So No Child Must Wait

Gurpreet: Not Allowed in School Due To Burned Hand

  Gurpreet 
  Originally uploaded by interplast.

Jalandhar, India - Seth Mazow, Interplast staff:  This is three-year-old Gurpreet. She was burned by boiling water over a year ago while her mother wasn't looking. Her left hand is severely burned. Even though she is only three and is too young for school, the two schools in her village have told her family that she will not be allowed to attend because she will scare the other children.

Life is unfair. Gurpreet, like any child, deserves to go to school. It saddens me to think about all the children who will not be allowed to develop their mental gifts because of injuries and birth defects.

Luckily for Gurpreet, we will be able to help her hand and allow her the opportunity to attend school. For her, life will be a little more fair.

Here is a close-up photo of Gurdeep's hand.

 

Burn Victim Sarabh, Saved From Amputation

  Burn Victim Sarabh 
  Originally uploaded by interplast.

Jalandhar, India - Seth Mazow, Interplast staff: Sarabh is four and a half. When he was one and a half, he stuck his right hand in the oven. Oddly enough, he didn't cry, he just left it in and looked at it bewilderedly. His mother had gone to the village well, and a neighbor who was walking by saw Sarabh and pulled his little hand out of the oven.

His father is a truck driver with a drinking habit. He is gone much of the time, and he only leaves Sarabh and his mother a little money to pay for food. There is no way that she could afford reconstructive surgery for her son if Interplast didn't come to town. They went to a government hospital that treats poor patients, but the overworked surgeons there said the only option was to amputate his hand. The mother held out, hoping for something better.

The other children in the village play with Sarabh, but they also beat him up frequently because he is different and can't defend himself very well. He doesn't want to go to school because of the mockery he will endure. He is quite a handful, and his mother describes him somewhat charitably as "stubborn". That trait will serve him well after the surgery as he relearns how to use his hand.

Indian and American Anesthesiologists Discussing Techniques

  Richard Gillerman Speaking at the Indian
Society of Anesthesiologists 
  Originally uploaded by interplast.

The Interplast anesthesiologists were invited to talk at the monthly meeting of the Indian Society of Anesthesiologists,  Jalandhar branch. Team leader Richard  Gillerman talked about Interplast and our model of empowerment and Deb Russy gave a lecture about specific anesthesia techniques. Apparently she spoke in English, but I could barely understand her medicalese. Fortunately the locals could, and a lively discussion ensued.

Clinic Day in India

  Pankaj, Richard and David Assessing a Patient 
  Originally uploaded by interplast.

Jalandhar, India - Seth Mazow, Interplast staff:  We had a pretty grueling journey here to Jalandhar. After about 37 hours of airplanes, airports, delays, reroutings, customs officials and bus rides, we arrived late on Sunday night.

The next day we held clinic, where we screened and scheduled patients for surgery. About 50 or 60 patients came on Monday, and another 40 or so on Tuesday. We accepted about half of the patients.

Unlike most Interplast trips, there are very few patients here with primary cleft lips. The operation to repair these types of clefts is easier and shorter than burn reconstructions. The patients we scheduled need advanced surgery that will take a long time. So while we may not operate on as many patients as we would on a normal Interplast surgical trip, we will certainly be busy here in Jalandhar.

In the photo, local anesthesiologist Pankaj Poonj teams up with Interplast team leader/anesthesiologist Richard Gillerman and pediatrician David Gillerman to evaluate Nisha.

From Jalandhar, India: Ian Wilson with Burn Patient

  Ian Wilson Looking At A Burn Patient's Hands 
  Originally uploaded by interplast.

Jalandhar, India - Seth Mazow, Interplast staff: Greetings from Jalandhar, India! For the next two weeks, 15 plastic surgeons, nurses, anesthesiologists, pediatricians and translator/coordinators will be operating on poor patients at Dr. Puneet Pasricha's hospital. Dr. Pasricha is a Smile Train partner who has recently begun working with Interplast as well. He owns his own private hospital here in Jalandhar, and he lives right above it. He is our local host, and was responsible for providing access to suitable surgical facilities and finding patients who need free reconstructive surgery who have no other access to care. We will be working here for the next two weeks, so if you would like to find out more about how we work or ask a question of our patients, please feel free to leave a comment, and we will try our best to satisfy your curiosity.

Ian Wilson and Burn Patient Post-Op

Ian Wilson and Burn Patient Post-Op
Originally uploaded by interplast.

Tra Vinh, Vietnam - Ian Wilson, Webster Fellow and plastic surgeon: This is Huynh and I after her successful surgery. The bandage around her neck is a brace to keep her chin from falling onto her chest. It has been stuck there for so long that she needs time to regain the muscle capacity to keep her head up. As I noted in a previous post about Hunyh and burn patients in general, we cannot do much to make her scars go away, but we can have a big impact on her functionality. It is hard for me to imagine going through life with my chin stuck to my chest, and now Hunyh will only have to deal with that daily tribulation in her memories.

Reconstructive Surgery in Tra Vinh, Vietnam

  Ian Wilson and patient with booties 
  Originally uploaded by interplast.

Tra Vinh, Vietnam - Ian Wilson, Webster Fellow and plastic surgeon:  Our surgical trip here in Tra Vinh, Vietnam is going quite well. We are in a town of 70,000 which is definitely not on the tourist trail. We work at a local government hospital which is busy dealing with common illnesses. So far we've seen 70-80 patients in clinic, and successfully completed some cleft lip and palate repairs and burn reconstructions. All are recovering well so far. Despite some intermittent surgical trips to this rural area, not all cleft kids have been repaired, so we have a bit of a backlog to work through.  There is a great need for burn reconstruction here as well.

The patient shown here just had her cleft lip repaired.  The child is very unhappy because her mouth feels different, the stitches are itchy, and she is in a strange hospital with tall and pale foreigners.  The mother, however, is perfectly thrilled.  Many pictures of patients after their surgeries do not do justice to the gratitude that is felt by relatives, and will soon be felt by the patient after the healing process winds down. 

Here are some more photos from the surgical team.

Releasing Burn Contractures Gives Functionality to Patient

  Vietnamese burn patient 
  Originally uploaded by interplast.

Tra Vinh, Vietnam - Ian Wilson, Webster Fellow and plastic surgeon: Huynh is a good example of what Interplast does best via a team approach emphasizing teaching and airway safety.

This lady got burned when she was a child in a house fire, sustaining major burns to her face, neck, arms, and chest . She survived this significant burn but developed horrific burn contractures and scarring because of the limitation of primary burn care available to her here in Tra Vinh, Vietnam. This neck contracture does not allow her to tilt her head backwards, and she has significant functional limitations because her chin is really stuck on her chest. Even her lip has been forced out of her mouth. Over the years she has had a number of surgeries but other teams were reluctant to deal with her neck contracture because of the difficulties involved.

We successfully released her neck burn contracture and reconstructed her neck with a large piece of skin from her belly. She essentially underwent an abdominoplasty to harvest the skin graft and leave her with a nice thin scar on her belly wall. This is a very good use for this supposedly cosmetic operation.

The real important part of her operation consisted of getting a secure airway. Interplast personnel have developed a lot of experience with these challenging cases. We have found that the best way to do this in these challenging situations is as follows.

We use local anesthesia and some sedation with Ketamine to keep the patient comfortable while the burn scar contracture is released. The patient is breathing normally during this initial stage and even appears awake but has no discomfort. Then the neck can be fully extended allowing the breathing tube to be placed without too much struggle. Once this is done, the general anesthesia is delivered much like any other routine case.

Her operation took a few hours to perform safely and she now is doing well on the hospital ward while her skin graft heals. Next week, we will make a nice comfortable collar for her to reduce the risk of the contracture recurring.  She might not look as beautiful as she once did, but she will probably have normal functionality, giving her the chance to live a normal life.

No-nos In Action

  Baby With No-nos in Quang Ngai, Vietnam 
  Originally uploaded by interplast.

This little guy just had his cleft lip repaired. To prevent him from picking at the stitches and potentially pulling them out, he is wearing no-nos on his arms. No-nos are the padded restraints that prevent children from bending their elbows and touching their face with their hands.

The no-nos for the Quang Ngai, Vietnam surgical trip were made by an 8th grade community service class at Whitefish Bay Middle School in Whitefish Bay, Wisconsin. The class includes Kate Mesrobian, daughter of team anesthesiologist Dr. Jay Mesrobian.

Interplast would like to thank these students for their hard work helping heal children around the world.  Here are more photos showing the students' hard work.

Interplast Grand Rounds: Technology and Telemedicine

  IGoR screenshot (click to enlarge)
  Originally uploaded by interplast.

Interplast Grand Rounds is an innovative web-based program that allows doctors and surgeons from the poorest parts of the world to come together with expert medical professionals from around the world in a virtual teaching hospital. Many of our surgical outreach directors and other medical partners have only limited access to the latest techniques and journal articles, and fewer still have the benefit of having many skilled colleagues nearby to bounce ideas off of for challenging cases.

So we created Interplast Grand Rounds (or IGoR, as we fondly call it around the office) that allows physicians from developing nations to post digital photographs and case summaries of complicated cases requiring reconstructive surgery and/or anesthesia.  Experts from around the world log on and offer insight and advice into available surgical techniques and follow-up care. When a new case is posted, all members are emailed and are free to comment and upload pictures.

In the last 24 hours, there has been significant activity regarding one case posted by our surgical outreach director in Zambia, Dr. Goran Jovic. The site is password protected, but we have made a screenshot of the discussion thread which is visible in its full size by clicking on the thumbnail above. 

Note the times and locations of the posts. 11 posts from six people (Gary F had a colleague post under his name for his last post) in five time zones covering three continents, all in the span of 18 hours.

This is an incredibly useful resource for people like Dr. Jovic, who is the only plastic surgeon in all of Zambia, and would have no other sounding board for difficult cases.

***NOTE: Some of the posts, including the original one demonstrating the initial problem, have photos. I have taken them out of the screenshot because they pretty graphic. If you would like to see the original version with pictures included, you may do so at your own risk.***