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| Dr. Raju (next to me) and Rama (middle) often worked with the two young anesthetists during surgery. |
This weekend, I spent some time in the Maharashtrian jungle's southern Gadchirolli district with over 60 Nagpur Rotary Club physicians and many young Indian medical students. Katie, not being one for blood, stayed at the school to hold down the fort from being invaded by lizards (and of course to help with the children). I was specifically under the direction of Dr. Raju Wilkinson, who I previously mentioned as performing Deepali's surgery, and his post graduate student, Rama. As I was soon to find out though, the doctors all seemed to enjoy sharing their knowledge and expertise with me! We traveled by bus to Hemalkasa where Dr. Prakash Amte, son of Baba Amte who is was a renowned Indian social worker and activist for the tribal peoples in southern Maharashtra, has been carrying out the work his father began. Interestingly, Baba Amte is now considered a type of saint for the work he did during his life, and for the actions and desires he spurred in others.
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| Of the four recovery wards, two were inside the hospital and two outside. The two outside did not have beds, so patients slept on the cement floor on sheets. |
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| This young mother had her hands full as both daughters required surgeries to fix their skin contractures. |
Each year, Nagpur Rotary Club travels to Dr. Prakash's jungle camp, Lok Biradari Prakalp, on roads that are so pocked with holes they look (AND FEEL!) like riding over Swiss cheese. Their goal is to complete many difficult surgeries for members of nearby tribal villages who have no access to medical care.
Lok Biradari Prakalp feels like a small village! Along with a brand new hospital facility containing three operating rooms with a total of 8 operating tables, Dr. Prakash also maintains a boarding school for tribal children, an enormous garden/farming operation, and a wildlife refuge. One morning, he showed us the animals-- poisonous snakes of all kinds, man-eating leopard and some "tame" leopards, one hyena, gazelles, peacocks (India's national birds), monkeys of course, a sloth bear, porcupines, giant brown squirrels, and some beautiful brown owls, to name a few.
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| Dr. Prakash has no fear of the man eating leopard he rescued and has formed a strong bond with him. |
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| Beautiful brown owls showed their 180 degree vision while I walked around their enclosure. |
To say that this area of India is rural is an understatement. Villages are built of sticks, stone, and mud, with the occasional sign of modernity such as an electrical wire or ancient satellite dish dotting the rooftops. But, at the same time, the communities remain vibrant with traditional, colorful Indian clothing and people of all ages going about their lives communally showing their happiness in the way they love one another. As an aside, I was told (near the end of the bus ride...thank you Dr. Raju!) that this jungle harbors many Indian rebels who plot against the Indian government. Fortunately, they are quite happy with the fact that the tribes are receiving medical care and so do not interfere, but welcome, the work at Lok Biradari Prakalp.
This year, when we arrived after nearly 8 hours of travel, tribal peoples, all waiting for their surgeries, greeted us at the gate of the complex with quizzical stares and waves. After such a long journey we relaxed with some chai before a traditional dinner of rice, dahl, and chipatis, where I learned that one always eats chipatis with the dahl and vegetables first, then finishes off the meal with rice to clean the plate.
After a night's rest under a mosquito net for which I was extremely thankful, 6AM arrived and our day began. Being in the jungle, we took the opportunity to go for a brisk morning walk before the heat of the day (both from the sun and the surgeries). After breakfast and chai, I found a spare set of scrubs and was instructed to scrub up and sterilize myself for surgery. Immediately, organized chaos ensued and did not cease until the last patient (surgery #109 not including optical procedures) awoke the following day around 6PM.
While in surgery, I experienced many things. From hydroceles, chyloceles, and hernias of all kinds, to hyperspleenism, skin contractures and grafts, breast fibroids, thyroid tumors, and sebaceous cysts, every surgery was performed by a team of excellent surgeons, nurses, student assistants, and anesthetists. Every surgery was free. My jobs generally included scrubbing up to prepare trays of instruments, mopping up blood during the procedures, and writing surgical notes dictated by the surgeons. Dr. Raju, Rama, and their colleagues each had their own style. For example, watching many hydroceles, each doctor ultimately completed the same thing, an eversion of the sac, but each used different techniques for finding, draining, and turning the sac, before making the stitches necessary to close the sac and the skin. I think this will prove to be one of the most important lessons I learn during my time here--it can (and should) be applied to not only medicine but life in general. Patients, friends, relatives, family members, any people you meet, are not all the same. Each must be treated with diligent compassion and care, but in the end, one develops and cultivates a style unique to herself/himself, so as to do the best work or service possible.
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| The women pictured here spent their time at camp preparing the OR instruments and tables and restocking the ever-dwindling supplies. Though they did not speak English and I only know a few Hindi phrases, their joyful attitudes were contagious and made me smile throughout the days! |
Some interesting things about my experience in the jungle surgical camp include the fact that even with the new hospital and competent staffing, supplies always seemed to run out. The sterile gowns were so few that each of us working in the operating rooms received only one or two per day. As a mere assistant, I was splattered with blood, hydrocelic fluid, pus, and many other bodily fluids, but then remained in the same gown because there were no others. However, from this, I learned another lesson that seems prevalent in rural medicine: some is better than none. Wearing the gown (with pristine and sterile gloves for every patient or whenever sterilization was broken) was better than not because the gown was still cleaner than our scrubs underneath despite the new additions from previous patients. This lesson seemed to be illustrated too by the fact that many patients presented with situations for which the standard of care requires testing and other measures prior to surgery. However, since these measures in the jungle camp are close to impossible, doctors worked under the conditions found, and success most often prevailed, relieving pain and suffering. One person said to me when I questioned this, "Is not some better than none?"
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| Each member of the team was given a certificate of appreciation for their generous service. |
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| We watched the sunset after camp from the dry, "winter" riverbed. |
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| Back at Nav Jeevan, Joy and Katie waited patiently for my return! :) |
Ultimately, time in the jungle proved fruitful for me, but more importantly for our 109+ patients. Each patient will receive the post operative care they require from Dr. Prakash's hospital, regularly staffed by two physicians, along with that provided them while the Rotary Team was there. Congratulations also are due to the Nagpur Rotary Club as they successfully performed the first-ever laproscopic surgery to be performed at Lok Biradari Prakalp this trip! Thank you very much to everyone for their kindness and warm welcome. I hope to join you again sometime.
Also, a very special thank you goes to the Hillsdale Rotary Club for their encouragement, financial support for this special trip, and work in making valuable international connections! I am very excited to share my experience with you when I return.
