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.