Jalandhar, India 2007 Surgical Trip

Using Humor To Teach Female Empowerment

Apologies for the bad audio in the video, the recovery room is a loud and hectic place.

Paula And An Unhappy Camper

  Paula And An Unhappy Camper 
  Originally uploaded by interplast.

Paula is a recovery room nurse. She monitors the patients as they wake up from anesthesia. This little guy just woke up from hand surgery, which is usually pretty painful. As you can see by the look on his face, he's not a very happy camper.

If You Insist...

  Richard And Seth Dragged Onstage 
  Originally uploaded by interplast.

Team leader Richard Gillerman and I coyly hid behind our cameras for a while, hoping we wouldn't suffer the nurses' fate.  We were quite content to remain in the background, watching the merriment.

That lasted a little while, but then the nursing students remembered us and dragged us on stage, much to our embarrassment. As you can see, I (on the left) was enjoying myself more than Richard (on the right) was.

Dancing After The Ceremony

Dawn Addressing Nursing Students

  Dawn Addressing Nursing Students 
  Originally uploaded by interplast.

At the ceremony, Dawn addressed the nursing students as the guest of honor and told them to respect themselves, as nursing is a respectable profession.

All of the nursing students told the Interplast nurses that in India, nurses are not well respected. This was a common complaint, and hopefully they took Dawn's words to heart.

Tour of Nursing School Facilities

  Phoenix Nursing School Facilities 
  Originally uploaded by interplast.

The teachers took our nurses for a tour of the facilities. This is the mock recovery room, where the students are taught about proper post-op care.

Candle Lighting

  Candle Lighting 
  Originally uploaded by interplast.

All of the Interplast nurses had a role of honor at the candle lighting ceremony. In this photo, nurses Careen Andrada and Jodi Clements light the candles of the students. After all the candles were lit, everyone recited the nurse's oath.

Nurses Invited to Candle Lighting Ceremony

  Interplast Nurses in Saris 
  Originally uploaded by interplast.

Dawn Lambie made such an impression as a nurse educator on the local nursing students that they wanted her and the rest of the nurses to go to a candle lighting ceremony at the nursing school. To my knowledge, it was the first time that Interplast nurses have been so honored.

Some of the lecturers came to the hotel early to dress up the nurses in traditional saris for the ceremony. They looked stunning.

Jalandhar Nursing Students Discuss Lessons

I talked with some of the nursing students after one of Dawn's lectures and asked them about what they learned.  It's a little hard to hear since the rest of the students were leaving the lecture room and we couldn't really break away to a quieter place.  Sorry!

Successful Surgery For Nisha

  Nisha In The Recovery Room 
  Originally uploaded by interplast.

Nisha's surgery went very well. Even though she is wearing a brace, you can see that the burn contracture has been released and her head is now free from her chest.

Nisha About To Have Surgery

Nisha About To Have Surgery
Originally uploaded by interplast.

Nisha is shown here on the operating table, wincing as the anesthesia is injected into her wrist. As eager as she was to have the surgery, she was a little scared of the needle.

Nisha Being Evaluated For Surgery

Nisha Being Evaluated For Surgery
Originally uploaded by interplast.

The mother considered bringing Nisha to a government-run charity hospital. But the government has rules in place to stem the killing of women, and would suspect the family of intentionally harming Nisha. This would lead to investigations that might result in punishments or necessitate an expensive bribe.

So Nisha came to Interplast. We will release her neck contracture so she can have head and neck mobility. She will come back next year for more surgeries, and will begin the process of regaining her functionality.

Nisha

Nisha
Originally uploaded by interplast.

This is Nisha, a twelve year old girl who got burned when her dupatta (an Indian scarf that is draped around the shoulders) caught fire as she was bending down to help cook. She has five sisters. In many places, such a family would be considered a blessing. Here in India, it can be a curse.

During clinic day, Nisha's mother pleaded with us to help Nisha, because she has five sisters. Nisha is the second oldest, and traditionally, the daughters are married off from oldest to youngest. Even though her burn is an accident, no one will want to marry her because of her disfigurement, inability to perform basic tasks due to her burns and the perception that her luck will befall children.

Since no one will marry her, her four younger sisters will have a much harder time finding a husband, and in rural Indian society, being an unmarried woman is a mark of shame and sadness.

Her mother sells pillows and sheets door-to-door, and heard about Interplast when she came to Seema and Puneet's house to ply her trade. Over time Seema heard about Nisha and told her mother to bring her in to see the Interplast team.

Burn Patient After

  Burn Patient After 
  Originally uploaded by interplast.

As you can see from the photo, the surgery was successful. In the ward he had his arm propped up on pillows in between his exercises, which consisted of him holding his arm up as far as he could for ten seconds at a time. Even though he needs more surgery, his ability to use both arms normally will make his life a lot better.

He was very thankful to the team for working his arm, and even though it's not healed completely, he knows what a difference it will make.

On a related note, the team would like to thank the Danellie Foundation for their generous support of this surgical trip.  The team is proud to be able to offer high quality health care for free for those in need, and we would not be here without the Danellie Foundation's partial funding of our efforts here.

Burn Patient Before

Burn Patient Before
Originally uploaded by interplast.

This man was burned in a car accident. His left arm is stuck in a bent position. Like many burn victims, he needs many surgeries to give him normal functionality. Unfortunately, Interplast could only do one operation for him, and his top priority was to have free use of his left arm.

Suraj And Family

Suraj And Family
Originally uploaded by interplast.

Their family is incredibly poor. They come from Bihar, the poorest state in India, and are strangers in Punjab. When he can find work picking potatoes, the father makes less than $2 a day. When there isn't any work in the fields, he scrapes by doing odd jobs.

Without Interplast, there is no way Suraj would have had a chance at a normal foot. Since he will probably be pulled out of school at a young age to help provide for the family, the jobs available to him will be manual and will require him to have working limbs. Thanks to Interplast, he will be able to provide for his family.

Suraj

Suraj and Mother
Originally uploaded by interplast.

This is Suraj. His mother thinks he is about two and a half years old, and she doesn't know how old she is herself.

One day, she was cooking in their home when an oil lamp fell to the floor and exploded. The fire burned Suraj's foot, causing him incredible pain and inhibiting his ability to walk or run. The other children don't like to play with him since he can't keep up, and even though they know that he was burned in an accident, they tease him frequently.

Dawn Teaching Nursing Techniques

Dawn Teaching Nursing Techniques
Originally uploaded by interplast.

Dawn is teaching some of the local nurses proper patient care in the recovery room. The students really appreciated her hands-on teaching style.

Nurse Education

  Dawn Lambie Lecturing 100+ Nursing Students 
  Originally uploaded by interplast.

Dawn Lambie is a nurse educator from Sacramento who lectured about 100-150 nursing students for two hours every afternoon. Most of the students were in the second or third year of their nursing education. Her topics ranged from burn management and organ functionality to patient care.

The teachers at the nursing schools were thrilled to have a guest lecturer who had different experiences from their own and could bring her own perspective to the students.

I talked to some of the nursing students and asked them what they thought of Dawn's lecturers and whether they would have learned these lessons from their own teachers at a later date. They told me that they really valued Dawn's presentation style. While they would have learned most of the content from their teachers, her explanations were really in-depth and well illustrated.  They really enjoyed getting the perspective of a nurse in a different medical environment than their own.

Puneet Talking To Mother of Cleft Baby

Puneet Talking To Mother of Cleft Baby
Originally uploaded by interplast.

This mother of a baby with a cleft lip saw the local advertisements about Interplast providing free reconstructive surgery and found the team at Puneet's Hospital. The baby, at only seven weeks of age, is too young to be operated on, so Puneet told the mother to come back when the child can withstand the rigors of anesthesia. He also explained proper techniques for feeding the child, and answered her many questions.

Nandini After Hand Surgery

Nandini After Hand Surgery
Originally uploaded by interplast.

Nandini's surgery was successful, and she will have more distinction between her fingers that will make it easier to use her hands for tasks such as eating and writing. Her collection of cute hats and her adorable little cooing sounds made her a favorite of the ward.

Drawings Hanging Up in the PACU

Drawings Hanging Up in the PACU
Originally uploaded by interplast.

Some of the children who were bored while waiting for their surgery began coloring. Once we put a couple of the pieces up in the PACU (recovery room), more kids became interested in joining in on the fun.

The kids are not allowed to drink or eat anything for hours before the surgery, and the hunger can be uncomfortable and distracting. As any parent can tell you, this can lead to quite a contagious bout of crankiness and tantrums. Luckily, coloring seemed to diffuse a lot of this tension, while brightening up an otherwise dreary room.

Nandini Undergoing Anesthesia

Nandini Undergoing Anesthesia
Originally uploaded by interplast.

Even though Nandini shrieked when taken away from her mother to undergo surgery, she was still pretty adorable. Dr. Raul Peragallo, the anesthesiologist tasked with putting her to sleep so the surgeons could repair her hand, was still smiling as she wailed away. Minutes after this picture was taken she was soundly asleep and the plastic surgeons went to work.

Nandini Doesn't Need Fingers To Be Cute

Nandini Rocking The Hat
Originally uploaded by interplast.

Nandini is cute as a button. She has amniotic band syndrome, which is a failure of the fingers to fully form. Her left hand only has two fingers and no opposable digit, which we will remedy. Her big brown eyes made her a favorite of the team and the ward, and she quickly found herself with dozens of aunties clucking about her. There is something about babies in hats that magnifies their cuteness.

We Made It In The Local Paper

David Norton Reading About David Norton
Originally uploaded by interplast.

Our participation at the Indian Society of Anesthesiologists meeting a few nights ago made the local newspaper. Pediatrician David Norton was quite keen to see if the photographer got his good side.

Madhu Anand Multitasking

Madhu Anand Multitasking
Originally uploaded by interplast.

Madhu Anand is one of our coordinator / translators. Her job never ends. She coordinates a thousand details and is always doing twenty things at once. While everyone else leaves their work behind at the hospital, she is always changing money, getting restaraunt reccomendations, hassling with the airlines, retrieving the luggage that the airlines left off our flight, etc. She's always doing fifty things at once, and this picture is pretty typical for her. The only odd thing about this shot is that I actually caught her sitting relatively still.

Sarabh's Family On Their Way Home

Sarabh's Family On Their Way Home
Originally uploaded by interplast.

Sarabh's surgery was very successful. The doctors released enough scar tissue to give him two fingers. This will allow him to get himself into even more trouble in no time. Even though he had a cast on, I can easily imagine which one he was holding up to me as I took this photo.

His father, seen holding him and trying to get him to look at the camera, came to the hospital to take him home.

I'm sorta sad to see him go. His mother had one of the most beautiful, impish smiles I've ever seen, and her eyes simply sparkled. Even though Sarabh is as stubborn as an ox, she always has a smile on her face.

American and Indian Surgeons Operating Together

Dr. Puneet Pasricha Operating
With Dr. Stefanie Feldman
Originally uploaded by interplast.

Dr. Puneet Pasricha scrubbed in with all three Interplast surgeons today, performing multiple procedures on two patients. Puneet has been an integral part of the team, working behind the scenes to make sure that countelss details get resolved easily. He has arranged transportation, alerted the local community to our presence, helped us acquire pain medication and just generally gotten everything done. His wife, Seema, is a successful gynecologist who, amongst her many titles (doctor, wife, mother) is an incredible cook. She has been keeping the team in a state of culinary bliss.

Puneet is an accomplished plastic surgeon, and this morning's session was informative for both him and the Interplast surgeons. Such collaborations are a vital part of Interplast's work.

Gurpreet: Not Allowed in School Due To Burned Hand

  Gurpreet 
  Originally uploaded by interplast.

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 congenital birth defects or injuries.

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.

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 nasty 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 for only a nominal fee, 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 as stubborn. Although that trait is currently keeping him out of school, it 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 Jalandhar branch of the Indian Society of Anesthesiologists. Richard 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

  Ian Wilson Assessing Patient 
  Originally uploaded by interplast.

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 are 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.

Ian Wilson Looking At A Burn Patient's Hands

  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 an Smile Train partner that 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 that 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.