brother eventually moved to Dehradun and met Dr. Yogi. He was so taken with Mamta and her condition that he decided to employ both her and her brother in the hospital. He has performed several “outreach surgeries” on her, the latest being only a month ago. Her entire face has now been reconstructed. Mamta is pictured her with her face bandaged, standing with our two coordinators/translators. The bandages are there to keep pressure on her cheeks to help shape her face. She will need to wear the mask for another year. Despite her condition and the fact she hasn’t seen her family in two years, she could not be more pleasant. We are privileged to have her assist us.

Dehradun's New Disha Hospital and Interplast Surgical Outreach Center

Dehradun's New Disha Hospital and Interplast Surgical Outreach Center
Originally uploaded by interplast

Kerosene Lamp the Cause of Lakmi's Burns

  Kerosene Lamp the Cause of Lakmi's Burns 
  Originally uploaded by interplast

From Sheila Wolfson, Interplast coordinator:   

The majority of our burn patients have been women, most likely explained by the fact they do all the cooking over the open fires. When Lakmi was 12 years old, she was eating next to a kerosene oil stove when her “dupatta” (stole) caught on fire. She tried to put out the fire with her hand and was severely burned on the side of her body. The only treatment she received was an ointment, so eventually her skin contracted and she lost most of the movement in her elbow. After the doctors release her burn contractures and perform a skin graft, she should have increased movement in her arm.

Sonica and Her Father

  Sonica and Her Father 
  Originally uploaded by interplast

From Sheila Wolfson, Interplast coordinator:   

When Sonica's father came in the PACU (post-care unit) to comfort her after her surgery, he expressed his gratitude to our team. He was very emotional when he told us that he was a very poor man and could not have afforded to have his daughter helped if the surgery was not performed for free. It really touched our hearts.

Sonica Awaiting Surgery

  Sonica Awaiting Surgery 
  Originally uploaded by interplast

From Sheila Wolfson, Interplast coordinator: 

Sonica, age 5, was a precious little girl we saw on the first day of our surgery. We were impressed by how patient she was as she sat in her hospital garb while she kept herself busy coloring. In the picture, you can see how all the fingers on her left hand are contracted and will need to be released so she will have more functional use of her hand.

Dr. Ben and Burn Patients

  Dr. Ben and Burn Patients 
  Originally uploaded by interplast

From Sheila Wolfson, Interplast coordinator:   

Many of the 100 or so patients we triaged on our clinic day traveled down the mountain to be seen by our team of 14 doctors, nurses and translators. Although we had been told by our hosts we would see many burn patients, it was truly overwhelming to see so many extensive burns with complex contractures; many patients had not been properly treated in years. Since the folks in the mountains have no electricity, it was no surprise that most of their burns were obtained from cooking stoves that exploded.

On the Way to Dehradun

  On the Way to Dehradun 
  Originally uploaded by interplast

From Sheila Wolfson, Interplast coordinator:

For most of our team, this was their first time to this lovely town of Dehradun, at the base of the Himalaya Mountains. The majority of the us traveled more than 25 hours from San Francisco to Delhi and after staying overnight, we continued our journey by bus for another eight hours to our site in Dehradun. Although Dehradun is only 250 or so kilometers from Delhi, the poor condition of the roads that are filled with motorbikes, carts pulled by oxen, trucks and the occasional elephant or camel, made for slow travels. Sugar cane fields, dung factories, small shacks and vending stands were prominent along the roads. As we traveled up the road to Dehradun, those of us who were still awake were pleasantly surprised by the monkeys on the side of the road. We knew our adventures were just beginning.

Mamta Returns for Further Surgery

  Mamta Returns for Further Surgery 
  Originally uploaded by interplast

Dehradun, India- Dr. Tim Sproule, Interplast volunteer plastic surgeon.

Mamta is now 7 years old and has returned for further surgery to release her burn contractures.  She was severely burned when she was 5 months old.  Last year, Interplast surgeons worked to improve her ability to eat and talk, but many more surgeries are needed for Mamta.  Here I am with Mamta.

Pediatrician Checking Patient

  Pediatrician Checking Patient 
  Originally uploaded by interplast

Dehradun, India- Dr. Tim Sproule, Interplast volunteer plastic surgeon.

Dr. Joe Herbert, volunteer pediatrician, checks to see if a possible patient is well enough for surgery.

Evaluating Patients

  Evaluating Patients 
  Originally uploaded by interplast

Dehradun, India- Dr. Tim Sproule, Interplast volunteer plastic surgeon.

At clinic, our prospective patients give us flower wreaths, and we then set out to evaluate what we could do.  Everyone is very appreciative. We definitely have our work cut out for us!

Clinic Under a Tree

  Clinic Under a Tree 
  Originally uploaded by interplast

Dehradun, India- Dr. Tim Sproule, Interplast volunteer plastic surgeon.

After getting settled, we proceeded to the clinic to assess our patients.   This was like no clinic I have ever been involved with in all my years of volunteering!  Clinic day was held under a giant tree, in a massive park, under the bright sunshine, with a beautiful view of the surrounding hills.

Getting to Work in India

   
  Originally uploaded by interplast

Dehradun, India- Dr. Tim Sproule, Interplast volunteer plastic surgeon.

I had my usual difficulties getting to my destination.  This time, it was an ice storm in Toronto which delayed my flight from taking off for two hours.  I arrived in Newark for my connecting flight with 30 minutes to spare and a few miles of terminal to run through.  Thankfully, the Continental Airline staff was great, and everything made it all the way to Delhi. 

I was met at the airport by Kush Aeron —a dedicated surgeon from Dehradun—who with his father has developed a great partnership with Interplast to help burn victims.  Over the next day, I met up with the various members of our team—all volunteering their time and expertise to help the Doctors Aeron in their work.

Outstanding Team

  Outstanding Team 
  Originally uploaded by interplast

Quang Ngai, Vietnam-Nicole Friedland, Interplast Staff. Photo by John Urban.

Here's a picture of the incredible volunteers who made all this work possible. These individuals give up two weeks of their lives, work under exhausting circumstances and often give up pay at home to be in Vietnam. They have operated on about 80 patients and dramatically changed hundreds of lives. The tears of gratitude from patients really have said it all. What a team!

The Kindness of Our Patients

  The Kindness of Our Patients 
  Originally uploaded by interplast

Quang Ngai, Vietnam-Nicole Friedland, Interplast Staff. Photo by John Urban.

To will be staying with her aunt who lives nearby for the next few nights. (To, her aunt and I are pictured here.) Her aunt is beautiful and likes to play shy with the photographer, playfully punching his arm when he manages to sneak a shot.

They will return for To's check-up on Friday. She will then have a two-day journey home. Each time To sees us, she reaches out her hand to take ours.