Hey Statesiders,

We’re all safely back and reacclimatizing, slowly. Some more slowly than others, depending on whether you got a good case of the airplane flu or not, which, I did….big time cough, laryngitis, sore throat, phlegm, mild fever, and chills, but this too is passing.

We’re all safely back and reacclimatizing, slowly. Some more slowly than others, depending on whether you got a good case of the airplane flu or not, which, I did….big time cough, laryngitis, sore throat, phlegm, mild fever, and chills, but this too is passing.  This is the final note home (blog, as the kids call it), below which you may find attached a copy of my report on the trip and a list of the operations, sent both in Apple and Word, for your opening.

The final few days were as hectic as usual with little time for writing home. You wait, counting on fingers the number of days till going home, and suddenly it is upon you, and you’re not at all prepared. Of course, lady luck challenged us dumping all the skin grafts on us the last few days rather than providing them for us during the first week. But such is fate. Earlier is preferable because after you harvest the STSG (Split Thickness Skin Graft), which is a few thousands of an inch thick, taking only the top few layers of living skin cells off the surface of the donor site, thus allowing the deeper layers to regenerate, healing into full-thickness normal skin. The donor site is like a 2nd-degree burn which hurts worse because the nerve fibers are exposed but not severed. That’s why the donor site is always more painful post grafting than the recipient site where the nerve cells are gone. The graft is usually harvested by Joe B  using a modern machine he got Zimmer to donate to us several years ago.

The skin, which is very elastic and tends to curl up annoyingly and shrink, is placed on the prepared graft site, well wetted with saline, and uncurled and stretched out to cover the defect, like patching a quilt. The corners are tacked down, and the loose edges are then sewn in place. The graft is “pie-crusted”, meaning tiny slits are pierced through the STSG to allow serum to leak out over the next few days (like steam out of a pie). Non-adhering dressings are placed on both donor and recipient sites and left for about 5 days. On the 5th+/- day, the first dressing is changed under sterile technique. The old dressing and non-adhering (we use Xeroform gauze impregnated with a bee’s wax-like vaseline) gauze is carefully teased off the underlying STSG without lifting the STSG off its underlying bed. What should be happening under the STSG are tiny blood vessels called capillaries begin to grow upward from the graft bed into the new skin, re-establishing blood flow to the STSG cells and anchoring the graft to the bed. So you do not want to disrupt any of these tiny capillaries while removing the old gauze.

You change the dressing because you want to be sure there is no infection smoldering there.  We changed a big STSG dressing Saturday morning on a 24-year-old kid we had operated on the previous Tuesday. This was only 4 days post-op, but we needed to see it before we left. This poor kid, burned as a child, with no PT (Physical Therapy) had been allowed to assume a fetal position, and his right upper arm became scarred to his side, rendering it useless. We were able to release the rather large scar, but this left a large defect with no skin covering, thus the graft. Fortunately, the graft looked like a 100% take, thus far. He was redressed, returned to the ward. Dr. Mary Anurupa, our Indian colleague, who is a fully trained Pediatrician, and a good doctor, was carefully instructed how to do future dressing changes, and will be able to carry on the care. It should heal nicely, hopefully! He should be ready to go home in another week from now. There, again hopefully, he and his Mother will remember the arm/elbow lifting exercises we carefully taught them before leaving or else his arm will remain useless against his side, and all will be for naught. Ideally, we would liked to have done the STSG early the first week, but such is fate. The final Thursday we did 2 other STSGs, all left in the capable hands of Dr. Mary.

Our new Ob-Gyn lady doc, Dr. Nagamani blossomed before our eyes when we got there, and was a whirling dervish, doing hysterectomies and Gyn cases as fast as she could get space on one of the OR tables. She had several more to do after we left. She looks like she is going to work out fine, hopefully!!?? You never know what will transpire after we leave, however. Sometimes things quiet down too much and not much gets done. Dr. Nagamani, by her own admission, however, clearly stated that she wanted to build her reputation, so maybe she will keep things going at a decent pace. Time will tell. On the final Thursday, she was doing 2 cases at once, as it were. She had a woman with a large ovarian cyst to remove on the OR table, with Dr. Sulochana helping her.  A 24-year-old woman had come in early labor. So she put the woman in labor on one of our old (very old) wooden (1930’s) delivery tables, and brought it into the OR where she was doing the ovarian cyst.

The Pitocin drip was started to assist the labor. Student nurses were checking both the maternal and fetal heart rates and reporting to Dr. Nagamani. I was asked, at one point to check to see how much she was dilated. I said I hadn’t checked a cervical dilation in 45 years!! Do it anyway, she said……fully dilated. The wooden table was right next to the door in and out of the OR, with OR personnel moving in and out right next to the woman as she pushed in active labor. Every one to two minutes, she would scrunch-up her face with a contraction, and push hard, sweating, with the obvious pain of delivery. Dr. Nagamani with perfect timing dropped out of the Ovarian case, and stepped over to catch the new-born baby-girl. Dr. Mary took the baby and recorded Apgars of 9 and 9. Mother and child in perfect shape. Of significant note: not once, during the entire labor, with people in and out the near-by door, no real privacy, no anesthesia, not once did that young mother utter a single audible cry. Talk about tough! Wow! We were all really impressed by her stoicism. Good job Mama! And good job Drs. Nagamani and Mary!! Sometimes you gotta do what you gotta do. Mother and child left the hospital several days later in fine condition, after all the women in the FSC team had had a chance to cuddle the baby, especially Betsy who loves babies.

Sunday 19Jan, our ‘day off’, we all went to visit the Leprosy Village which is an eye-opener for the first timers, and benefits those poor souls whom we visit. It makes such a big difference to them (or to any of the down-trodden) to have someone show that they care. That’s true not only for lepers, but for orphans, old folks, or any ostracized community of people all over the world. That’s why we say that Its not so important that you as a volunteer ‘do something’, as that you just ‘be something’ for others. Just your physical presence, your laying on of your hand, your warm smile, that’s what makes the difference for these people. So our visit to the leprosy Village was a big moment for all, as was that afternoon’s visit to the children’s homes (orphanages), and the old folks home, people who have no family or whose families have turned them out. Perhaps the most touching is the Happy Home, a place started by a young Christian couple who had a call to care for children with AIDS or orphaned by AIDS. These sweet children, through no fault of their own, had no home, no future, until they were taken in by this loving couple. 60 kids, now with a roof over their heads, food for their bodies, and schooling for their minds. We were told that over the 7 years of the Homes existence, they have lost 15 kids to the disease, but the rest are doing fine. The kids range in age from 4 to 16. They sang and danced for us, and their smiles melted our hearts. Its amazing to realize how easy it is, living in this wonderful country of ours, to forget just how really fortunate we all are, living here.

We ended the FSC’14 by doing 251 procedures on 247 patients (4 had multiple procedures), and 32 dental cases by Dr. Annie Christie.  675 patients were consulted on during the FSC. Over a thousand people were cared for over all. This is a new record.  As mentioned above, I have attached a copy of my report on the FSC and a list of the Operations….these are in both Apple and Word formats for your convenience. If you have trouble, let me know.   So that’s it for 2014, and until next January 2015, that’s the way it looks from here.

Thanks for your support…………..
Geo.

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LIST OF CASES

Free Surgical Camp 2014
St. Mary’s Mission Hospital, Khammam, India

Major Surgeries

Thyroidectomy – 27
R lobectomy – 15
L lobectomy – 7
Subtotal – 5
L Inguinal – 11
Umbilical – 6
Incisional -4
Ventral (epigast) -3
Genito-urinary -41
R Hydrocoele -11
L Hydrocoele -13
Bilat Hydro -9
Orchiectomy -4          
Circumcision -4
Gynecology -25
TAHysterectomy – 11
Vaginal Hyster. -5                     
Salping/oophorex – 1      
Myomectomy -1
Vaginal Delivery -1
Pessary insertion -1

         

Minor Surgeries
Lipomas – 28
Cyst – 36
Breast mass – 4
Skin neoplasm – 12
Burn scar release – 4
Thyroglossal – 2
Plastic/STSG – 2
Carotid Body – 1
Ganglion – 3
Parotidectomy – 5
Anal Fistulotomy – 9
Anal Sphincterotomy – 1
Pilonidal – 1
Hemorrhoid Banding –   11
U/S guided Inject’n – 1
Dental Clinic – 32
Anesthesias – 239
General – 41
Spinal – 87
Ketamine & local – 11
Local/sedation – 20
Local –  68
Hernia – 40
Abscess – 5
R Inguinal – 16

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Female – 113
Male – 134

Ages:

0-12: 17
13-20: 17
21-40: 112
41-50: 53
51-60: 28
61-70: 8
70+: 1

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LIST OF PARTICIPANTS

Participants: Surgeons – Drs. Joe Bardenheier, Bob Dwyer, Dirk Noyes, and George Longstreth;

Anesthesiologists – Drs. Judy Freeman, Katie Schenning, and Gopi Chand;

Ob-Gyn – Drs. Nagamani, Sulochana;

Pediatrics – Dr. Mary Anurupa;Radiologist – Drs.Ryan Schenning, Ravindra; Dental – Dr. Annie Christie; Consulting Cardiologist – Dr. Gopinath

Radiologist – Drs.Ryan Schenning, Ravindra;Dental – Dr. Annie Christie; Consulting Cardiologist – Dr. Gopinath

Dental – Dr. Annie Christie; Consulting Cardiologist – Dr. Gopinath, Mr. Joe Bardenheier, IV; Mrs. Kath Noyes; FSC Co-founder Mrs. Betsy Longstreth; David & Lee Emerson; Cindy Emerson Keefer; Brooks & Kelly Barrett;

Translators -Revs. Joseph, Titus, and Vincent;Nursing – Sister Deborah and her talented staff, and friend and former California nurse, Phoebe;

Our hosts – Vasantha John Mary and Rev.PC John Mark, President CSU.

Nursing – Sister Deborah and her talented staff, and friend and former California nurse, Phoebe;

Our Trouble-shooting handiman – Raju Palakapti; OurPublicist – Samson Azariah;

Hospital Administrator – Mr. B. Jayasheeludu;Our hosts – Vasantha John Mark and Rev.PC John Mark, President CSU.

Somehow, through the miracles of modern science and technology and despite the foibles of our fellow men, our entire American team of Volunteers and all our 20+ duffles and luggage arrived in Hyderabad on time and in correct numbers. Hallelujah!! We all checked into the Novotel, a new, much improved venue right on schedule. Everyone was up and accounted for at 9AM breakfast Sunday morning 12Jan’14, except for Dirk & Kath Noyes and their Indian doctor friend who arrived on time later at noon. Joining us also were John Mark, TL Reddy, and Franklin and his family. Warm greetings and introductions were passed around with many joyous words and smiles.

Right on time, for once, we boarded the bus John Mark had hired, and took off for Khammam on the new highway. Four lanes of good pavement all the way to Suryapet (150km), stopping briefly for a snack and restrooms which were clean and presentable. We arrived in Khammam in mid afternoon (India time is 101/2 hours ahead of New York), which felt like 1:30AM Sunday to most of us, and were shown our rooms, some of which were in the final stages of renovation with paint drying and toilets being hooked up, but which were very nice, clean, and comfortably western. Greetings, garlands, and old friendships renewed were warmly appreciated at John Mark’s house, and the first timers were welcomed by lovely Vasantha, our Mother away from home. We regrouped in the OR, had a great tour of the new buildings and renovations accomplished by Mr. Jay over the past year, and set to work unpacking our 25-30 duffles of supplies brought from generous donors in the USA. A delicious, somewhat toned-down-spice Indian supper was enjoyed and everyone crashed into bed.

Screening Clinic, usually a lesson in complete chaos, was started not only on time at 8AM Monday morning after breakfast at John Mark’s (where all our meals were given us as a large group), but also with significant orderliness thanks to the managerial skills of Joe,IV. The patients were registered, had vital signs recorded, and were directed to one of the 4 USA Surgeons according to the chief complaint. Joe,IV was traffic cop, problem solver, job director, and chief toy hander-outer.

About 10AM, right on schedule, our old friend, Bishop Vadapalli arrived for Opening Ceremonies, and Screening Clinic was put on hold amid a new round of greetings, garlands, well-wishes, and prayers for the success of the Free Surgical Camp (FSC)2014. Betsy Longstreth, co-founder of FSC in 1999, was especially welcomed for her return after 11 years away. Mr Nama, Member of the Indian Parliament, benefactor of the poor, and supporter of St. Mary’s Mission Hospital (SMMH), was warmly welcomed as Our Special Guest at Opening Ceremonies. Both Bishop Vadapalli and Mr. Nama spoke glowingly of our efforts at FSC over the years, and with great hope for this year’s effort.

Upon conclusion, we returned to Screening Clinic, working through roughly 250 patients until 7PM with a break for lunch. This took the concerted effort of most of the team plus Drs. Mary and Nagamani, and Nurse Phoebe. Drs. Judy and Katie were busy in the OR, working with Dr.Gopi Chand, learning the names of Indian drugs, the new anesthesia machine, and preparing for Tuesdays onslaught of cases. Dr. Ryan working with Dr. Ravindra (Dr. Nagamani’s husband volunteering his time to help us out) called the Ultra Sound (US) technician to come fix the machine we had rented for the month. Ryan ended up doing hundreds of US exams during the 2 weeks in addition to assisting very ably in the OR, a huge addition to FSC.

Operations started on schedule Tuesday AM, as usual, but by Tuesday evening 10PM supper at John Mark’s, we had done a record 35 cases in one day. From this auspicious start the camp took off. Over the next 10 days, we did 283 procedures on 279 patients, 32 of which were dental (done by Dr. Annie Christie, Dr. Sulochana’s daughter), and consulted on 675 patients, a new record for the number of people served. There was a huge variety of cases that we were able to do, cancers resected, cancers unresectable, huge herniae, hydrocoeles, thyroid tumors, parotid tumors, neck masses, breast masses, anal problems, burn scar releases with limbs freed up, and multiple lumps, bumps, lipomas, and cysts. Many predictable, some surprises. The non-medical first timers were taught sterile technique, how to scrub surgically, gowns, hats, masks, gloves, belly up to the OR table and lend a hand mopping blood or holding retractors. Rounds were made every day after the OR was finished. Patients were medicated, dressings changed, those ready were discharged, ready often to walk home, some to downtown Khammam, some to a distant village.

A new tradition has evolved at FSC nightly after the work is done, before dinner at John Mark’s. We all gather to rehash the days events over a cool glass or two of Kingfisher beer, with funny stories of the day, unusual events, jokes, much laughter, and a wonderful comraderie that pulled the team together, which, in turn, resulted in a well-oiled work-force that broke previous records. I’m guessing that this was due both the esprit-de-corps and to Joe,IVs experienced hand in executive management. He had the operative flow and the team so well organized that it bespoke of his efficiency. Everyone just fell into a niche where they were comfortable contributing to the cause, some with many, varied tasks.

By Friday afternoon, 24Jan’14, we were able to finish the schedule by 5PM, give our own personal thanks to our beloved OR Crew of nurses, translators, and helpers who worked tirelessly 12+ hours a day, and get ready for Closing Ceremonies, at which, again, our good friend and partner, Bishop Vadapalli was the honored guest, honoring us and our work with his words and his presence, for which we are very grateful. This was followed by one last beer fest and dinner at John Mark’s house, much to Vasantha’s relief. She certainly put up with our delays, tardiness, irregular schedules with a constant smile and welcome, for which we all thank her greatly.

Saturday morning we made final rounds, discharging almost all of the few remaining patients, and leaving very explicit details for management follow-up for those needing it in the very capable hands of Drs. Mary and Nagamani. We said our final thanks of appreciation and good-byes to our exhausted friends, boarded the bus, and headed for Hyderabad and the Rajiv Gandhi Airport home.

I am very proud of what our team accomplished this year. They did an outstanding job, each person adding his or her particular piece that was the big picture…..sine qua non! We left behind in India almost a thousand people, the vast majority of whom we will never meet again, but who are and will be eternally and personally grateful to the effort made. We all worked hard and did our part, but this would not have happened but for the incredible generosity of our friends and donors, mostly in the USA, who gave their equipment and money to make FSC possible this and every year. It is to you, and you know who you are, that we give our sincere thanks and appreciation. We the vols, get the fame, the glory, the beer, the memories, but without your donor-support and generosity, particularly from the Heaton Family, none of this show of international brotherhood would have been possible. A sincere thank you to our team, to our Indian friends, and to our supporters. God bless you all.

Respectfully submitted, George Longstreth,MD