Pl(e)astic Surgery . . .

Since last Monday, we've been having quite a lot of surgeries going on as Dr. Nandamani is here. And with Dr. Ron Hiles also being with us, we had lot of people coming down for plastic surgeries. 

In addition to the routine contractures following burns or accidents, another group of patients were those with small areas of discolouration of skin or small scars who wanted a change for the normal. Quite interesting, since our area is quite an impoverished area with almost a majority of population with hardly any proper access for basic healthcare. 

Couple of the cases. There was a young man with a small scar in the face. He was of the opinion that he was not getting good marriage proposals because of the scar. I thought that the scar gave him quite a macho look. 

There was another young man who had a scar below his lip which he thought was spoiling his looks. He started to quote surgeries and procedures done on some Bollywood stars which helped them look better . . . and how they got a break into doing some special films . . . etc. etc.

There were 3 cases of tattoos where the patient realised that the choice of the tattoo was not a great one . . . and the patients wished that they had not done it. I found out that one of the best ways to remove a tattoo was to rub salt on it and put a dressing over it after the skin had become raw. 

Then, there were cases like that was a young boy who had a very bad keloid after a burns. The problem was that there could be a recurrence even after we took off the keloid. But the father was pleading for skin like that of a new born baby. 

As we saw these patients, we got talking into how there were such wrong notions about what plastic surgery could do . . . and how much films and the media has fostered it. Another aspect was how much people hated the way they are and wished that they look like the demigods and demigoddesses they saw on screen. 

I'm amazed how much there is an emphasis on looking perfect in the societies that we live in, rather than a preference for lives that are beneficial to mankind. And of course, there is quite a world out there who earns a living by doing exactly the same. 

On the whole, I'm however amazed at the ability of surgery to bring back quite a lot of functionality in the lives of quite a lot of our patients who had been suffering mainly because of contractures caused by accidents especially burns. The contractures are caused because of neglect of the injuries. And which is what exactly we plan to prevent by having the burns unit at NJH. 

Cutting costs . . . Part 2

This is for guys who may be involved in lots of construction within their institutions and if you're doing the constructions yourselves (without the involvement of a contractor). 

Here, at NJH, we need quite a lot of new constructions as almost all of our buildings are quite old and much beyond repair. In addition, we need newer buildings for new facilities. 

When the burns unit construction started, few of my friends who were in the business of constructing buildings advised me to invest in a brick making machine. 

Now, it's quite a time since we had been using it. 

We did a little costing exercise to help us find out if the machine is worth buying. 

Now, a concrete hollow brick is equivalent to 8 smaller oven baked bricks. 

The costs . . . 

Bricks made per day (min 500, max 550)
Labour cost (12 labourers X 130 INR)				1300
Cement (12 sacks X 350 INR)				4200
Gravel/Stone chips (2 tractors X 1800 INR)				3600
Stone dust (2 tractors X 300 INR)				600
Electricity (max 50 units)				300
TOTAL COST				10000

Therefore, the cost per brick is about 20 INR if you discounted the machine cost. 

To substitute the 500 hollow bricks, we would need about 4000 (500X8) oven baked bricks the cost of which would be approximately 20,000-24,000 INR in our part of the country. (In South India, the cost per oven baked brick is about 8-9 INR)

That's a 50% saving. And if you consider the cost of the brick making machine, we break even as soon as we have made 12500 bricks (25 days of working). We've already made about 3000 bricks. 

There are quite a lot of advantages of the hollow brick. However, the best thing I like about them . . . they are much environment friendly compared to the oven baked red bricks. Of course, we have a control on the quality of the brick. 

The reasons . . . we use waste material (stone chips and stone dust); there is no baking of the bricks, we save cement during the finishing of the building as the surface of the hollow bricks are quite smooth, the hollow space saves quite a lot of materials used . . .

If you liked this post, you will also like Cutting costs.

Burns Unit, The Latest (2)

Snaps from the burns unit construction . . . 

After the scaffolding removed and the roof ready.

Please do remember about the need for a surgeon on our regular rolls for the smooth functioning of the burns unit. 

Photo Post . . . 28 Dec 2013

Miscellaneous snaps taken by our staff . . .

Recently few of our staff spotted Bison at the Betla National Park (courtesy: Mr. Abinash Biswal)

Another couple seen by the same group (courtesy: Mr. Abinash Biswal)

Dentition of one of our patients . . . Believe me, this is his normal look (courtesy: Dr Nandamani)

Another snap with the fog in the background (courtesy: Dr Nandamani)

Oral cancer with extensive spread (courtesy: Dr Nandamani)

Snap taken when the roof of the burns unit was being laid . . . (courtesy: Dr Nandamani)

Skin graft which has well taken up . . . (courtesy: Dr Nandamani)

Christmas celebrations in Community Health Department

Burns Unit . . . The Latest . . .

Below are snaps of the concreting of the roof of the burns unit. We thank the Lord for the good climate and thank you all who remembered this in your prayers . . . 

Now, we would need to wait for about a month before the roof sets. Please pray that everything would go well . . . and the burns unit would be a blessing for the people around this place. 

Skin Graft Mesher . . .

We were quite thankful when the Burns Unit support team at UK comprising Dr Ron Hiles, Dr Colin Binks and Ms RuthAnn Fanstone allowed us to buy a Skin Graft Mesher from funds which were allocated for the burns unit. 

It has been with us for sometime. But nobody requiring a graft was coming to us. Even when there was someone who would have benefitted from the graft - we did not get consent. 

Ultimately, we got a patient - but he was not a burns patient. The young boy had a snake bite and was managed at home. Unfortunately, his skin got necrosed and started to slough off when he thought about coming to healthcare. First seen at a Catholic dispensary in Latehar - he was referred to us. 

After almost quite a month taken to make the wound clean - it was ready for the graft. And of my, we were all so excited to use the machine. Below are few snaps of Nandamani and team getting the graft on to the exposed leg . .  .

The leg to be grafted . . .

Nandamani at work . . .

Starting the work . . .

The graft almost complete . . .

We are very much thankful to all those who donated towards the burns unit, the funds of which were used to buy this machine. And of course to our support team in UK who facilitated the same . . .

Summer vacation . . . Part 1

Well, ultimately, we got to take a vacation . . . although a short one. We've promised to take a longer version during Autumn this year.


I've not been an enthusiastic photographer during the trip . . .however, below are few good ones . . .


Below are couple of snaps which I took of the Burns Unit construction which I took before I started off.

The brick making machine had come out really well . . . It looks like a good investment . . . 

The upcoming burns unit . . . 

Couple of snaps from the train journey to Alappuzha . . . We travelled by the Dhanbad-Alappuzha express - the only option we really have . . .

We had packed enough food . . . But, Shalom had to have  Potato Bondas from the pantry as soon as he got into the train . . . A scene 5 minutes into the journey . . . Of course, Charis is also turning out into one great train fan . . .

10 cups of tea . . . 5 cups, the ones further away - the milk had split. . .
The pantry guys were gracious to replace is as soon as the problem was diagnosed . . . 

Charis keeping Chesed in good spirits . . . 

Shalom also joining in the act . . . 

Came Andhra and we had mangoes coming in . . . and Charis was right into it . . . 

Chesed sleeping off in Ammachi's arms . . . 

Charis taking a walk in the Chengannur railway station . . . 

Waiting at Trivandrum Pettah railway station . . .and having hot vadas . . . 

Well, this blog has turned out into a long one . . . Rest of the snaps in a later post . . . especially those from Trivandrum . . . 

Burns Unit - NJH

We have been talking about a separate facility for the management of burns patients at NJH for quite a long time.

The initial process of deciding on the final details had been going on for the last one year. Sometime during last February, we had Dr Ron Hiles do a symbolic removal of a brick from a portion of the building which we plan to renovate as part of the burns unit.

There are 3 key people who have been very instrumental in pursuing the dream of a separate facility for burn patient management at NJH. Dr Colin Binks, who was the surgeon at NJH for quite a long time – almost 30 years, Dr Ron Hiles, consultant plastic surgeon from the UK who has been regularly visiting NJH since the last 25 years and Ms RuthAnn Fanstone, consultant at Interburns.

Later, I had the opportunity to be part of a Burns care workshop organized by Interburns in Srimongol, Sylhet, Bangladesh. It was a great time where I could grasp more concepts about the setting up of the burns unit at NJH.

RuthAnn was with us in September, where further discussions took place on the organization of the burns unit and we were well set to start the process of constructions.

The construction was kicked off with few of us starting off the digging for the foundation of the building sometime in early October.

Later, during the celebration of the Golden Jubilee, Dr Ron Hiles and Dr Santosh Mathew laid the foundation stone for the building in the presence of quite an august audience. Work has been progressing since then.

We have started the construction of the building in faith. The total budget for the building is about 32, 00,000. As of now we only have about 25% of the money. We depend on the Lord for the rest of the funds necessary to complete the construction. And we need to get it quite fast as delay in the completion would only raise the costs involved.

In addition, we also need a good committed and dedicated team to build around Dr Nandamani who leads the initiative. As the work among burns patients are on the increase, we also look at the possibility of having one more surgeon who would be able to shoulder the increasing number of general surgery patients.

Please keep us in prayers and do respond in whichever way possible.