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« September 2007 | Main | November 2007 »

The Challenges Faced on the Field

From Dr. Kiran Nakarmi, plastic surgeon and director of Interplast’s Surgical Outreach Center in Nepal:

Our team was on an outreach trip in Lumbini Nursing Home in Butwal, Nepal. Toward the end of our stay, we were informed by one of the parents about a child living with a cleft lip in his village. The child belonged to a fishing community which represents the poorest society in Nepal. The fishing community is referred to as Bote. They subsist solely on fishing, owning no land to farm or property.

In the Bote community, men have the reputation of spending their leftover money on alcohol and not caring well for their children. The women typically don’t travel outside the village, making it virtually impossible for the child to reach us for surgery.

We were able to get the phone number for the only phone available in the entire village. With some persistence, we were able to convince the phone owner to call the child along with his father. We then kept the father on the phone for a few hours while we could arrive to see the child.

We left Butwal at 6 pm and arrived at the village at 9 pm. The monsoon rain had begun to fall, and the narrow road was full of bends, making our drive an unpleasant experience. We finally reached the Kaligandaki River and found it was swollen due to the monsoon rain. Since the road ended there, we had to cross the river using a suspension bridge and walk through the middle of a jungle to reach the village.

When we finally arrived, we found to our dismay that after waiting a few hours the father had already left with the child. Disheartened we drove back to a nearby hydroelectricity station where a phone was available. We called the village again and arranged the child be brought there. Finally, around 10 pm we were able to see the child. We drove him back to Butwal with us and he was kept in the hospital overnight.

The next morning we went to the hospital expecting to see him and operate, but when we arrived, the father had taken the child without any notice-thinking the surgery would cost them money. Despite our many attempts to explain the surgery and accommodations were free, they were not convinced.

It was a very sad moment for all of us. We did our best to communicate with them but failed. From my experience, many of the poor people we work with have numerous questions on their minds but are reluctant to ask them. We learned a valuable lesson from this incident. I hope next time we can help this child after helping the parents to understand our humanitarian intentions and that their child will receive surgery without any cost to them.

Operating on Drissa

Beverly Kent, October 3, 2007

We will have probably our longest day yet today. The patients are just so numerous and needy and there is much to do. We are doing our best with what we have.

One of the patients for today is Drissa . He was the patient we operated on last year who had lost his entire eyelid (and had many other injuries) when he was set on fire by one of his father’s wives. Jean Labelle reconstructed his upper lid last year; Roberto will reconstruct his lower lid today. Drissa was living on the street when we met him last year. He was brought to us by a group of U.S., French, and Canadian people working here who had adopted his cause and wanted to find care for him. Since then, he has found a room to live in and is working as a janitor at a Canadian organization.

The team party for our host colleagues is tomorrow evening. As of now, we have over 70 people coming, not including the team. Tim, the American doctor who runs a street clinic for kids, was able to get us a room at the American International Club of Bamako, which used to  house the U.S. Marines guarding the U.S. Embassy. The woman running the center is an American who was married to a Malian. She has been extremely nice and helpful in putting together our reception.

Exchange in session

Beverly Kent, October 2, 2007

Yesterday, Mark Singleton held an informal session with the anesthesia staff at the hospital. He really enjoyed the exchange and said they asked very good, probing questions. He told me that it is amazing how little they have here in terms of equipment and supplies, but the chief anesthesiologist had a good grasp of the information in his session. . Tomorrow morning the surgeons and nurses will be holding their sessions with the hospital personnel.

Removing a heavy load

Beverly Kent, October 1, 2007

Last week, we operated on an 11-year-old girl who had keloids that completely covered her ears. The surgeons removed over two pounds of keloid from each ear. The poor girl was carrying such a heavy load; we couldn’t believe it. Marshall did a skin graft on both ears and hopes that the keloids will not grow back, which they tend to do.

Day trip to Segou

Beverly Kent, September 29

On Saturday after making rounds, we went on a long road trip to Segou, a town north of Bamako along the Niger River. The village tribesmen were fishermen and we were able to see how they lived in their adobe huts. The children ran around playing while the women were busy preparing meals. The open fires everywhere were an indication of why we see so many burn contractures on the children who come to us for surgery. Marshall was the big hit with the kids; everywhere he went happy, laughing children surrounded him. Their big smiles were contagious and we all delighted in their spirited play. After another long hot trip home, we fell into bed exhausted but happy with our day.

Interplast new Chief Medical Officer in Baltimore

On October 11, Johns Hopkins Center for Global Health opens its exhibit of inspiring photographs by renowned photographer Phil Borges, illustrating the work of Interplast in Vietnam and Peru. The exhibit, open to the public, will be in the East and Miles Room, off the Turner Concourse in the School of Medicine from October 11-19.
Interplast’s new Chief Medical Officer Dr. Scott Corlew― will give a short talk about Interplast’s work at the exhibit’s opening reception at 5:30pm October 11. If you are in the area, please join Interplast and Johns Hopkins for an evening of touching photography and engaging conversation.
Please contact us for further information.

Burns in Bamako

From Beverly Kent,
Director of Volunteer Services (October 1):

We are doing very well as a team. We have completed 44 surgeries so far and we are certainly going to surpass the number we did last year.

Anesthesiologist Mark Singleton will be giving a presentation to the local staff today. They are very eager to learn and have given him a list of topics they’d like covered. The same goes with the surgical and nursing staff. Mostly, they are interested in the basics of burn care. The burns here are horrific. We saddened at the horrible burn scars and contractures and how avoidable the burns are in the first place. We are glad the medical community―at least the hospital we are working from― is concerned about burn care.  Severe burns are a huge problem in Africa and many developing countries. For example, African children lose six times more productive years from disabling fire burns than from war.

Jacques continues to be the hero of the team. He is exactly the type of coordinator each trip should have. Not only is he able to hop on the back of a motorcycle at a moment's notice to get us essential items, he is so sweet with the kids and the locals. He has even learned lots of Bambara and is able to comfort the patients. The staff loves him. They seem to love all of us and appreciate everything we are doing.

We are also going to have the team party at the American International Club of Bamako.

Must go back to work. Just wanted to give an update.

Global Health