January 16, 2013 - Team Reunited

Finally the team is together and we can begin to do what we do.  We all had a chance to meet and greet at breakfast, which was a fun blend of the spicy and local with the oatmeal and toast we all know from home.  We had some time to catch up on what is happening with the boxes, what we will do without them, and make our way to the hospital.

The good things - 13 of the 14 cartons arrived.  The team is together again.  We will scrutinize and use what we can locally, and will be able to make recommendations based on what we would need or improve for our uses and expectations (we usually give no input on local equipment and supplies).  Kush has been able to amass for us almost everything we normally use.  We will focus on education and collaboration with local workers.  We have a list of interesting patients.  We will use more local and regional, a better approach in some cases for controlling pain.  We got to move on from the box issue and look forward.

The bad things - what can there be?!!  This will be an exciting adventure with a new boost to the learning curve for us all. 

Our beautiful first patient - who can forget why we are here?

While the anesthesiologists were duct taping, checking circuits, verifying oxygen source, and all specifics to the safety of our job, the first case began under local anesthesia.

 

Born with syndactyly, or fusion of fingers, this patient had her index finger separated from the long and ring fingers.  She will now be able to better use her hand as a tool.  She opted not to have the next two fingers separated just yet, which will be a more involved procedure.

 

 Machines aren't so bad - Halothane vaporizer, tank oxygen and nitrous oxide, pressure valves, Mapleson D circuits, serviced who knows when - who can complain?  We are electricians and mechanics to some extent, so we can figure it out...

Like I said - who can forget why we are here?  One of our lovely first-day patients with me, both happy.

Facial burn that left her with bilateral scars at the corners of her mouth, resulting in poor mouth opening.  The skin simply would not stretch because the elasticity is lost with the scarring.  She received many tiny little "Z-plasties", which is a zig-zag incision reapproximated off center to add length.  Just like when you button a shirt with the buttons matched to the wrong holes - the length of your shirt in front seems longer.  This will give her the ability to speak and eat more easily.  We are doing as much as we can with local anesthetics, the safest way we have to approach these cases.   Most of our patients have experienced severe burns, usually around cooking, and without proper care and rehabilitation at the time of the burn, are left with severe, debilitating scars.

I made this close-up to hopefully anonymize for the patient, but it is a good illustration of what this scarring can do.  This patient cannot open or even close her eye.  Imagine the discomfort of life with that.

She has had a new eyelid reconstructed; in process here.  A small piece of skin was removed from behind her ear, where the scar will not show and extra skin can be shared, and the tight scarring loosened to allow movement and protection of her eye.  In the U.S., she would obtain multiple revisions to get it right, but we have this one opportunity to get her the most function as possible in one go.

Another graphic example of how debilitating these burn contractures can be - this is a patient lying down, her arm coming off down and to the right, and her axilla is fused.  Her arm is literally stuck by her side.  She will get a release that will expose bare tissues, and there will not be enough skin here to wrap around the space created.  This will be taken from her thigh as a skin graft.

We usually travel with our own autoclave to be sure the instruments are clean and sterile between uses.  Because our equipment is detained at customs, here is what we are using.  We are managing and the nurses are being very creative.  Everyone has pulled together in an amazing way and a new layer of strength from the ReSurge team has been uncovered.

Similar to the axilla shown below (the contracted shoulder joint), the elbow joint can fuse the same way.  This patient was frozen at 90 degrees at the elbow, so her arm will be freed up by an incision over the scarred area, and placement of a skin graft to cover what would otherwise be lacking skin.

Our burn therapist Beth applying a splint and dressings after a surgery.  The repair does not end with the release and skin graft; there is much work to be done to be sure the tissues heal in the proper way.  Burns are a nasty problem for all.

This adorable patient is being seen by the pediatrician.

She needs to have her hand reconstructed, and is very cooperative!  She loves to show us her knowledge of English, and we love it back!

We had an amazing day of intensity for the anesthesiologists - using equipment and circuits we had not seen or thought of for years.  We are patching together TIVA - total intravenous anesthesia - with nitrous and sedation.  Tomorrow we have some bigger cases, unique positioning of the patients, and more extensive procedures.  I am confident this team will rise to the occasion - amazing talent and dedication from all!

The vans drove us all home at about 8pm - I was too tired to even eat dinner, so off to bed and good rest for the next day.