Every morning on our way into the hospital, we can see the many who are still struggling to find their way back home. Make-shift lean-to spaces, organized communities of Chinese-donated tent-homes, or simply those sitting on the sidewalk looking lost. The city is slowly consolidating the rubble and making its way back to the usual buzz, but the rebuilding and return to normalcy will take time and energy. Most of the city stands and is back to work, but without many machines to help, it is still heart wrenching to see families reclaiming their homes, stone by stone.
A problem for us in the US is the overabundance of trash we generate in hospitals. Everything is wrapped individually - sometimes by many layers - and the multiple bags of trash per procedure are mountainous. A technique they use here is to flash a tin of needed cloth (not paper) gowns, drapes, wraps, or whatever is needed for the patient in question. Here is one of the metal tins with a holder for tongs. The holder has been sterilized, as have the tongs, but a non-sterile non-gloved person uses the handle to reach into the bin and pull out the sterile items. That also saves on gloves, and allows many to step in to help if needed. It will make many cringe who deal with infection control, but it works and in this setting saves so much in resources.
This is taking place at the bedside of a burn patient in the recovery area.
We had one major case today - our first free flap using the microscope and the latissimus dorsi muscle. These two photos show Drs. Pramila and Kiran working to free up a portion of the back muscle needed to donate to the leg. Without covering the wound he has, he probably would lose his leg if not his life from infection. The flap is a portion of muscle with its overlying skin and a vein and artery found that can be used to attach to a vein and artery found in the leg. In its new home, the muscle can fill in a defect and heal over to protect and return intact skin and bulk to the leg. Sorry if this is too gorey for some of you, but it really is a thing of beauty.
Many hands make light work.
Here we can see the two teams at work - harvesting the flap and preparing the leg to receive it. Once the gross dissection is done in the leg, the microscope is moved in to facilitate anastomosing the blood vessels from the flap and the leg together so that the blood will nourish the flap once again and the healing can begin in its new home. Dr. MeGee is the expert on this procedure, and he is guiding the two local surgeons through the procedure. Eventually he is sitting on a stool away from the table, and Drs. Nakarmy and Rai proceed with the flap placement. We will do several of these same procedures to give them a chance to perfect their technique.
As with any OR, but especially here in warm Nepal, cooling is critical for the surgeons in their layers of gowns.
One of my favorite patients so far - this is the gentleman who was tending to his animals when the earthquake buried his leg and he has been here since. He has a very infectious nearly toothless grin that broadcasts his determination and appreciation. He lay through a long procedure under spinal without sedation, and for the hours he was there, whenever I peeked around the drape to see him, I got that big grin. He is shown here heading back to the ward for wound care.
And speaking of happy smiles - these are two of the wonderful ladies with whom we work alongside.
One of the four workers funded by the cafeteria profits, keeping the floors swept and the patients in a comfortable space.
The cables shown the other day disappearing into a building wall as seen from the hospital, with trolley swinging in the wind.
Right next to our view of the valley, the trees, and the trolley is a board with essential information for each case. A big step to help with documentation for cases.
The graft has been brought into place, wrapped around the wound, attached to its new vessels, and voila! It is a thing of beauty. Over time, the muscle fibers will atrophy and soften, and it will look right at home.
Never ceasing to amaze - Dr. Rai mops up after the case, and then was spotted cleaning the bed after the patient was moved in recovery. He is forever setting an example and doing what he can to make everyone feel equal.
We all made our way home and headed for the rooftop cafe to have some unwind time. It is exciting to see all this work, but it is stressful for us out of our comfort zone of routines and systems, unlimited resources, and easy communication. But we are surrounded with people determined to make it work and that is the boost we need.
