Wednesday Evening - Day Four Continued....

Once work was complete, we (Marty, Dave, Julie, Ken, and I) arrived back at the guest house and took a quick walk down the street to see the market place (photo posted pre trip). It was exactly like the photo and we were celebrities as the locals clamored to take pictures with us. The vegetables were beautiful and the scene was complete with wandering goats and cows. It was the dustiest place I had ever been! We walked back to the guest house for a quick bucket bathing session pre-dinner. We were no sooner cleaned up when a group of 'hoping to be patients' arrived at our door seeking a surgical consult. It was rather comical, and as tempting as it was to send them down to Dr. Leber's room as we knew how much he would have loved a house call, Ken proceeded to hold a mini clinic out in the corridor.

Later Wednesday evening, we were hosted for dinner at a Chinese restaurant where we had a combination Chinese, Indian, and sort of Italian tasting meal. We did not get to the restaurant until about 9:00pm, so it was another eat and run back to bed evening, except for a couple folks that walked back down the street to where a wedding was going on to check out the scene.

As with most evenings, our tireless PACU nurses along with Dr. Mukul Parikh were the last to leave the hospital and last to arrive for the meal. We all cannot express our thanks enough to Barb and Bansari for their hard work every day as they attend to the patients in a very chaotic recovery area where multiple family members gather around trying to "help." It is a cultural thing here that entire families accompany their loved ones to the hospital. It is a sight and a lot of sound to behold.

Tomorrow will be here before we know it....

Alba - A Little Girl Whose Life is Changed

Alpa - A Little Girl Whose Life is Changed

On Tuesday I shared a little about Dr. Alvear's pull though procedure. This morning I rounded with Dr. Alvear to check on Alpa, the 11 year old 'surprise' patient. She was a surprise in that she was not on the original list, but showed up for clinic on Monday and had surgery on Tuesday. She and her family live in the next town, about 45 minutes from here. She was born without an anus, and was given a colostomy to save her life. In the US, this may not have been necessary as they might have been able to determine that the rectum terminated at the vagina and could have rearranged the organs at that point, creating an anus and eliminating the need for the colostomy. In countries such as India, they don't have the training for this technique. Yesterday, Dr Alvear found the rectum in the vagina and was able to perform the pull through procedure and in about 3to 6 months, doctors here will be able to close the colostomy and she will become a normal, functioning child.

We asked her with the help of Bansari Mandalia,of one our our nurses from Harrisburg, who speaks the language, if she would like to get rid of her colostomy bag and the answer to that was a very clear YES. Dr. Alvear asked her if she was was happy, and she grinned from ear to ear. She shared with us that she goes to school, which is unusual for kids with colostomy and that she is in the 5th grade and worried that her teacher will be upset with her for missing school for this operation and that her favorite subject is literature.

Her mother, Manjula and younger 6 year old brother, Vandan who is in 2nd grade were at her side; a small group compared to some of the patients who bring as many as a dozen relatives to the hospital with them. Alpa will be discharged from the hospital today to go home and will return to see the local surgeons in a week.

I wonder if we will ever see her again, or learn about her life as she grows up....

Thankful to be able to share these stories with you,

- Cheryl

Posting your comments

Hi,

Many friends have emailed me peri salty to let me know they commented, but we cannot see your comments. In order to,save and publish your comment, please follow the steps on the blog. Not an expert at this, but it may ask you to,create a goggle account. Why not ? It's free - Grin.

For those whose comments we got, we are thrilled to get them.

We are hungry to hear from you.

Best, Cheryl

Additional Pictures from the Morning Adventure - Wednesday

Here are 3 more images

Wednesday morning - Pre Workday Adventure

The adventurers were up very early again for another pre sunrise hike and nature time. We drove out into countryside again to walk several kilometers along a road that cuts through a palm tree grove where the tres soars to the heavens. It is worthy to note that these are the only palm trees for many, many miles. Our hosts advised us that sea was thought to have been as far inland as this area years ago. It is now a combination of marsh and dry lands, filled with dozens of bird varieties. Dave Leber declared the most noteworthy bird this morning was a Saris Crane, standing 5ft tall. It is the tallest bird in India and tends to live in cultivation well water areas, such as the rice paddies were were walking by. We also saw Rose-Ringed Parakeets who were buzzing around the tall palm treetops. That Dave sure knows his birds.

We walked along in silence and murmured conversation observing not only the birds, but the beauty of this country, a dry and thirsty land in so many ways. The sun lumbered slowly up over top of the horizon while a troop of monkeys sprung to life leaping; from tree to tree, some holding babies as if they were going to take into flight. I was so fun to watch them play.

As we observed some farmers lighting their fires for tea and milking  a few cows, we were reminded all to quickly that it was time to speed back to town, the day was about to begin and patients would be expecting us shortly.

I hope you enjoy the photos and be sure to look closely for the monkey in the tree. Time to get to work!

Thank You Dr Motter for Sharing this Story with Our Readers

The team had a very rough afternoon on Monday and many lost sleep as they thought of this young patient and our friend Bill and how hard this was. Last night at dinner, Anesthesiologist, Bill Motter asked me if he could share the story on my Blog. Of course, I said....

In Bill's own words:

"On Monday, my 12 y/o patient died. Mitesh Prajapati had no known past medical history - a healthy boy coming in for a simple inguinal hernia repair. The safest anesthetic, given our lack of anesthesia machines, was a spinal block with sedation. Mitesh smiled all the way into the OR. The block was easy, and I used conservative doses of both spinal medication and sedation. Forty five minutes later, as Dr. Alvear placed the last stitch, I noticed Mitesh was turning blue-grey. The BP from 2 minutes ago had been normal. The pulsox still said his blood oxygen was OK. Then he died.

I said to Dr. Alvear, "I think we have a problem..." He placed the dressing, took down the drapes, and used my stethoscope to listen for heart sounds as I called for help (specifically Dr. Parikh), ordered medications, maintained an open airway and asked Lindsey, our SRNA, to assemble the Ambu bag with O2, so that I could breath for him. Meanwhile, Dr. Alvear had already started chest compressions. We gave epinephrine and lidocaine, and, a minute after chest compressions started, he had a strong heartbeat. I placed an LMA (airway) and continued ventilating until he began breathing on his own. Duration of resuscitation was less than 7 minutes.

Mitesh awoke and began crying, but clearly something was wrong. His neurological reflexes appeared to be intact, but his mental status was not normal. In the PACU he showed signs of increased brain pressure, which we began to treat, but he continued in his barely conscious state. Mitesh received invaluable help in the PACU from nurse Bansari Mandalia and surgeon Adnan Alseidi.

Mitesh's family, especially his father, was devastated. A simple surgery had severely damaged their child. I'm a dad with two sons. I felt his pain; but worse, I felt as if, perhaps, I had caused it. What had I done wrong? I couldn't figure it out.

I accompanied Mitesh to the ICU, where I told the story yet again. The ICU doctor was very attentive, but I knew it didn't make sense to anyone - the sudden cardiopulmonary collapse; it didn't make sense to me, and I was there when it happened. Mitesh was no better when I left the hospital that night. Had I killed someone's son?

The next morning I accompanied Bansari and Adnan to the ICU. There was Mitesh, looking slightly sleepy, but otherwise normal. Adnan looked at the CT scan performed overnight, which was normal except for... a mild hydrocephalus. That was it. Mildly increased pressure in the brain from birth which would only show itself if it worsened, or if someone did a spinal block or tap, lowering the pressure below the brain, allowing it to herniate into the funnel of the Foramen Magnum. By lunchtime Tuesday, his family said Mitesh was completely normal again. He was eating, talking, walking, smiling and joking.

The incident with Mitesh demonstrated to me that I was working with a well trained group of people who, despite different backgrounds and working in a foreign country, could function as a strong team. I was at a good hospital with well trained local physicians, all of whom played a huge role in saving the life of Mitesh. It reinforced the importance of basic resuscitation skills, including immediate, modern CPR. And it made very clear to me how fragile life is.

Thank you to everyone involved in bringing Mitesh back to life and returning him, as a normal boy, to his family. With awareness and treatment of his underlying hydrocephalus, he should live a long and productive life."

- Bill Motter, MD

Thank you Bill, thank you Team, thank you God

The Ear Reconstruction photos

A series of four photos I took while watched from the the start to the completion of this remarkable procedure!

Day Three - Tuesday in Khambhat

And on the third day....There was order at our surgical mission camp. The day began as others; in the darkness that comes before dawn. Yawning team members climbed aboard our shuttle cars and headed for a quick breakfast at the hospital before beginning a day filled with surgeries.

The best news of all was received early on, one of our patients who was very sick following their procedure had turned the corner and everyone was thrilled by the news!

It was such a smooth day with the usual improvisation for supplies, a few rolling power outages - you know, just another day at the office. I did however get to observe a most remarkable surgery in the plastics room where Dr. Leber took cartilage from a 19 year old young man's rib cage (near the sternum) and proceeded to carve it with the aid of a self-made template into an ear. The patient had only a floppy mass of poorly developed tissue and within 2 hours, he had what should heal into a normal shaped exterior ear. Truly remarkable.

In a nearby room Dr. Alvear performed a pull though procedure creating a rectum and an anus for a young 11 year old child girl who had a colostomy from birth due to an imperforate anus. The lives of these two patients are forever changed for the better, as are the hearts of those who where privileged to be a part of the healing.

To night, the local Rotary Club honored the team with some speeches and rose bouquets for each WSF member, along with another amazing Indian meal. We were short stay dinner guests and departed for the guest house to seek rest in our beds. Tomorrow promises to be a busy day.

So far away,
- Cheryl

More photos from Monday

Thought you would want to see some more photos from yesterday.
General sites, and three of our anesthesia team, Bill Motter, Neelima Parikh, Diana Davidson doing wheat they do best

Meet Aashay Shah from Allentown, PA

Aashay has been a true pleasure to get to know and work with here in Khambhat. He is a hard worker and jumps in where ever he can be of assistance. I asked home to share a bit about himself, and here is what he said:

Hello, my name is Aashay Shah. I am from Allentown, PA and attended The Pennsylvania State University with a B.S. in Health Policy and Administration and a concentration in pre-medicine. I have always had a strong interest in pursuing a career in health care as a physician and my chosen field of study allowed me to marry my interests between the clinical and administrative aspects of health care. When I was at Penn State, I was heavily involved with the Penn State Dance Marathon (THON) and helped fundraise nearly $40 million dollars to benefit pediatric cancer patients at the Hershey Medical Center. As a part of THON, I danced for 46 hours nonstop to raise awareness for the pediatric cancer patients and served on the Donor Alumni Relations committee as a Captain to facilitate the mail solicitation campaign. I look forward to attending medical school in the near future and being able to assist on future missions.

Day Two - It Really is Monday

Several of us rose much before dawn for a quick trip to a bird sanctuary where we observed, with the watchful eye and education of Dave Leber, over 35 different species of varied colored, shaped and sized fowl. Dave was like a kid in a candy store and it is was a beautiful sunrise as we walked along the shores of a small lake. We moved to a different location where an observation tower was located, and out of nowhere the caretaker of the wetlands station appeared and offered to make us tea. We accepted and he built a fire and proceeded to brew this concoction in a large pot, over the open wood fire. It was quite good and actually tasted like nothing we had ever experienced before. Then, we sped back to the guest house to grab our gear and get to the hospital on time.

Today was another busy day of surgeries and teamwork. It never ceases to amaze me how so many people can come together and in less than 24 hours, function like a well oiled machine. Working together, never a cross word to each other, even when things don't go smoothly. And, just like at home, things don't always go as smoothly as we would like and we do have our share of equipment malfunctions, lack of adequate or appropriate supplies or unexpected patient reactions to anesthesia or surgical procedures. This evens extends to our ability to access the Internet to send out these blogs or to check in with family & friends at home. Even so, I would say that the spirit of the volunteers at World Surgical Foundation perseveres. We have seen this in our Indian hosts as well, as they have been extremely gracious in providing support to our team in so many ways. Even the OR staff are eager to get involved and work with us in any way possible.

While I write this another late evening comes to a close. We were treated to dinner again by our local hosts and then returned to our guest house, where we indulged in a "bucket shower", ever grateful for soap and hot water. It is time turn in, the clock approaches 11:00 pm in a few minutes. It has been a long day and 5:30 am comes as early here as is does at home on a workday.

While we hear the drone of the nightly chanting at a very nearby temple, now we lay ourselves down to sleep. Rest well team, it was another wonderful day to serve with you.

Love to our families and friends at home. Thank you for staying with us.

Gratefully,
-- Cheryl

More of Monday's Images

Sights from Monday

Here are some sights from Monday, January 20th

Surgical Camp Day One - Cambay Hospital / Khambhat, Gujarat,India

Sunday, January 20, 2013

What a difference some sleep makes. The noise of that busy street below faded to only an occasional horn beep, while very close by, there must have been a celebration of epic proportion. Music, singing, chanting, fireworks blasting until the wee hours. For me, sleep came effortlessly and was deep, for others the noise of the party interfered with their rest. Nonetheless, we were all up in the darkness around 6:00am to ready for the day. Breakfast was served as 6:30, another traditional local meal. It is all just delicious.

A little after 7:00 our controlled (I use that term loosely) chaos ensured as surgeons, anesthesia personnel, and nurses gathered supplies to stock their ORs to get their first case started on time.

The local staff preps all of our patients, meaning inserting an IV catheter and capping it off. Children are playing in the dirt courtyard waiting their turn and adults sit cross legged on blankets under the tree or in chairs lining the hallway. We are far from the pre-op we know at home. The patients are calm, and seemingly anything but nervous or fearful to 'go under the knife.' There are no hospital gowns or patient hair bonnets, but rather they enter the OR in their street clothes and what clothing needs to be pulled up or down, gets pulled and away we go. Even so, we are prepping with betadine and utilizing sterile technique in all cases as best we can.

Today's cases included young and old. There were hysterectomies, hernias, burn scar revisions, keloids, and ear reconstruction. Additionally, a share of hypospadias, nasal surgery, oral surgery and a hemangioma and more. Each specialty had plenty to do as they worked through the day and improvised when exactly the surgical supply they would have had at their fingertips at home was nowhere to be found or when momentary darkness came during one of the numerous rolling blackouts.

At 3:00 pm another group of locally pre-screened patients arrived for our team to have a look and make a final determination if their procedure could be done safely here. It was very heart breaking to see some that had to be turned away because it would be unsafe to perform the complicated surgery needed at this facility, in addition to needing more types of specialists on hand. It makes one so grateful to live in a country where, as difficult as it may be to work though the system, a patient has a much higher chance of receiving care.

TV reporters from VTV news broadcasters came to film a documentary about what we are doing here. In typical Indian fashion, they were extremely unobtrusive and thankful that we allowed the group to be filmed. I was sure to give them the blog URL as well as the WSF website address!

All in all, it was a successful day with many procedures being performed.

After work we where shuttled out to a large sandy area close to the seas (we could not see the sea) where over 10,000 people were flying kites, the close of a larger festival that occurs on January 14th which draws over 100,000 people from across the area flying kites like crazy. It was quite a site to behold, and needless to say we stuck out as not from these parts. Many people asked if they could take a picture with us, we were rock stars -- almost famous, grin... Our wonderful hosts had a local woman prepare dinner for us and we ate on the rooftop of our guest house. It was another fantastic evening and early to bed.

You are out there reading, aren't you?

Photos coming shortly.

T+40 Something......., A Hard Day's Night, Part Two

We arrived in Ahmedabad about 3:30 am local time, approximately 34 hours from leaving home. We met three more team members who began their journey from North Carolina, California and another from Harrisburg. We were met by several smiling faces, among them one of the coordinators of this surgical camp, Kiran Patel who couldn't have been more gracious. They loaded up our bags into the back of a sort of extended pickup truck and we boarded the bus for a 2+ hour drive south to Khambhat.

Several of the group certainly hinted at our ages at the sight of this bus which conjured up images of Woodstock and comments like "I haven't smelled that since the last Grateful Dead concert, or "roll 'em if you got 'em." Spirits were good despite the fact that we were all a bit delirious from lack of sleep. So off we went like a band of pseudo gypsies in the darkness with a few laughs, a couple cases of water, and some dry snacks provided by our hosts. Just one more cramped legged event and we would arrive at our surgical camp destination.

As our first sunrise in two days began, we spotted an elephant walking with its owner, many camel drawn carts, cows just hanging around and even some goats. As early as it was, there were people walking and driving about, and apparently school is in session on Saturday as we saw children with their book bags headed for a day of learning.

Our first stop: Cambay Hospital, a sprawling compound of very old to relatively newer buildings, a veritable labyrinth of connected structures. We were treated to breakfast -- how many meals have we eaten since our last sleep???? --- some welcome information and then we unloaded the medical bags before heading to the Vardayini Guest house on Station Road. Did you read the blog with the Google Earth photo last week? Well, that very spot is about one block away! As we surveyed the town from our 4th floor hall open area we watched dozen of long-tailed monkeys playing on adjacent rooftops and roof patios. We will surely keep our door closed, and locked as to not welcome any uninvited simian visitors from intruding while we sleep tonight. Our home away from home is, well, basic. A hot shower consists of using a large bucket and giant ladle. The bathroom is much like one on a boat, that is it's an 'all in one situation.' After a very brief rest we headed back to the hospital to set up supplies and screen patients for a few hours -- work beings early tomorrow .

Our hosts had a dinner for us at a restaurant across the street which is apparently a local favorite. A note to my friend, Karen Chrestay - while you might be horrified thus far, this meal would have won you over. It was right out of an episode of Anthony Bourdain - I half expected him to walk in at any moment. Not much of an idea of what exactly it all was, but I devoured every bite and cannot wait for the next cuisine adventure - Indian Food, Local style.

It is now 9:52pm local tome Saturday night and we are headed to sleep. This Hard Day's Night has come to a close, for tomorrow is a new day. Not sure
when this will post as we have some WiFi issues tonight. Tomorrow we begin our job of making a difference in the lives of friends we have not met and in our own.

Thank you for reading. Sweet Dreams,
Cheryl

T+24:32 It's Been A Hard Day's Night - Part One

Ken and I left my house a little over 24 hours ago. The train ride to NYC was smooth and we happily met up with 14 members of the team for the 2nd leg of the journey. We arrived in Abu Dhabi just a short while ago, and it is nightfall here (our 2nd of the day -- how does that work). The sun was setting as we made our initial approach into the area. Looking out over the wing of our aircraft into the dusky Persian Gulf we saw many water craft, freighters, fishers and of course the "keepers of the peace" all dotting the water with their night running lights illuminated. As a point of reference, Abu Dhabi is the capital of United Arab Emirates and is located right on the Persian Gulf with a population of over 1 million people. Originally the gateway to India, this land is filled with history.

This is an ultra modern airport in a very affluent part of the world. It's fascinating to people watch in such an airport, noticing individuals from many nations and in diverse costume speaking foreign languages. Groups dressed in white robes heads covered, men in baggy pants and tunics, ladies in richly colored saris, the casual tourist in jeans or sweat pants, and so much more. I just love that I am privileged to see it all.

We have all stretched our legs and made our way to the gate for our next flight that leaves here around 11:00pm local time. We were delighted to find our dear friend Dr. Julie Sofer (see an earlier post to learn more about Julie) who had arrived about the same time as our flight, but flew in from Detroit. We will connect with a few more team members in Ahmedabad when we arrive there 3:25am Saturday, January 19 (local time). We are time warp travelers at this point and as Dr. Roger Levin joked as we got off the last flight where we were served 2 dinners "we have a few hours here, perhaps we should grab another meal and a another dinner roll."

Here are a couple images for your viewing pleasure. I'm signing off until we get to India. Every team member has expressed their thanks that you are all out there, yet with us on this journey. We would love to hear from you via comments and words of encouragement posted to our blog.

Until the next post in the next city in e next time zone,

Peace,
- Cheryl

Today is the Day!

Good Morning Readers,

So glad to see you are checking out the blog often.  I see you all have looked at the blog over 700 time as of this moment!  Wow, this is terrific.  Please say with us and be sure to post to your comments.  We will leave shortly for the train to begin our journey, so be sure to stay tuned.  It is 8:52 on Thursday night in India, and only 10:23 am here.

May we all have safe travels,

Namaste,

Cheryl

T-1 Day - Meet our India Mission Leader!!

The coordinator of our mission to India this year is Dr. Mukul Parikh, an anesthesiologist who works in Harrisburg.  I have had the pleasure to work alongside him the past two years on trips to the Philippines.   He has a passion for helping others and has done a marvelous job in coordinating this trip including accommodations, meals, ground transportation and oh, did I mention the hospital already has pre-screened over 200 patients and provided us with names, ages, type of cases and other information.  These folks are ready to have their surgeries!  I hope they serve hearty breakfast in Khambhat, because we are all going to need a lot of energy as we are really going to be busy.  Thank you Mukul for overseeing this fantastic journey; can’t wait to see you and everyone tomorrow!!

Here is what Mukul emailed me this morning:

Hi Cheryl,

Thank you for doing this blog.  I have sent it to many friends- they are already following it.  Attached is a photo my wife, Neelima took yesterday.   (due to technical difficulties, I will have to post the photo later)

Here is my bio:

·         In Private Practice since 1984

·         Chairman, Dept of Anesthesia at Pinnacle Health System, Harrisburg, PA since 2008

·         Vice-Chair Dept of Anesthesia at Pinnacle Health System, Harrisburg, PA 1999-2007. There are 50 members in Anesthesia Dept

·         Clinical Director, Anesthesia Dept at Polyclinic Medical Center 1994-1999

·         President, Central Penn Anesthesia 1989-1999

·         Fellowship Cardiac Anesthesia and Critical Care, Syracuse, NY. 1983-1984

·         Anesthesia residency Syracuse, NY, 1980-1983

·         Medical School/Internship Osmania Medical College, Hyderabad, India. 1972-1979.

I have been participating in World Surgical Foundation and other Surgical Missions since 2000. Total of 13 Missions so far including multiple trips to the Philippines, India, Thailand and Ethiopia.  I have organized/coordinated missions to India in 2004 (Vadodara), 2008 (Hyderabad) and most recently our oup this week - Khambat (2013).  I am married to Neelima Parikh, MD- an Anesthesiologist.  I follow her on all the missions- both for surgery and in LIFE.  We have 2 sons- Ankur- Urologist in private practice in Worcester,Mass., and Anuj-  who is a 3^rd year General Surgery Resident at Pinnacle Health System, Harrisburg, PA.  I am so happy that Anuj will be coming along with us to participate on Khambhat Mission. 

Looking forward to Khambhat- one of the most organized and generous host Hospital- with more than 200 patients pre-screened and ready. 

Well, my readers;  that is what I have for today.  Perhaps tonight after I pack my still unpacked clothing, I will post again.  Thank you for coming along with us.  It means a lot to each and every member of the team.

On the Street Where We Will Live

The marvels of Google Earth brought us to Station Road, where the guest house sits.  This is the street where our team will make their home away from home for the next 2 weeks.  I thought you might like to have a look.

Dorothy, we are not in Kansas any longer......

Are you out there?  Are you ready to travel with us now?

Thank you for reading, I'd love to get your comments to share with the team!

-cheryl

Welcome Dr. Dr Parul Krishnamurthy as we prepare to head to India Tomorrow

I’m an Ob/Gyn in the Harrisburg, PA area for 9 years. I’m extremely grateful to WSF for this superb opportunity (my first one) to be the Gynecologist for this India Mission in Khambath, Gujarat. Ethnically hailing from this region myself makes it especially satisfying to make a meaningful contribution to the lives of the underprivileged women of this area. Women’s Health and Empowerment is my passion. I love to travel and spend time with family, enjoy cooking, entertaining and bridge. I also enjoy Dance in its many forms (Indian Classical genres, Indian Folk, Bollywood and Zumba).

My deepest gratitude and many thanks to all those around me who have made this possible.

Particularly, my colleagues at Women’s First Ob/Gyn Harrisburg, PA.  The Gyn OR staff at Pinnacle Health facilities.  The Hersha Group for their abundant generosity.  Dr. Mukul Parikh for superb logistical support.  My supportive family and finally my mother who has been the guiding light in my life and career inspiring me through all tribulations to this day.

T-1 Day and More Friends are Stopping by

Dr. Neelima Parikh and her friend Diana Davidson stopped in to my blog yesterday to say:

Hi Cheryl, 

thanks for all the hard  work. !!... job well done..... I have sent the blog info to my family and friends...

This is  what i feel about the mission..: have been doing the surgical mission work for past 12 plus yrs....visited Philippines , Thailand,  Ethiopia ,  and India in my previous visits... enjoy them very much.... get a lot out for me and also learn a lot.

Diana adds that  she has been doing the missions for ten years.  Thailand, India, Ethiopia and the Philippines Thank you Diana

Have a Good Day..

Neelima & Diana