Dehradun, India 2009

Punkaj's Letter

Dehradun, India-Nicole Friedland, Interplast chief development officer. Photos by John Urban.

Punkaj stayed at the clinic for the entire week leading up to his surgery. It was too far and expensive of a journey to travel back and forth between his home. A few days before his surgery he respectfully asked the surgeons if he could have a different surgery then they had originally planned. He was set to have additional work done to further release his neck. Instead, he asked if he could have the contracture in his armpits released. He shared that his school is a long way from his home and he has to ride his bike to get there. Because of his contractures, it is difficult for him to lift his arms high enough to hold the handle bars and this difficulty was impacting how often he was able to attend class. Of course, the doctors agreed and before we left Punkaj received the surgery which will give him much greater movement in his arms and shoulder.

Here is an excerpt from Punkaj's letter to the volunteer translator and team: "You and all your team members are very nice. All of you are God sent to us. You are like God on earth for us. All of you have our heartfelt prayers. May God give you all the happiness and may he grant all your wishes. May you always be happy."

In this blog, although he may never see it and he surely doesn't understand English, I'd like to write my own note back:

Punkaj - Your bright and hopeful spirit touched our hearts. It was our joy and our privilege to be able to help you. Every day when we arrived at clinic you greeted us with a smile, a 'good morning maam' and stretched our your hands to take ours in greeting. What a lovely person you are. We wish you success and happiness.

Partners in Progress

Dehradun, India-Nicole Friedland, Interplast chief development officer. Photo by John Urban.

We've been very happy to have Wai-Ling Eng, member of the board of directors of Ronald McDonald House Charities (RMHC,) join us for the second half of the trip.

RMHC has been one of Interplast's strongest partners, supporting our surgical programs for over a decade. It was great to see Wai-Ling interacting with all the kids. Her background as a nurse was truly helpful, and she was welcomed in to the operating room to observe numerous operations.

At the dinner last night with our local partners, Wai-Ling shared the following:

"My experience with you has re-affirmed the reason we fund you and the type of work you do, which is consistent with our mission to create, find and support programs that improve the health and well-being of children...if you change a child's life, you change a family's life too, which can change a community and ultimately the world. What you do accomplishes this with long term and meaningful impact to children, their families and their communities."

We'd like to thank Wai-Ling for making the long journey to join this team. Her energy and enthusiasm were a welcome addition to our experience. We would like to thank and recognize RMHC for their continued commitment to healing bodies and changing lives.

Punkaj

Punkaj
Originally uploaded by interplast

Dehradun, India-Nicole Friedland, Interplast chief development officer. Photo by John Urban.

Punkaj took a full day on the bus to travel here for the surgery, so he's been staying at the clinic until his surgery this coming week. We've all fallen in love with him—he has a beautiful smile, bright eyes and a loving heart. He wrote the entire team the sweetest letter of gratitude. I've asked the interpreter to translate it, and I will post it in a future blog.

Punkaj burned himself when he was making tea, and he went to light the gas stove. He didn't know there was a leak in the gas, and the fire exploded on to his neck, chin and torso. Interplast performed surgery on him last February to release his chin.

Renu before her burn

Renu before her burn
Originally uploaded by interplast

Dehradun, India-Nicole Friedland, Interplast chief development officer.

This is a picture of Renu before her burn accident. She is the woman mentioned in the blog post titled “Ravages of burns.” Renu has been a really tough case for the team. Her burns are a result of domestic abuse. It's been incredibly challenging for us to have her husband here with her. She is clearly traumatized in every way. She has a master’s in geography and was making a good life. She told the translator, "Look at me. People must think I am the most useless person on earth. What good is my master’s?" She moves gingerly, with obvious pain. Her case has been one of our most disturbing ones.

Surgery was done on her last week to release her lip and nose contractures.

Priyanka recovering

Priyanka recovering
Originally uploaded by interplast

Dehradun, India-Nicole Friedland, Interplast chief development officer. Photo by John Urban.

This is Priyanka in recovery. Because her ear was closed, and the surgeon opened her canal during surgery, she's draining a significant infection. We have kept her at the clinic until she recovers as she and her father have a long journey home and won't easily be able to return should complications arise.

We've all fallen in love with her. She's become quite comfortable with us now and is a sweet little chatter box—in Hindi of course!

Prachi

Prachi
Originally uploaded by interplast

Dehradun, India-Nicole Friedland, Interplast chief development officer. Photo by John Urban.

We can all tell from Prachi's beautiful smile and happy nature that she is easily one for the most popular girls in her school. The problem is she's been held back three grades, because she so frequently can’t attend that she's fallen behind. Prachi's loose synthetic dress caught fire when she stepped over a lantern. Her thighs and groin area were badly burned and contracted together so she could not separate her thighs, and her entire genital area was covered in scar tissue.

This case quickly emerged as the most important one for the team. The doctors felt they had the chance to give this little girl her future back. We also worried that she is on the cusp of menstruation which will raise new serious complications for her. She's about 11 now. The doctors debated this case heavily, considering doing an entire release or a release in two stages with separate surgeries over the coming year. The concern was that her burns were so significant that the full release might be too much pain for her to endure. There are limited narcotics available, even to doctors, in India and the team felt torn between the ethical need to release her legs and the ethics of choosing a course that could result in excruciating pain for a child.

The surgery was completed on Thursday. The doctors informed us that the scar tissue was simply between her two thighs and her groin is completely untouched by the scars. They bandaged her thighs and we all breathed a great sigh of release. Now Prachi can walk and run and go to school. She can grow in to a woman and have future children of her own.

We've been visiting Prachi in the recovery ward and she's doing fine with the pain. Every time we see her she asks immediately, "When can I get up and walk?!"

Soon. Very soon.

Tears of joy

Dehradun, India-Nicole Friedland, Interplast chief development officer.

One thing that touched me very much today happened when Dr. Kush was taking us over to the ward that is housed in his living room.  The patients and their families tend to sit in the front courtyard where they've set up a TV and a small stove where a vendor has come to cook eggs.  The team likes to refer to it as the hospital cafeteria.  We came around the corner to a private area and two men were sitting together, huddled over, and one of them was sobbing.  Kush immediately went over to see what was wrong.  It was one of the fathers whose child had had her cleft lip repaired that morning.  He was overcome with joy to see her healed and whole for the first time in her life.  She lookedto be about 10 years old to me.  

The Oscars and Humanity

Originally uploaded by interplast

Dehradun, India-Nicole Friedland, Interplast chief development officer. Photo by John Urban.

Yesterday the Oscars were held in America. We were delighted to learn that our wonderful partner The Smile Train received an Academy Award for best short documentary for the film Smile Pinki. The team was hoping to be back to the hotel by 8:30 pm to have a small Oscar party and watch the rerun of the show on the English TV station. How striking a contrast to think of the patients we are working on now and the challenges they face in their lives against the epitome of the celebration of all that is beautiful. I am so grateful that this forum became a chance to share the story of poor people around the world who simply need help from their global community. This is called humanity.

Dr. Kush

Dr. Kush
Originally uploaded by interplast

Dehradun, India-Nicole Friedland, Interplast chief development officer. Photo by John Urban.

Dr. Kush Aeron is the son of Interplast's surgical outreach director, Dr. Yogi Aeron. You can tell immediately that he's a special human being, deeply committed to helping those less fortunate than himself with his medical skills. I've been blown away by his energy and humility. From scrubbing in for surgery, inviting in local community members to be inspired to support this work, and translating for patients to simply carting in water for the team, he is constantly busy and working to help the team see as many patients as possible in our two weeks here. This family is deeply committed to their service. They live in a home next to the small surgical clinic with two operating rooms. Because the team will be doing multiple surgeries a day, and the recovery ward can't hold all the patients, they have cleared out their own living room and turned it in to an additional ward. Several patients who have been abandoned are actually living with them and employed at the clinic. One lovely girl named Mamta is just such a case. Her entire face was destroyed when she was just one year old and the Aerons are slowly reconstructing it for her. I'll tell you her story in a future blog.

Anil

Anil
Originally uploaded by interplast

Dehradun, India-Nicole Friedland, Interplast chief development officer. Photo by John Urban.

Anil is a 50 year old who lost his livelihood as a journalist because of his burn. He has trouble turning his head and lifting his arms so he can't ride a motorbike to get the latest stories. He's already had several surgeries by Interplast and his improvement is significant. He burned himself when he was cooking, and he lit a match and the gas exploded. Anil took great care to comb his long healthy hair and set it nicely for his photograph. He was very interested in John's (our team photographer) camera and told us he was one of the first journalist/photographers to shoot with a digital camera in India. Today he will have his arm and neck contractures released.

Burned Mother and Son

Burned Mother and Son
Originally uploaded by interplast

Dehradun, India-Nicole Friedland, Interplast chief development officer. Photo by John Urban.

The trip is very inspiring but also deeply disturbing. I found myself having trouble sleeping last night because it is so overwhelming. This morning we started to interview the patients to get their stories and photos. The first one was a mother and son who were both badly burned. The mother was sharing her story of an exploding stove. Our local partner came by and told us that he had learned through a source that she had actually put the child in her lap and self immolated, probably due to marital abuse. I actually was overcome and had to leave the room to compose myself. Of course, we can't know the real story, but her little boy's face is just destroyed.  He's just five years old and so adorable behind all that terrible scarring across his face. Such a tragic story. Some of these people are grossly disfigured but they are just humans. I feel so badly for them. Both I and the translator were crying several times this morning. These stories are hard to hear and to see, but what is hardest is to see how much suffering is in the eyes of these people.

Pagwati

Dehradun, India-Nicole Friedland, Interplast chief development officer. Photo by John Urban.

This beautiful lady was burned when she was adding kerosene to a lit lamp and her synthetic clothes caught fire and fused to her skin.  Her neck is restricted in movement and her armpit is contracted, so she can't raise her hand above her shoulder.  She was amazingly joyful and her eyes were at peace.  We were all struck by her lovely spirit.  Many of the burn patients are depressed and withdrawn.

I asked specifically about her ability to remain so joyful in light of what she has suffered and how she is living each day.  She paused, and was silent.  Tears came to her eyes and she told us that the only reason she could feel this way was because of how her family loved her and accepted her.  She said her husband has done everything possible to get her help and is a huge worry-wart.  She warned us that he would be very anxious during her surgery today.  Her four sisters have all jumped in to help her and to care for her two small boys while she is away.  Her own parents have passed away but her husband's family is very caring to her.  She says as long as they accept her, she is happy.  

Priyanka

Priyanka
Originally uploaded by interplast

Dehradun, India-Nicole Friedland, Interplast chief development officer. Photo by John Urban.

Today we meet Priyanka. At the young age of 8 years old she's already endured multiple surgeries. She was burned at age one when a household cleaner, containing acid, spilled all over her head and chest. When Interplast volunteer pediatrician Dr. Janet Volpe saw her on clinic day, she cried out her name with delight. Dr. Volpe was on the team trip in 2006 that did surgery on Priyanka to improve her eyelid and give her an eyebrow.

Her father remembered Janet and immediately rummaged through his bag to show a certificate of appreciation that the Interplast team had given him in 2006. He made himself incredibly useful on the ward, helping all the other patients with their recovery. It was a nice reunion. They had come to seek more surgery. After being examined by surgeons Dr. Tom Davenport and Dr. Eric Mooney, it was agreed that they would do some more work to improve Priyanka's eyelid and to work on her ear, which was severely damaged and on further inspection, completely closed. It is our hope that by opening the ear canal, she may gain hearing in that ear.

I sat with the father who enthusiastically shared his gratitude to Interplast. He said that as he prepared to leave the house for clinic, the roads were covered with a foot and half of snow and the buses were not running. He grabbed his two travel bags and picked up Priyanka and walked five kilometers (approximately 3 miles) through the snow until he could get to open roads. He is determined to come every time Interplast sends a team to seek more surgery for his daughter. He told us that before Interplast performed surgery on Priyanka, he was distraught, but as his daughter improved he is regaining hope for his daughter and feeling better every day.

I was struck by this. Priyanka is very disfigured. No matter how many surgeries she receives, she will never fit in neatly to society. I asked Dr. Kush why Priyanka’s father is so heartened. He pulled her original chart and I immediately understood. When Priyanka first came for surgery, her neck was fused to her chest and she could barely turn her head, she is now able to with ease. Even more visually alarming, and certainly endangering to her vision, her left eyelid was fused open to her eyebrow area. Doctors were able to release her eyelid, saving her sight and dramatically improve her appearance.

It is overwhelming to realize how deeply these small changes improve patients' lives. These are human beings, perfectly healthy and normal, whose outer appearance is forever and permanently disfigured. Often times, their spirits are equally traumatized. I hope as these two weeks go by we will lighten their spirit and find the shared joy of our common humanity. It is so good to know that we can help alleviate their suffering, even in small steps over the years.

Ravages of burns

Ravages of burns
Originally uploaded by interplast

Dehradun, India-Nicole Friedland, Interplast chief development officer. Photo by John Urban.

All around are people who have literally lost their faces and hands to the ravages of burns. A chin is melted on to a chest, fingers are stuck in a clump, lips are curled open permanently and noses burnt or contracted away. These patients have been burned in fires, some recently and some as small babies. Sadly, for some, there is nothing we can do. A young woman's eyes avert from us with shame. Her bottom lip is now permanently fused open under her chin, exposing gum and teeth. Six months ago she was burned when a gas cooking stove exploded. She is already grossly disfigured. Today, there is nothing we can do for her. At this stage, the wound must heal first. Come back next time, we encourage her. We ask the team's physical therapist to try and work with her to improve the healing process and prepare her for surgery.

It is heartbreaking. Patients’ eyes show shame and suffering, but they have done nothing to warrant shame. I am struck by the pain they live with—both physical and emotional.
We'd like to be able to erase all traces of the disfigurement, as is often easy to do with a cleft surgery, but these are much more complicated cases. The scars of their burns will remain with them forever.

There are stories of hope though. I am learning that with burns we can find hope in small ways. We met a man who had a neck release operation performed by Interplast at an earlier date. He enthusiastically turned his head left and right and up and down, showing his freedom of movement. He shared that since his surgery he's secured a job as a driver, something he could never do before his neck release.

Our team

Our Team
Originally uploaded by interplast

Dehradun, India-Nicole Friedland, Interplast chief development officer.

Our team is enthusiastic and excited to be here—knowing that we can make a difference in these people's lives and grateful for the opportunity to do so.

Overwhelmed and grateful

Overwhelmed and grateful
Originally uploaded by interplast

Dehradun, India-Nicole Friedland, Interplast chief development officer. Photo by John Urban.

When we arrive at the small hospital which is run by Dr. Kush Aeron and Dr. Yogi Aeron, director of Interplast's surgical outreach center in Dehradun, India, we are immediately overwhelmed by the pictures of patients, before and after, plastered over the walls of the reception room. It is shocking and alarming to realize the plight of these patients who are often severely disfigured by burns or congenital deformities. We stare at the pictures and silently take it in. Doctors who have been here before recognize past patients. For me, it is overwhelming. Even though I work at Interplast, I've never seen so many alarming photos in one setting.

It is good preparation for the next step of the day, which is meeting all the prospective patients. When we first arrived, patients had lined up to meet us. Many members of the team get teary, some unable to talk. We don't often see these kinds of disfigurements. Even experienced doctors, who have been on many Interplast trips are quiet, struck anew by the enormity of the challenges faced by these poor individuals.

Within hours, it is all down to business and examinations. Patients are greeted, examined, procedures discussed. I am captivated by the surgeon’s discussions. A patient will sit before them with hands frozen into claws, eyes pulling down toward cheeks, lips curling back, arms stuck to sides.

My favorite part is hearing a surgeon ask, through the translator, "What would you like done?” Each patient has something clear in his or her mind, some improvement which will make life better. Afterwards, the pediatrician and anesthesiologist examine every patient to make sure they are healthy and ready for surgery. At the end of the day there are 45 patients scheduled over a two week period—many will have multiple operations. We know many more patients will arrive. As we close down the clinic, two more patients arrive and are scheduled for surgery the very next day.