Up early, breakfast, pile in the car, tackle the roads. Last night it poured rain like only humid countries
can do. I walked up to the rooftop at about
3 a.m., and it was a torrential noise.
Steamy, pounding, and abundant water everywhere. It was amazing!
Everything is so rinsed and the dust levels are down, so we
can see much more on this ride. Coming
into Kirtipur, we stop and take photos of the town. It is an amazing mix of debris and color;
poverty and pride. Each day we learn
more about the attitudes, patterns, and way of life of these wonderful people.
We quickly make rounds and see some of the patients. Mohan and Nancy get right to work on their
patients who need splints. One of their
patients is our most tragic – a 4 month old who was being rubbed in oil in a
ritual at 2 months old, and as he became slippery and wiggled, he fell face
down into a fire, burning his entire face.
His skin has that melty appearance that such untreated burns get, and now
2 months after his injuries he is forming contractures and remodeling in a way
that will affect him the rest of his life.
He has no eyelids, his nostrils are only pinholes, and he has
microstomia – an opening for a mouth that would barely admit a pea. Most babies need to breathe through their
nose as they feed, and of course we all open our mouths wide to feed, cough,
and get air. Imagine the nightmare of
feeding such a baby, getting him to spit up, or do anything. Of course he is malnourished and very tiny. What Mohan constructed for this baby was two
soft plastic hooks to put at each corner of the mouth, and then a rubber band
strap around the back of the head to place gentle traction on the mouth
opening. In just a couple of days the
opening has gone from about ½ centimeter to over 1 centimeter, and they are now
able to give him solid food.
It is a shocking photo, but gives an idea of the obstacles
that these societies face with little communication, no preventive education,
lack of infrastructure, fire as the only source of light and heat, no clean or
running water, too many little ones to watch, and distant if any medical
help. It makes me weak in the knees; so
very, very appreciative of my life.
On the bright side, we have the children who are well, and
like any young child, in love with life and the prospect of engaging others in
laughter.
We all moved on to the teaching room and began our
lectures. We have 15 nursing students, 2
anesthesia assistants (“Anes. Ass.” They have written on their name tags), 2
surgical residents, 2 plastic surgery residents, the staff nurses, and a
visiting medical student from Germany whose English puts me to shame. It is a wide audience and targeting our
teaching - also given that English is a distant second language for most of
them – is going to be tricky.
I give a brief overview of anesthesia, and Anne does a great
job talking about asepsis (cleanliness and sterility) in the OR. We have had a chance to watch them work, and
are seeing some holes in their practice that we will try to target. After a morning of teaching, we go to the OR
and try to put some of what we said into place.
The main thing we notice is chaos. There is not much team work, and not much communication with the patient or
between the providers as the patient travels through the pre-op area, into the
OR, under anesthesia and surgery, and then into the recovery area. The patient is not given explanations, there
are cell phones and chit-chatting all around.
We decide to do some role-playing tomorrow, because as we try to unravel
this today, it is not sinking in…
As with most Resurge trips, most of the patients are release
of burn contractures with skin graft placements or Z-plasties (zigzag repair to
release tension on the skin). The
procedures go well, and we have many teaching opportunities.
Another long ride home, short walk to a free-trade outlet
store for some treats to bring home, a quick dinner on the rooftop, and a
welcome horizontal sleep. I managed to
down ½ an Everest brand beer, and it quickly downed me. Great full-night sleep. Wish I could bring one home for my sons –
nice light lager but with a brief hoppy finish.
Ryan, you have created a monster!
Had to load up a couple of days late, and now have another
day behind us. The internet was down!
