bonmom: Dehradun January 17, 2013 - the wheels are turning

Thursday - second day of doing cases. It usually takes a couple of days to get a rhythm going, which we seem to have done. The lack of equipment has not slowed things down by much, but the limitations loom every ready to trip us up. We try to remain careful and deliberate, but issues sometimes only surface in the middle of a case. Vigilance and attention to detail must prevail.

This young child was burned by milk her mother was heating. Probably boiling to help avoid infectious diseases, the effort harmed the child more than it helped. There are multiple facial scars, but she can live with these. Her left hand is almost useless from the scars that keep her hand fixed and are pulling the thumb and fingers backwards.

One of our dear helpers - this man feeds the patients breakfast and lunch every day. The hospital does not offer food. The patients' families bring food and even some of the cookers that are the very cause of some of the burns. The food is not always enough, some families are far from home, and some are alone. This daily portion of bread and milk is enough to sustain them for their visit.

We do have a nutritionist on this trip, and her job must be daunting. Most families focus on calories - how to get from day to day with food in the stomach. The notion of being selective to help with weight gain and improved general health will be a challenge to implement.

Contractures in a world of legs - this child got burns on the back of her legs, improper wound care and follow-up, and was left with scarring that keeps her knees bent and fixed. Imagine how good it feels to move our legs after being in one position - she has not ever been able to do that. She can't even sit in a chair. Our hope is to provide some function and some leg opening.

Every morning and every evening the team rounds to see how the patients are doing. We are always greeted with smiles and questions. It is gratifying to see the improvement and to hear the comments. David, the pediatrician who has come with us works with these patients while we are in surgery. He screens them to be sure patients are ready to come to the OR, checks them again the day of surgery, sees them post-operatively, gets them their prescriptions, and does their discharge to home. He is also our team doctor, and in India usually several people can get at least some GI upset. We may not be children, but he takes good care of everyone!

"Namaste." This child will need some eyelid reconstruction, but no one has really figured out what. He was not accepted at the clinic, but Dr. Yogi must have a plan. So we see him every day and say hello, and his fate is not yet decided...

Wanted to share with my medical colleagues what the machine looks like here. The gauges do not work, the metal frame was filthy (we cleaned it up), there is no monitor (we have to beg and borrow), and the inhalational agent containers belong in a museum. But the flow dials work and the oxygen comes from the tank, so that's a start...

The plug plate we use to give us more places to attach our electronics. The power seems to go out at least once a day, and we continue operating with flashlights. I have used my electrical tape to wrap a few connections, but there still are some shorts and issues. Not ideal, but we are making it work.

One of the vaporizors on the machine. The yellow toggle will redirect the oxygen by the vaporizors to blow by and pick up some vapors to take to the patient. The jar for this one was broken and gone, and no name left to give us a hint which agent it was.

Here is the halothane vaporizer; kind of a jelly jar with the blow-by at the top.

We don't have a child-sized pediatric cuff, so we folded over an adult one. It seemed to work fine!

Cuff unfolded to show its true size...

I have never seen a real ether mask - here one is. The frame and gauze was placed over a patient's face and ether dripped over the top. The patient would breathe if too awake, and slow breathing (getting less ether) when becoming too deeply asleep. Amazing what we are finding in the drawers here!

This is the knee contracture releases, done prone and bilateral on the young girl who could not open her kneeds. It turned out to be a big case, which was a bit scary with the equipment we are using. But my very talented anesthesia colleagues made it work.

This is the hand of the baby who had been burned by the milk. Her thumb, which most of her life has bent pulled over the back of her hand by scar, is being attached to a plastic box to keep it pulled forward so it can heal in a more functional location.