So No Child Must Wait

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.