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.

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.