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6:30 pm Annual day 2017 @ Lady Willingdon Hospital
Annual day 2017 @ Lady Willingdon Hospital
Nov 27 @ 6:30 pm – 7:30 pm
Winter is here, with its woollens and the year is drawing to a close. We hope to have the annual day of the hospital on 27th November 2017. Our Bishop, Rt. Rev Pradeep Kumar Samantaroy[...]

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Surgical camp in Pangi

Posted by: Philip Alex | Posted on: October 16th, 2016 | 0 Comments

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The Chandrabhagha river slices a gorge through gargantuan granite cliffs that make the Pangi valley simultaneously inaccessible and breathtakingly beautiful. An unprotected road blasted three hundred feet high above the river along the side of granite and shale provides the only access into the valley. The journey is a bone rattling, nail biting, dust coated ordeal from anywhere between thirteen to sixteen hours. One has to wonder, while negotiating the precipitous curves, what would have led people to journey so far into wild inhospitable terrain to live? Myth and folklore have it that the Pangwalis, as they are known, were runaway criminals, or slaves fleeing from an irate king. The twenty thousand people here are evidently ethnically different, with peaked features, sharp eyes and aquiline noses.

 

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Our team of twenty seven packed into two tempo travellers one pick up truck and one SUV bounced and jiggled their way to the sub divisional headquarters in Pangi called Killar, the location of government offices and the only hospital in the entire region. The hospital itself is a ramshackle wood and stone structure, dark, dingy, much like a subterranean cavern complete with rocks that serve for steps at the entrance. Our staff formed a human chain and unloaded our equipment, including our operating microscope, operating light, cautery machine, ultrasound machine, autoclave, and the entire stock of medicines and consumables which we needed. Every item had to be brought in, down to the sticking plaster. Having unloaded all this, we retired to our guest houses to wash off the grime and dust.

Just before dinner, our team leader, Dr. Bishan Shasni received a distress call from the government doctors at the hospital. They had a young lady who was in shock, whom they thought probably had an ectopic pregnancy that had burst inside her abdomen and was bleeding. Another short statured teenage mother had been in labor for two days and was probably having obstructed labor. The doctors there could not help, and these patients would not make it out to another hospital alive. Our operative and anesthetic staff piled into our vehicles and raced to the hospital.

Over there we found that the lady with the probable ectopic had been in shock for the past three hours. Her blood pressure was not recordable, she was pale, and her abdomen was extremely tender to touch. The pregnant mother was fully dilated (which means that the mouth of her uterus had opened completely) but the baby was stuck. Apparently she was in this state for the past six hours.

We really did not have a choice. The operating theatre in the civil hospital is generally unused, utilized only when teams like ours come in to operate. It was not fumigated by us or cleaned by our staff, who have a time tested ritual to sterilize the operating environment. They usually spend one day doing just this. We had just arrived, and had planned to sterilize the theatre the next day. But this situation required a solution that could not be postponed. Our team swung into action.thumb_dsc07656_1024

Within half an hour they had the basic equipment ready and a functional operational table ready to go. We used this time to resuscitate both patients with iv fluids and prepare them for surgery. Our radiologist Dr. Uma Shankar confirmed our suspicions of a ruptured ectopic with the portable ultrasound machine we had brought with us. With a hurried prayer, we rushed the lady with the burst ectopic pregnancy onto the operating table. Our anesthetist Dr. Prashant Varghese quickly intubated the patient and had her ready for the knife. There was two litres of blood in the belly, and indeed the right tube had an ectopic pregnancy which was bleeding. The bleeding was controlled, the ectopic removed safely and within the hour the patient was extubated and returned safely to the ward, now with a recordable blood pressure. The table was immediately readied for the lady with the obstructed labor. By now, our gynaecologist Dr. Priya had arrived, after a harrowing journey when her vehicle went off the road and nearly over the precipice after having reached Killar town. She had left from Manali after us and was travelling alone. Unfazed despite this ,she rolled her sleeves up and operated on the lady, delivering a healthy baby in a matter of minutes, a baby who to our great reassurance protested loudly at his extrication,. The baby was breech (upside down in the mothers tummy, with its hindquarters presenting first).

The next day, both patients were doing well, the lady with the ectopic sitting up and smiling, wan and pale, but well. The young Nepali couple were thrilled with their little one, who was sleeping peacefully next to his mother who herself looked like a school girl. With a huge sigh of relief, our team resumed the normal pattern of our camps, setting up rooms for ultrasound, eye examinations, a pharmacy and consultations, and the theatre staff started their magical transformation of the theatre into a sterile haven for surgeries.

Patients poured in, clamouring and jockeying with each other for precedence to be seen. Our staff had worked out a numbering system by which they would be seen, but they did not want to follow it. Eventually, the melee subsided, and some semblance of orderly consultations commenced. Patients were examined by the doctors, tested in the laboratory, x rayed or sent for ultrasound examinations. The ultrasound machine was the rage. Every one wanted an ultrasound, even those with headache foot pain, shoulder pain and knee pain. They were very hard to dissuade or be convinced that the magical black screen would not help them. We even heard the patients leaving the consultation whisper to those waiting to be seen “Say you have abdominal pain, not knee pain” so that they could justify the use of the box with the wand that uncovers all secrets of the body. Dr. Uma bravely soldiered on doing about seventy ultrasound examinations every day.

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Rounds were conducted twice a day, and we came face to face with the fear and trepidation that the people live with. The lack of any viable health services for emergencies have filled the people with fear which is written large on their faces. It took a lot of convincing, cajoling and humourous reassurance to get them to relax and believe that their wounds were not going to burst or explode, or some other drastic complication happen to them. Those who were well enough to go home were unwilling to leave, wanting to stay till all the sutures were removed. However beds were limited and every day there was a new wave of surgeries to be done.

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All the operations went well. There were no complications, and even our two emergent cases did not develop any wound infection, which was truly the grace of God. The eye team of Dr. Satish and Naveen were overwhelmed by the need of surgeries to be performed. We were very aware of the overshadowing grace and presence of God through all the days we were there. It was with great joy and a sense of accomplishment that we loaded up our vehicles again on the last day for our return to Manali. A brief visit to a mountain lake nearby provided a welcome break on the last day, an opportunity for all to experience the joy of walking mountain trails and revel in the beauty all around.

We are very grateful that we could do this camp again this year. We are grateful to all those who came, and worked hard to provide hope and healing to a people deprived of the chance for safe surgery. We are also humbled that God would so prepare us and providentially plan for us to be there to save those three lives that first night, an testimony to His great love for the people of Pangi.

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Download the pdf version here;

[pdf-embedder url="http://www.manalihospital.com/wp-content/uploads/2016/10/Blog-report.pdf" title="blog-report"]

 

Dr. Khup eye surgeon

Posted by: Philip Alex | Posted on: July 16th, 2016 | 0 Comments

We are grateful to Dr. Khup Minsong, eye surgeon for conducting a camp here in LWH Manali and operating on patients providing cataract surgery here in Manali. Dr. Khup has a long history of experience with eye surgery having practiced for many years in various locations all over India.

Dr. Khup

Mesenteric lymphangioma

Posted by: Philip Alex | Posted on: July 14th, 2016 | 0 Comments

Dr. Dhruv Ghosh operated on a six year old child who had presented with a large mass in the abdomen and pain every time he ate something. Imaging had shown a huge cyst in his abdomen. Intra operatively it was found to be a large cystic mesenteric lymphangioma. The child underwent a resection anastomosis and has been discharged well. Thanks Dr. Dhruv!

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Diaphragmatic hernia with sac repair

Posted by: Philip Alex | Posted on: July 14th, 2016 | 0 Comments

Dr. Dhruv Ghosh operated on a four year old with a large left sided diaphragmatic hernia with a sac (eventration). The four year old child could not be taken to any higher centre and was malnourished. The child stood the surgery very well and has been discharged home. Thanks Dr. Dhruv!

The intraoperative photo shows the repair.

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Littre’s hernia

Posted by: Philip Alex | Posted on: July 14th, 2016 | 0 Comments

A seventy five year old gentleman came with the history of an irreducible swelling in the groin for a day and inability to pass stool or flatus. On the operating table he was found to have a Littre’s hernia. He had a Meckel’s diverticulum in a femoral hernia which was gangrenous. He underwent resection anastomosis and repair successfully.

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Dr. George Ani, ent surgeon exemplare, RIP

Posted by: Philip Alex | Posted on: April 8th, 2016 | 0 Comments

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I  returned from George Ani’s funeral on the 3rd of February 2016.

Equating the familiar mental image of his twinkling smile and that easy shake of his head with his now still body was a surreal impossibility. He was killed by a speeding vehicle while on a cycle from Vellore to Bangalore. Time then froze into a snapshot framed by Annie his wife, his bewildered kids, as wafting waves of incense stirred the heated air. The seismic shock of the moment fragmented into a barrage of questions and suppositions which whirled with the fan stirred wind, each shouting, but echoed by a silence bereft of answers. Here is the transcript of my message at his funeral. It is an attempt to find meaning and hope, and offer that hope to all those who hurt as we do.

“I stand here today on behalf of my family, my wife Anna and my son Nathaniel. I come on behalf of the Lady Willingdon Hospital Manali, and also on behalf of the many mission hospitals all over the North of India. I stand here today also on behalf of thousands of patients not only in the Kullu valley and beyond, but also on behalf of many thousands of patients in remote locations all over India.

I knew George from his student days. The songs we sang at his funeral were songs we had sung together with him. I watched him grow and mature, graduate, and go for postgraduate training to C.M.C. Vellore in E.N.T. Watched as he became an exemplary surgeon. By this time we were in Manali mission hospital. Manali mission hospital is the only viable hope for patients in the Kullu valley and beyond the 13500 foot Rohtang pass which isolates 45000 people beyond its natural barrier. George first came by himself for an ENT camp to Manali six years ago. Seeing the immense need he help set us up with all the necessary equipment for regular camps. He subsequently came to us faithfully twice every year for the next six years. He personally motivated other ent surgeons to accompany him. His department supported him in this endeavour. He used to come for four or five days, in which time he would see three to four hundred patients and perform ten to fourteen complicated surgeries before his return to vellore. This was a huge boon to so many patients, for whom access to this sort of service would normally mean an eight hour drive to Chandigarh and huge costs, both of which were beyond the reach of many.

I would like to share two stories from his times with us. Both stories have to do with time. The first is about a three year old boy called Man Singh, the son of a daily labourer who was brought to us with stridor and a progressive inability to breathe. We could only think of diphtheria, or croup, none of which fit into his pattern of presentation. We put a tube down his windpipe and put the boy on a ventilator to keep him alive. We talked to the father about taking the boy down to a higher centre but were greeted with that glazed expression which we know means that we might has well have suggested taking his child to the moon. The father of the boy asked us to remove the machine and give him the boy so he could take him home to die. But George was scheduled to come the next day. I persuaded the father to permit us to keep the boy till George had come to see him. He agreed. George came, saw the boy and diagnosed a rare condition of congenital abductor palsy where the vocal cords are unable to open thereby causing the difficulty in breathing. He then performed a surgery by trying to lateralise the cords and inserted a tracheostomy tube below the vocal cords through which the child could breath. The child was discharged well and has subsequently been seeing George for the next two years. Last September George advised us to remove the tracheostomy tube. This child who was now five was discharged completely well. If George had been even a day late, I would not have been able to persuade the father to keep the child and the child would be dead. Here in Kerala you may not be able to understand why a father would rather choose death for his child than the option of taking the child to a higher centre, but that is the reality that a large proportion of India lives with. God however, had chosen George to come just at the right time so that this boy could live.

The second story is from the very last time George was with us last September. He had travelled overnight by taxi from Mussourie where he finished a camp. He had seen about three hundred patients, and had performed twelve surgeries in Manali. He had to leave by bus at five pm and had just commenced his last surgery, a modified radical mastoidectomy at two thirty pm. This surgery normally takes anywhere between three to six hours. I was considering alternate travel arrangements when at four thirty I saw George outside with his bag. He said that he felt God’s hand permitting him to finish the surgery in record time. He was able to get on to his bus in time.

Today, as we see him lying still, many of us have questions. Some of the questions are about time. Most of these questions do not have answers. Some of those questions are suppositions that open oppressive doors of guilt or fear. But George would not have us live under these shadows. His times were undoubtedly in the hands of the Lord of the universe. And he lived a full life, filling the unforgiving minute with sixty seconds worth of distance run. So it is our unbelief that questions the progress of time in the Master’s hand. We have to believe that God knows exactly what He is doing, though it does not take away our pain or furnish answers to a shrouded future. We don’t know what the future holds, but we do know who holds the future. And so, we can come to say thank you. Thank you George for who you are, for your smile, your humility and for your passion for life and to see God’s kingdom come here on earth. Thank God for the privilege we have of knowing George. We can hope, because we know that this hope will not disappoint us, because of God’s love that has been poured out in our hearts through the Holy Spirit who was given to us. (Rom 5:5).

Pangi Surgical camp.

Posted by: Philip Alex | Posted on: September 19th, 2015 | 0 Comments

PANGI SURGICAL CAMP 2015

 

 

Twenty six people. Two tempo travellers (11 seaters). One Bolero (five seater). One pickup loaded with medical supplies. That’s what it takes to get safe surgery to Pangi, at the edge of the border of Himachal Pradesh with China. The entire cavalcade was poised and ready to leave by eleven am, to embark on the two hundred and sixty kilometer journey that would span two days. A particular concern for me was one and a half year old Lucas, son of the radiologist, whose parents seemed most confident would stand the journey well. I did not share their confidence. Getting a team together like this was a huge effort. The gynaecologist Dr. Vaneeta, from New Delhi, had stepped in at the last minute to substitute for someone who could not come. The radiologist Dr. Joshua was from CMC Ludhiana, placid and calm despite having spent the last twelve hours in a public bus with his wife and child. The eye surgeon was an old hand at surgery in rural places, Dr. Jai Xavier, and his technician, Mr. Sandeep, was also from C.M.C. Ludhiana. Our new eye technician, Mr. Shivdayal completed his outfit. We had an anesthetist from St. Stephens hospital, Dr. Rao, together with his resident in anesthesia, Dr. Aditya. Our anesthetic technician, Mr. Rewat Ram completed that section of the team. In addition there were nurses, lab technician, pharmacist, surgical resident, operating theatre staff, two drivers, a cook and his assistant.

 

Much like a travelling circus, or a posse setting off on a distant pursuit, the cavalcade left the gates of Lady Willingdon Hospital, in high spirits and with great anticipation. The grueling road beyond the Rohtang pass, the dust that entered every crevice and cranny, and the constant bone jolting bumping over the next one hundred and sixty kilometers did much to dampen that enthusiasm as a tired convoy pulled into our centre in Madgram, and collapsed on blankets, mattresses and sleeping bags in the night. We were very quiet and downcast that night, because we received the horrendous news of the death of the child of one of the drivers whose vehicle we had hired. The child had been in Udaipur, and had slipped to her death from the bridge earlier in the day. The driver was sent back to Manali to his family that night and another took his place.

Early the next morning, shutterbugs were out early, attempting to capture on their cameras the first fingers of dawn creeping over the snow clad peaks in the distance. Bleary eyed, the others fell in line for a hurried breakfast, before clambering on to the same vehicles again.

 

We finally arrived in Killar in Pangi in the evening. There was intense altercation between guest house keepers and our team leader Dr. Bishan, who was trying to fit the posse into shelters for the night. The cooks busied themselves providing food for all, and finally all were fed, and found a place to sleep. The team unloaded all the supplies at the ancient district hospital, established in 1987, a wooden structure with crumbling stone steps down which a leaking pipe constantly discharged effluent as if in an attempt to wash off the ubiquitous grime and dust. The one operating theatre was spacious, but unused after the surgical camp from the year prior, conducted by a team that had come in from Delhi. As we entered, sleeves rolled, with buckets, brooms, gloves and masks, we were horrified to find caked and congealed blood under one of the operating table mattresses, a bloody testament to the conditions that we were now called upon to sanitize. Our team stepped up to the task, and after much labour, transformed the space into a sterile and functional operating theatre which inspired confidence to work in. Fumigation machines were employed double time, but to our dismay we found that the shiny new autoclaves were faulty. Earlier we were assured that one worked perfectly. So a scramble again to fix them, and commandeer smaller autoclaves to sterilize the necessary supplies. The room that we were directed to for eye surgeries had mould on the ceilings and walls, and dust everywhere, and we could not bring ourselves to consider operating there, despite assurances from all the staff that in the years gone by, all the eye surgeries had been conducted uneventfully in it. So we made a decision to give the eye surgeon a fresh theatre in the morning, to be followed by the general surgery list.

 

We began screening patients early the next morning, on the 11th of September, and long lines of patients waiting patiently for their turn to be seen was indication of the pressing health needs prevalent in the area.(I have written about this in my previous blog after our screening camp held here in June this year). Our operating lists began to rapidly fill up over the next days. Eye surgery would finish by two pm, and a brief lunch break would precede the general surgery team taking over the precincts. General surgery the first day continued till one thirty in the morning. The next days the lists moved quicker and finished at more civilized times. We performed twenty five eye surgeries and forty five surgical cases over four days. Every day would start with a short devotion in our rest house, a sumptuous breakfast then rounds, followed by outpatient clinic while the eye surgeons went directly into the theatre. They would emerge at lunch time to see patients in the afternoon as the general surgical crew traded places with them. The day ended with rounds of all the postoperative patients who were left in the care of one of our staff nurses who stayed with them through the night. All surgeries went well, without any complications. There were brief periods when the electricity would go off, and all sorts of devices providing illumination were pressed into service, torches, mobile phones, until the generator we had brought with us was yanked to life. Most surgeries were done under either local or regional block or spinal anesthesia, except tonsillectomies for which we used general anesthesia. A tired troup would return to the rest houses, and the morale always received a fillip from the amazing meals that our cook would conjure up for us from that rustic kitchen.

 

All the team members gelled very well together as a team, and were welded by the second day into a very efficient group. Lucas did admirably, as his parents had predicted, and quickly became the camp mascot. Some skills he learnt in Pangi, to the chagrin of his parents, but the delight of some of our team were to throw stones when directed, chase boys, and wave to girls.

 

 

Days and nights ran into each other, and soon it was time to pack up again, fit the entire outfit into assorted cardboard boxes, load up the wagons, and hit the trail again. We were all tired, but very grateful and satisfied as we all piled into the vehicles for the long ride to Manali. As our convoy negotiated the turns in the boulder strewn path that served as a road blasted from the sheer cliff face above a five hundred feet gorge, we returned knowing that something changed, forever, inside each of us from this expedition. Images are frozen in our minds, varied snapshots that have burnt into memory. Of sunlight rippling on the foaming distant river, a mountain goat poised for a leap on the edge of the precipice on three legs, the smile and wave of children watching us drive by. Much much, more than we have given, have we received. Adieu, for now, till next year.

Spiti sputterings

Posted by: Philip Alex | Posted on: August 10th, 2015 | 0 Comments

 

MEDICAL TRIP TO SPITI

The Rohtang pass crosses at 13500 feet and then swings to the east towards Spiti. Approached over a boulder strewn apology for a road  it is intersected and often inundated by natural streams, it is a punishing journey for both man and machine.

Our team of nineteen members found themselves separated early into the journey by the breakdown of one of our vehicles on the 31st of July. One vehicle went ahead, the other had to wait for replacement parts to be sent by vehicle from Manali. Finally, all made it safely to Kaza by nightfall. Our team leader, Dr. Bishan Shasni was most relieved.

The next day our camp members swung into action, functioning like a well oiled machine and set up stations in the district hospital for eye, surgery, medicine, gynaecology, laboratory and pharmacy. The team was constituted from C.M.C. Ludhiana for eye (Mr. Anil Kumar, ) medicine (Dr. Parvesh Paul), and gynaecology (Dr. Ankur). Since we had difficulty in procuring a radiologist, Dr. Banga had kindly consented to come from sundernagar on the morning of the first of August. He left Kothi at two am, but had to turn back from Chatru since the road was blocked by a truck that had broken down. Dr. Kundal, our regular radiologist had to be transported from Sundernagar to Tabo on the 3rd, a fifteen hour journey. This unforeseen event called for a reorganization in the camp schedule. Our team continued the camps in Sagnam, Tabo and Losar, but our radiologist returned to Kaza to complete the scheduled ultrasounds from our previous clinic in Kaza. All this meant a lot of travel over bumpy roads, and lo and behold, the spring leaf suspension in our force traveller also broke down. More replacement parts were procured from Manali. Men did not fare better than machines, since team members were afflicted with early altitude sickness and were treated for it.

Despite these difficulties, every camp site was flooded with patients. We saw over one thousand patients and performed over one hundred and seventy ultrasound examinations. Patients were screened for diabetes, and underwent gynaecologic, medical and surgical check ups. They were dispensed medicines which we had carried with us. The eye technician Anil had been checking for cataracts and refractive errors. We hope to carry the prescription glasses in to these patients on our next camp.

The people of the Spiti valley have a heartwarming bonhomie and sense of humour that permits them to endure the inclement weather and living conditions bereft of what we consider basic necessities. Health facilities and access to services are possible only if they are able to leave the valley and go to either Manali, Kullu or Simla. Normal labour becomes a risky and unpredictable ordeal, in which mother and child are both at risk. There was no provision for antenatal ultrasound in the entire valley, and there were long lines of patients often in the late stages of pregnancy waiting uncomplainingly for our radiologist to perform the examinations.

It was encouraging to see patients we had operated on last year doing well. They had just come by to get “checked up”. We found quite a few patients had visited Kullu for their medical needs, others Simla. Common conditions encountered were osteoarthritis, hypertension (frequently undiagnosed), and gall stones. Most people however were reasonably healthy, and indeed in such an environment one can imagine that only the fittest survive. Helminthiasis was as common as the children who carried them in their mildly distended bellies.

Since the population of the whole valley is only ten thousand scattered across sparsely populated villages, we did not see large numbers of patients with pathology. However one can well imagine that those we did see represented those with significant problems who had come to take advantage of our camp.

The day before we left, we were honored us with ceremonial scarves and a bottle of “ara” (a local brew) by the local mahila mandal women. Their obvious gratitude touched each of us for what we had done was a miniscule attempt for us, but their tear laden eyes spoke of a gratitude borne of having to live in the face of so many uncertainties with little hope for reprieve.

We hope to return again this year to conduct a surgical camp in Kaza.

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Medical team in Pangi valley

Posted by: Philip Alex | Posted on: July 2nd, 2015 | 0 Comments

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MEDICAL CAMP IN PANGI VALLEY

 

The district of Lahaul and Chamba in Himachal stretches west across the Rohtang pass, which is the lifeline providing access into the region populated by about thirty five thousand people. For about five months of the year, this snaking mountain pass is blocked with snow, rendering urgent access impossible. The mountainous terrain has precipitous gorges enfolding rushing streams that flow into the Chandra, and the Bagha rivers. These rivers join at Tandi to form the ChandraBhaga which later becomes the Chenab. The Chenab cuts like a knife through sheer rock in the Pangi valley towering above its rushing flow. A semblance of a road has been blasted along these sheer cliff faces, and is the only access into the Pangi valley. This trip was a first for the Mission hospital staff. A team of nineteen people in three vehicles pushed our way into this valley. Thankfully, all the vehicles made it without incident, though we were delayed by incessant rain that had caused landslides and closed the road for a day.

 

The team was composed of a gynaecologist (Dr. Sailesh), and radiologist from CMC Ludhiana (Dr. Pyares), a medicine consultant from C.M.C. Vellore (Dr. Abhilash), eye technician (Mr. Anil Kumar), dentist (Dr. Riya), laboratory staff, nurses, pharmacist, and a cook. Dr. Bishan Shasni, our Community consultant led and organized the whole endeavour. We stayed in a variety of government guest houses all along the way. The first two days was at Keylong, in the district hospital, and subsequent camps were in Udaipur, Killad, Sach, and Purthi.

 

A total of 1410 patients were seen. 296 ultrasound examinations were performed. All patients were screened for hypertension and diabetes. 94 dental procedures were performed. Every camp day consisted of the team organizing themselves in the government facilities, moving tables and chairs into position, setting up the pharmacy, and eye equipment, and settling down to see long lines of patients till the evening. A quick lunch break was a welcome interruption during which the team cook Punchok kept our spirits up by conjuring up exotic dishes out of very makeshift kitchens.

 

Two of our team members came down with altitude sickness, which we were able to detect and treat early. No one fell ill subsequently which was a blessing.

 

In Keylong, the response was lukewarm. Trifling complaints were an indication that the people here had access to health providers elswehere and had been obtaining treatment for themselves. The potato farmers in this region have money that permits them to access health care in Chandigarh and Simla, which is their recourse in the face of any medical emergency. We were able to care for a number of Nepali patients here who are employed as daily labour. Some of their stories in the setting of the recent earthquake in their homeland were heartwrenching. A little boy came and sat in my opd, unable to open his mouth at all. He had fallen from a tree and had probably fractured his temporomandibular joint which had subsequently fused, closing his jaws permanently in a locked position. The surgery he needed would be a challenge anywhere. We said we could consider attempting this in Manali, at which his uncle began to weep. His entire home was wiped out in the earthquake, and his family members were now all with him here in Keylong.

 

Stories of desperation continued to pull at my heart strings as we made our way across the valley. The further we went, the deeper was the desperation. We entered the Pangi valley late at night, which was probably fortunate for most of the group as the dark obscured the precipitous drop into the gorge as our vehicles careened round the sliver on the mountainsides that serves as a road.

 

We were consistently overwhelmed every subsequent day with large numbers of patients in Udaipur, Killad, Sach and Purthi. Despite the crowds, the people were most respectful and considerate to each other, waiting patiently in long lines and permitting precedence to the aged and the young for treatment. The people are very gentle, and simple. A peculiar notched white cap characterises the Pangi man, and the women are adorned with necklaces and a multicolored cap called a joji that rises above their jet black hair like the hood of a cobra. They wear the traditional pattoo (or woven blanket) in a peculiar underarm fashion, with a fringe that is tossed over the other shoulder. They have peaked features, aquiline noses and sharp chins that permit easy identification. Their origins are ill defined, with some murky reference to their ancestors being driven out by the Chamba mountain kings. It is easy to imagine that desperation or a desire to hide would have driven these folk into their mountain hideaway, isolated and inaccessible.

 

Those characteristics many generations later has worked against them. Nature’s havoc and the ravages of ill health has caused them to see their own die from preventable and treatable diseases. Childbirth is an event with an unpredictable outcome for mother and child. Injury and trauma is a pathway to the grave. Most accidents on these roads are fatal, since no one can survive the precipitous drop into the gorge. The government hospital is staffed by two enthusiastic but inexperienced doctors, who do the best they can. With no access to surgery, or advanced medicine, they feel helpless more often than not, since their nearest referral hospital with a hope of treatment is eight to ten hours away on these roads. There is no postgraduate in the entire region.

 

As patients came to us, I sensed a deep and indolent sorrow that has permeated the fabric of life. A sorrow probably birthed from helplessness and bereft of hope. It surfaced in the tears of a mother being told her baby was well. Was it relief? Or was it from months of not knowing and imagining the worst? A man who was over a hundred had a carcinoma on his ear for two years. On being told we will return to operate on it, he reached down to touch my feet, a person who was half his age. What can do that to a man who is over a hundred? The people were most grateful for any treatment given to them.

 

The government NRHM program permits teams to operate in Killad and Udaipur annually and we saw quite a few who had their surgery at these camps. These camps had been conducted by other teams in the past. This seems to be an avenue of hope for them to obtain treatment. For most of them, the possibility of leaving the valley to go for treatment at bigger centres is like being advised a trip to the moon. Yet, we also were witness to questionable practices at these camps, like a twenty six year old lady whose uterus was removed, and another thirty five year old lady whose ovaries were also simultaneously removed. There were stories of some of these surgeries going very wrong. A lady had become septic and continued to bleed post operatively from a previous camp and required referral, large amounts of blood transfusion and a month in another centre before she was well enough to return. All this was very sobering to me, because the onus of providing surgical services in such an environment safely is an onerous one, not only to ensure that we are able to provide a service, but more importantly to provide it safely.

 

One thousand four hundred patients later, we leave with a sense of fulfillment, but we also carry with us some of the sorrrow of the people, which is an impetus for us to return, and hold out hope. That is what the gospel is for all desperate mankind, a hope, a message that God has opened a way for a desperate people, holding out a hope for healing and wholeness, the substitution of a smile for rivulets of sorrow. We hope to be back, very soon.

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Written by Dr. Philip Alexander, Medical Superintendent,

Lady Willingdon Hospital, Manali

HP INDIA

 

 

Squamous cell ca kidney

Posted by: Philip Alex | Posted on: May 26th, 2015 | 0 Comments

Mr. R came to our hospital having been operated here twenty years ago for stone disease in his right kidney. On examination he had a large palpable kidney and a bulge in the right renal angle. Imaging showed a large number of stones in the kidney and a mass in his upper pole. DTPA scanning showed poor kidney function. He was taken for a right radical nephroureterectomy. The images are included below. The differentials at the time were xanthogranulomatous pyelonephritis or hypernephroma but the biopsy has returned as squamous cell ca. 

He has been since discharged well and will be on follow up.