Post-burn contracture - Hand

About a week back, Dr. Nandamani was here for his bimonthly visit. Although it was a shorter visit than usual, we had quite a many surgeries. 

Of note, was a young man who was from one of the target villages of the Community Based Rehabilitation for the Disabled. This young man had approached our staff with a post burn contracture of his fingers which were quite expensive for him to get operated. 

Unfortunately, he did not have a RSBY card . . . however, we operated him for a cost of about 5000 INR although the actual cost was approximately 13,000 INR. 

Snaps of his hand before the surgery . . .

And the surgery in progress .. .. ..

Dr. Nandamani would be coming next on March 31st. He would be continuing his bimonthly visits till March 2015 when he would join the hospital back for good. 

There was one more young lady who also had a burn contracture of the finger following a neglected burn injury. A surgery has been done on her too. 

Please pray that both these young people would be able to use their hands well after the surgery. 

Both these surgeries may be quite simple ones for experienced hand surgeons. However, the fact remains that there are quite a many patients with such conditions who would never think about visiting a specialty centre where such surgeries are attempted - the first reason being the logistics of such a travel and the second being the cost . . . 

Surgeons such as Nandamani who chose to serve in underserved areas like ours are a blessing to countless people like these young people . . . 

I would also like to invite surgeons and other consultants who would like to come to us on a short-term period and do similar surgeries . . . Of course, the best time to visit would be from September to March .. .. .. well, December and January only if you can adjust to the severe cold. 

Looking forward

It’s going to be 4 years since we have been serving at NJH. When I first saw this place in 2003, I was fascinated by the possibilities in this place. And I’m thankful that the Lord has used us as a family to bring hope and smiles to the lives of quite a lot of people.

Over the last year, we were in the middle of a decision making process about Angel going ahead for a Master’s qualification. We had requested quite a lot of our friends to pray over it. 

We did not want that to happen just for the heck of it. We were quite sure that we are going ahead with it only if it was within the Lord’s will.

Couple of weeks back, we were led to believe that the Lord wanted us to continue here over the next year.

From the world's view, this was the best time for Angel to do her masters. However, we are convinced now that it does not fall into God’s plan for us for the time-being.

Now that we’re sure that we’re staying on, I thought I should jot down my dreams for this place. When there are dreams, there needs to be things put in place if they need to become reality. People . . . infrastructure . . . the major things.

It was couple of hours back that Dr. Roshine, our Medicine Consultant, Mr. Dinesh, our engineer and myself were in the ward looking at temperatures in the different areas. It’s been too cold over the last couple of days. And we had to do some checking to see if patients were comfortable. As we went into the Neonatal Intensive Care Unit, we could not stop wondering aloud on how much we need to have a paediatrician at NJH.

Of course, if you ask any mission hospital doctor, the first need anybody will blurt out is the need for more doctors, especially specialists.

As we continue our stint in NJH, we look at the prospect of more co-labourers . . .

It is now 52 years since the founding of the hospital. Most of the buildings are more than 30-40 years old. This means that we need quite a lot of new buildings. Hospital area including new outpatient areas, theatre complexes, intensive care units etc and residential spaces for staff are a crying need.

We have a nursing school which needs to be upgraded to a GNM/BSc nursing training facility. Qualified and committed staff along with more buildings is needed.

Could I request you to pray specifically for us as we continue at NJH? The dreams are quite huge. But, I think they are quite possible. But, more important is that we stay within the Will of the Lord for our lives . . .

To start off, we look forward to few specific things we would like to see in 2014. Permit me to put them down here.

1. Tuberculosis is a major challenge in the region. We want to do more in this area. Having a Tuberculosis Unit in NJH gives us quite a lot of leverage. Kindly pray that we will be able to do more for controlling tuberculosis in the region and the country. There are couple of things we are looking at. The first is research and the second thing is starting off Drug Sensitivity and Culture.

2. Starting a specific facility for non-communicable diseases in a rural set-up like ours is something I look forward in 2014. Kindly pray as Dr. Roshine sets it up at NJH.

3. Dr. Nandamani returns to NJH in January 2015. I would like to complete the Burns Unit by then. Please pray for resources including committed staff.

4. We have seen quite a few patients dying of Carcinoma Cervix in the region. Angel has been quite pressing to start off PAP Smear or VIA for Ca Cervix screening. Please pray as we plan.

5. New residential complexes are a pressing need.

6. Kindly pray as we consolidate the impacts we have made through the Community Health projects.

7. Consultant leaders in the specialities of Surgery, Obstetrics, Orthopaedics and Pediatrics with a belief in the saving grace and healing of Jesus Christ are something we should benefit from.

8. We’ve got a team of young and enthusiastic staff. Kindly pray that they’ll continue to grow in the Lordship of Jesus Christ. 

9. Complete ground work to start a blood bank.

10. Develop the specialty of Neonatology with emphasis on training. 

We value support and prayers . . . again, more prayers to remain in His Will. 

Wish all of you a blessed 2014 . . .

Surgery at NJH

During my short vacation, it was quite a blessing to have Dr. Nandamani and Dr. Ango to be with us. 

And I believe that it was a big relief for quite a few of our patients, especially to 2 young men who came with acute abdomen. 

The first one was VK, a 16 year old who came in with acute abdominal pain and distension. Of course, it was intestinal obstruction. 

On opening the abdomen, this is what we found . . .  

In addition, there was an area of constriction caused by tuberculosis which caused the obstruction. 

Then, there was one more young man who is still recuperating from the surgery for a duodenal perforation. 

After quite a long time, we had quite a large renal stone (staghorn calculus) removed. 

It does not need much research to conclude that a surgeon is a very much essential component in the scheme of things in a mission hospital. I wish we had a surgeon who was always around. Our surgical load is immense. Dr. Nandamani did about 70 surgeries in a space of around 2 weeks. 

Dr. Nandamani coming on a bimonthly basis is a major relief for us. We praise and thank the Lord for his bigheartedness. 

Could I request prayers for a regular surgeon to be at NJH? 

VK just before discharge . . . 

Plastic Surgery . . .

The term 'plastic surgery' conjures up images of perfect smiles, chin lifts, ironed out crease lines of the forehead, smoothened wrinkles for most of us . . .

We've been privileged to have Dr. Ron Hiles from England coming almost every year to teach and facilitate our surgeons to do 'plastic surgery'. Most of the time, it involves straightening out contracted limbs following accidents . . . especially burns . . . most of them neglected when they should have been well taken care of. 

Accompanying Dr. Hiles is Ms. RuthAnn Fanstone, an accomplished Physiotherapist, also from England who specialises in burns management. 

Since Dr. Nandamani is away on a long leave, we've requested him also to be around when these special surgeries take place. This year, it's going to be another milestone for us as a new physiotherapy graduate, Ms. Sheron Mathew from the Christian Medical College, Vellore would join us.

And for the first time, we tried some advertising on the radio. For most of us, it's a forgotten means of communication media. But, it still holds fort in remote areas such as ours. 

We've already got about 15 patients lined up only for the 'plastic surgery'. Cases as severe as the burn contracture in this one year old child . . .

. . . to the love-stuck young man who realised the folly of permanently tattooing his first love's name on his forearm. 

There would be quite a lot of patients who would not be able to pay for their surgeries. If you would like to make a contribution to help us subsidize the cost, please get in touch. 

Visitors at NJH

It was a privilege to have Ms RuthAnn from Interburns and her friend, Mrs Juliet over the last week. Ms RuthAnn visited us as part of the work she is doing with Interburns to popularize and promote burn care in NJH. I shall put in a post about Interburns later as time permits.

Burn care in NJH is not anything new and we had been talking about a separate unit for managing burns in this part of the country. As far as we know, we are the only unit in West Jharkhand who manages burns. As evident from my previous posts (Pediatric Burns, Neglected burns, Prodigal son, Mismanaged burns), we have been quite busy managing burns.

Ms RuthAnn is a trained physiotherapist who has developed a specific interest in burn care during her time at Duncan Hospital, Raxaul – another unit of Emmanuel Hospital Association.

As far as I understood, Interburns has been standing for a more active management of burns with tangential excision of burn wounds and skin grafting along with active physiotherapy. To the layman – it sounds complex. Well, let me explain.

RuthAnn along with the EHA team in Burn Care Retreat at Bangladesh

 

The older management of burns involved daily dressings which used to be messy and took quite a long time. In addition, there was also contracture formation which made life quite difficult for the patient. In tangential excision, the burn wound is excised as soon as possible and a skin graft is done immediately. It speedens up healing, decreases the amount of time the patient spends in hospital and prevents contractions.

One of the major accomplishments RuthAnn has made is to popularize the use of commonly available materials to make splints designed to prevent contractures after skin grafting. To help us with the making of splints, she graciously donated a heat gun to us.

RuthAnn teaching Dinesh to make splints

MI recieving a locally made splint to prevent contracture of his left axilla

MI being helped with physiotherapy

RuthAnn’s friend, Juliet accompanied her and helped us in umpteen numbers of ways including helping her with the classes for nurses, accompanying the Community Health team and encouraging us and providing a good time for many of us. We are quite thankful to Juliet for the time she spent in prayer for us.

We look forward to RuthAnn and Juliet coming back to see a flourishing burns unit and a improved hospital set up.

Theatre Musings

I write this as I give moral and anesthesia support to Dr Nandamani as he is operating on JH, a 70 year old retired teacher from Satbarwa, our nearest market. JH had come about a week back with an acute retention of urine. We had put in a catheter and found out that he has enlargement of the prostate gland, a common condition in elderly males.

Doing the open prostatectomy

JH is fairly well off considering that he was a retired government teacher. And he is rich enough to go off to Ranchi and get a TURP done. TURP stands for Transurethral Resection of the Prostate where we widen the route of the urine  through the urethra by slicing off parts of the prostate using a endoscope which is put through the urethra. There are quite a lot of people who swear by TURP whereas the older surgeons would vouch on how better is an open prostatectomy.

We gave the options of either getting a TURP done at Ranchi or an open prostatectomy at NJH. We are not sure why – JH opted for the open prostatectomy which Dr Nandamani is doing today.

We request your prayers as Nandamani finishes his surgery and continues on with his list of surgeries today. Before this surgery, we already had a hysterectomy and a hydrocelectomy. Once the prostatectomy gets over, we would proceed to a burn contracture release for a patient who acquired the injury quite a long time back which has handicapped her.

And then there is a young man with an intestinal obstruction who has a hemoglobin of only 4 gm%. We told his relatives that we can operate only if we have at least 3 pints of blood. They have brought the blood today. So, we could be operating him soon after the burn contracture release surgery is over.

Dr Nandamani examining the burn contracture before surgery

Talking of low hemoglobins, we had a 37 year old lady, SD with a 1 gm% hemoglobin. Seems outrageous. She delivered her 3^rd pregnancy sometime in the midnight. And her placenta was not coming out. The baby was dead – for the relatives’ description – it must have been dead for quite a long time. We knew that we had a uphill task. However, we took it up as a challenge. Dinesh, our engineer donated one pint blood and we proceeded to attempt to remove the placenta. It was a disaster. It seems like placenta accreta and the products being removed was stinking. I removed whatever I could.

The relatives have gone to get more blood. Her blood group being AB positive – that is not going to be easy. SD has pulled on so far. From a medical science perspective, she does not stand much chance. But here at NJH, we see quite a lot of miracles. And we pray for one more.

In the OPD, as I had written about in a previous post (http://jeevankuruvilla.blogspot.com/2011/09/tuberculosis-are-we-winning-war.html), we had more tuberculosis patients of whose 2 X-Rays are shown below.