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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. 


Those spectacular dances

Posted by: Philip Alex | Posted on: December 7th, 2014 | 0 Comments

And here are the spectacular dances conducted by the lwh and daystar teams during our annual day extravaganza. Look them up on utube by clicking the web addresses, and ENJOY!






Annual day message

Posted by: Philip Alex | Posted on: November 30th, 2014 | 0 Comments

Here is the transcript of the Annual day message by Dr. Philip Alexander:



Another year has passed by. Personally this year marks ten years of us being with you all and working here. For many of you that might be thirty, or twenty. For others it might be one, or two. Others will be in between. All of us have learnt from each other. All of us have changed. We are not today what we were yesterday. We see that in the growth of our children, and prefer not to see it in the lines in our faces and grey in our hair.


This is the first time in history that the hospital and school have met together for an annual day program. For me, that is a great encouragement. And the reason I say that is because we are all about some common business in Manali. The hospital and School are testimony and witness to what God is doing here in our midst. What has God been doing here?


In the hospital I am most grateful for each of you who work and put your shoulder and hands to the work. To long hours of work and intense pressures. To putting patients first, ahead of your own comforts, food and sleep. For every person who joins hands to deliver a standard of care at an affordable cost in the spirit of Christ. We have done it. You have done it. We have become an efficient team, functioning together and doing our best to provide this quality of care here in Manali and I am proud of all of you. Let us continue to hold this standard high. Our people we work for deserve no less. I am particularly proud of our community outreach this year, which has been targeted and specific and has brought hope to many who may not have had hope otherwise and wish to recognize the efforts of the whole team, led by Dr. Bishan Shasani. At this time I also want to thank and appreciate Dr Ranjit Christopher, who characteristically will stay behind the scenes but has played a very important role in taking the hospital forwards and keeping things ticking. I am also very grateful to our team of nurses and ward aides headed by Sister Rashmi who are the ones being the hands and feet of ministering Gods’ love. Having said that, I do want to acknowledge every person in the hospital team, whom I consider an essential part of all our effort here. Thank you.


In the school I am most proud of each of the staff who have jelled together as a team and demonstrated that the cause of the school is much greater than the differences that may exist. For pulling together, under Mr. Vijay’s leadership and emerging today stronger and demonstrating that nothing can divide you because all of you love Daystar school and the students you serve. You have now started a new chapter with the eleventh and twelfth ISC class and may the daystar school flag flutter high and give hope and a future for all who pass under it.


Jeremiah 29:11 declares that the Lord has a plan for us, a plan to give us hope and a future. We have seen this in personal lives and in the life of this society. The most important thing I would like all of us to recognize is that this effort is not about us. Not about hospital, or school, or Mr. Vijay or about me, not about one or two people, or about a group of people. We must all recognize that we are part of God’s plan. All of us. Together. No one is above, no one is below. We answer to Him in our work, and in our attitude. That is a fearsome statement, because whether we realize it or not, acknowledge it or not, it is a truth. What it means is that He will measure, judge, reward and uplift. Our work should be of such a high standard, that we should be able to hear him say “Well done, good and faithful servant”. Because in the final summary that is what all of life is about, about us being faithful to what He has given us to do and doing it with an attitude of a servant.


Thinking about the next year, I want to leave with you one phrase which I believe is what our combined service here does for the community. That phrase is “holding out hope”. That is what we do. We hold out a hope. For patients, for students, for parents, for desperate situations. We don’t provide it, nor own it or distribute it as if it was our possession. We hold it out. It is up to the patients, students and those we serve to lay hold of it. When patients and students leave us they should leave us with hope. All patients may not be cured, and all students may not come first in class, but each should leave us with hope. Because we do possess a hope that has been given to us. It is not ours. It was given to us. We may not always have all the cures, or solutions. But we have a hope. We may not always see the road in the darkness, but hope is our guide and light for the future. We hold on to that hope and hold it out for others. The Bible says “those that lived in the darkness have seen a great light”. That is the coming of Christmas, the coming of Jesus into the world to provide that hope. He did not come to fix the world, but to provide all those who have no hope a living hope while in the world. A hope that does not disappoint us. A hope that will lead us. It is the hope in a living God.


What do we hope for in the next year? What do you hope for in your personal lives, family lives and in the lives of our institutions? I hope for His kingdom to come in me, in my family and in our institutions. When His kingdom comes, all darkness will have to give way to light, and the hope that is within us will be a light shining in the darkness, drawing others to it, and igniting hope in all the people’s hearts, which basically is the Christmas message for all the world.


May you all have a wonderful holiday, a blessed Christmas and a hope filled new year.

LWH Emerge cricket champions!

Posted by: Philip Alex | Posted on: November 9th, 2014 | 0 Comments


LWH clinched the Alexander Trophy with yet another thrilling low scoring match against DSS

REIGNING CHAMPIONS: Jubilant LWH team after winning the series by 2-0

Manali, Nov 8: What a match! DSS fought hard despite a low total to defend. A clean hit by Suram in Vijju’s over pitched delivery in the 18th over gave a comfortable win to the Willingdons in the end. LWH skittled DSS for a paltry 88 with an over to spare. DSS batsmen fell like a pack of cards in less than an hour’s time. Thanks for the disciplined attack by LWH bowlers. Despite a cautious start by DSS openers, Manish was sent back to the pavilion cheaply by pacer Sanjay. Promoted to No. 3, Anand looked in a good nick but couldn’t stay long enough. Another overcautious opener Vijay castled by Roshan Lal with a beautiful delivery on the leg stump. By then DSS scored just 27 runs in 8 overs. This brought DSS skipper Vijju to redeem the team from another tense situation. With Rahul on the other end Vijju kept the wickets intact for a brief partnership of 15 runs. But L C Thakur beguiled Rahul with a slow delivery and lured him to play a lofted shot ending up in Vinay’s hand at Mid-off. Debutant Maitrey joined Vijju and made a 23 run partnership. Last match bowling hero Suresh took another three quick wickets and took LWH into a commanding situation. Sanjay hit the last nail on DSS coffin by castling Rakesh with just 88 on the board.

Confident of chasing 88 in no time, LWH openers took the team to 25 without loss in 6 overs. With good fielding and bowling changes DSS team knocked out 4 wickets for 58 at the end of 15 overs. With disciplined attack Pawan and Vijay gave just 30 runs in their 10 overs quota taking 3 crucial wickets. Needing 31 of 30 balls LWH seems to be panicked for a while. But Man of the match Rewat kept the cool and took the team to the door steps of yet another close finish scoring 31 of just 32 balls. In the end Suram rode the team to a spectacular win with a six over the mid wicket fence.

Today’s match proved that cricket is not always a batsmen game!

LWH took the lead to 2-0 with one match to go on Nov 15. Final match is crucial for both the teams. LWH will look to prove their dominance, while DSS will play for their pride. So far the two teams met four times since Dec 2013 winning two each.

Brief Scores: DSS won the toss and elected to bat

DSS 88 all out 19.1 (Vijju 34, Roshan 3/20, Sanjay 3/4, Suresh 3/21) lost to LWH 89 for 7 in 18.2 overs (Rewat 31, Pawan 2/18, Rahul 2/24).

Man of the Match: REWAT RAM

Kaaza surgical camp.. reminiscence

Posted by: Philip Alex | Posted on: October 13th, 2014 | 0 Comments





The first fingers of the sun gilded the snow on the mountains guarding the Rohtang pass as our team assembled at dawn. An obstetrician from Baptist hospital Bangalore, eye doctor, optometrist and eye surgeon, anesthetist and radiologist from C.M.C. Ludhiana, and the rest of the team from the Lady Willingdon Hospital Manali gathered around the three vehicles. Only the pharmacist was missing, having been delayed arriving. The obstetrician declared his order of priorities in declaring the pharmacist dispensable provided the cook was on board. The cook was indeed on board, ready to feed the twenty mouths that climbed onto three vehicles bound for Kaaza for an NRHM surgical camp.

This camp was the result of years of anticipation and patient planning. It was the first time our hospital had directly organized such a camp, though members had been on such camps organized by other teams earlier. Our community consultant Dr. Bishan was the key person who orchestrated it. We gathered for prayer, and then the vehicles pulled out of the hospital courtyard.

The first leg of the journey involved crossing the Rohtang pass, at 13500 feet, to enter the Lahaul Spiti district north of the formidable lower Himalayan mountains. The towering mountains inspired gasps and repetitive clunks and clicks of the shutters of a variety of cameras, all desperately attempting to capture their magnificence in a digital format through a speeding car window.

A brief stop for a breakfast of paratas with a local chutney that brought tears of delight at Chattru, and the day seemed off to a very good start. The road (or what passes off as a road) was a challenge at every twist and turn, fording streams and rock strewn rivulets that objected to mankinds feeble attempts to tame wind and water. The mountain road soon gave way to what appeared to be a rock strewn desert, and every vehicle seemed to have liberty to choose a path of least resistance which they could then call a road. It was here that the Scorpio at the tail end of our little convoy suddenly stopped. The driver got out, and one look at his face was enough for the passengers to understand that all was not well. The support rod holding the engine onto the chassis had broken, and one side of the vehicle was listing badly. The other vehicles had since gone ahead so that left five travellers wondering what to do next. A passing taxi driver stopped by, sized up the situation and nonchalantly suggested that we jack the vehicle up, take the affected wheel off, and shore up the engine with one of the many stones littering the landscape. It seemed a preposterous plan, but we were game to try anything, and soon, we had an oval stone sitting snugly in the space between the engine and the chassis. The ministering angels’ advice worked, and he drove off in a cloud of dust, as we gingerly eased our vehicle forwards. We made it to Batal bridge, and were met by a return party setting out in search of us, wondering if we had fallen off the landscape somewhere.

A brief stop here for lunch, and then off again, to Kaaza. The road thenceforth is mile after mile of bone breaking jaw jiggling ride on rocks. We were grateful to arrive in Kaaza by evening. The entire team unloaded all the vehicles in the government hospital and set about the task of creating an operation theater. We had to reinstall the operating light and set up every piece of equipment. Our staff worked their magic on a very basic room, and transformed it into a professional operating room. This process begins with hosing down and wiping down the whole room, including the ceiling, installing every piece of equipment, then fumigating it overnight with a fumigation machine. While this process was under way, I noticed that the obstetrician was looking pale and cyanosed. Auscultation revealed that he was in pulmonary edema and his blood pressure had skyrocketed. So he became the first patient, as we rushed him into the ward, hooked him up on oxygen and shot him up full of Lasix and steroids. He needed monitoring through the night but was well enough by the next morning to come and see patients in the opd despite our requests to rest.

The Kaaza civil hospital is built on two levels, with the operating theatre on the ground floor. The wards are on the first floor and there is a ramp that allows patient transfer. The rooms on the ground floor were quickly converted into consultation rooms for the surgeon and anesthetist and gynaecologist, and the ultrasound machine set up next to the laboratory. An impromptu vision testing centre was set up in the corridor. Our medicines were stocked in the aditus next to the nurses station on the first floor. Everyone worked quickly and efficiently and all was soon ready to cater to the long lines of patients which were beginning to form already at eight am. There was a formal inauguration at nine am presided over by the local Sub divisional magistrate, and then the camp was in full swing. Out patient clinic went all day, and the very first day we saw two hundred and seventy patients. We had planned to see patients every morning and operate in the afternoons.

Though this was intended as a surgical camp, we were seeing patients of all ages, and with a variety of complaints, from the elderly lady complaining of gas ascending from her uterus to her head, to the little boy who sidled up and confessed to a large white snake emerging from out his behind. Surgical patients did arrive, but we found a great reluctance and a fear among the populace. We learned that complications from previously conducted camps had instilled a great fear in all the people. We had to work hard to overcome this.

Despite their trepidation, some patients did come forward for surgery, which was performed the next day. The first patient was a lady with an ectopic pregnancy. It was so fortunate for her that we were there, because just the week prior, a lady with a similar history was referred to a higher centre, but did not make it and died on the way, as did a patient with a ruptured appendix. Surgical options here are non existent, despite the presence of a utilizable operating theatre. In this day and age, patients having to die deprived of a surgeon seems a conundrum in the face of India entering the new millennium and bordering on the brink of being called a superpower. We can send a machine to mars to take some photographs, but our people still die with preventable surgical illness. Most surgeries, even cholecystectomies, were conducted under spinal anesthesia. The Boyles machine available does not have a closed circuit so long durations of anesthesia is fraught with the risk of hypercarbia. However, most surgeries can be completed within the hour, which is a safe duration for a spinal anesthetic. The operating surgeon therefore has to be skilled enough to complete the variety of procedures within the hour, and equally important is synchrony with his scrub staff and floor nurse. Speed is a double edged sword, and safety has to be the parameter paramount in the conduct of surgery. Perioperative antibiotics suffices for clean contaminated surgery, and no antibiotics are administered for clean surgery. Disposable drapes and gowns minimize the need to transport and autoclave sheets. As each surgery finishes, the staff clean and pack these instruments and ready them for the autoclave which is kept hissing and fizzing accompanying the music playing in the ot. Eight to ten surgeries can be thus safely finished in eight hours. Minor surgeries are interspersed with majors, as they require only a few basic instruments and local anesthesia. Two copies of the operating lists exist, one in the ot and another with the staff in the wards, and mobile phones are used to call up patients. Utilizing husbands or fathers name and village to prevent a wrong operation on the wrong patient protects each step along the path to surgery from error, particularly because every third person is called Tenzin. Every patient has an individual file which is meticulously filled with clinical details. Every patient is photographed pre and post operatively to fulfill the requirements of the NRHM and the case sheet is also photographed to for identification.

Congregation and banter around the dining table, which was always groaning with delicacies prepared by our camp cook, mark the end of the day. The cook was as important as a primary caregiver, since he constantly kept up the camp morale with ingenious dishes prepared with very basic amenities. For example, he made the pasta sauce, and a pizza base, and baked it inside a large aluminium dish converted into an oven by placing the pizza on four similar sized stones carefully arranged within. We never realized stones could have so many uses nor that camp pizza could be so tasty.

Over one thousand patients were seen in the camp, four hundred and seventy ultrasound examinations performed, fifty two surgeries safely conducted among which were twenty eye surgeries. Rounds were held twice a day and all the staff did a great job caring for the patients pre and postoperatively. All medicines were issued from stock carried with us who was able to thus keep a careful watch on their utilization and availability. Every patient received a discharge summary and a post operative follow up plan. We remained on site till the patients were safely discharged and none felt abandoned or without recourse to help. The local doctors were apprised of the plans for each patient and the patients connected with the doctors so that follow up would be smooth and uneventful.

It was with a sense of great satisfaction and fulfillment we then piled into the vehicles to return to the Manali base hospital. We were very grateful for every day, and for the healing for all the patients, many of whom would never have been able to have recourse to the procedures that we were able to do for them.

Well done Mission hospital!



Whats the case?

Posted by: Philip Alex | Posted on: September 9th, 2014 | 0 Comments




A thirty eight year old lady presented to our hospital with hemoptysis. She had no fever or chest pain. She has a history of hemoptysis one year ago, which subsided with no treatment. A close up of a chest x ray revealed the above pathology. What is the sign so well demonstrated, and what is the pathology?


See the photographs

Posted by: Philip Alex | Posted on: July 30th, 2014 | 0 Comments

Some of the photographs from the Spiti camp have been uploaded to the Spiti gallery. Please see the latest snaps, because the snaps from the last year are also in this gallery. Happy viewing!

Report on the Lahaul Spiti camp

Posted by: Philip Alex | Posted on: July 21st, 2014 | 0 Comments

The camp in Lahaul spiti conducted by the LWH was a mega success. Two thousand and sixty three patients were seen in eight camps over the ten days. A detailed report is enclosed with significant observations which can form the basis for future work. We thank Dr. Bishan Shashani for organising the whole trip and the NRHM and the Tribal Welfare department for the funding to have made this possible.

Report modified



Play ball

Posted by: Philip Alex | Posted on: June 3rd, 2014 | 0 Comments






A team game is a pleasure to watch, as different players pass a ball along, to achieve a goal. Each player puts in his or her part, and the ball passes along, till it goes through a hoop or a goal with a resounding roar from the onlookers marking its passage.

Patient care is not very different, as the patient passes along in his or her passage through a health care facility, being passed along from department to department, each person contributing in varied ways to the healing that flows from the hospital. The patient recovers and leaves, but there is no resounding roar, only a calm satisfaction in hearts as we know we have done our bit in Gods great pattern of healing.

I stand in the operating theatre as the cases progress, and wonder and thank God for the team in Manali. For every one who puts their hand to the task of taking care of patients in whatever capacity, direct or indirect.

I am so grateful for every one, and for the team here, by which we work together like a smooth machine, taking care of people who come here, hurt, hurting and in pain.

We truly are a team. I am very thankful and proud of you. Let us continue to play ball.

Young boy with tb abdomen

Posted by: Philip Alex | Posted on: May 8th, 2014 | 0 Comments

A 11 year old boy was brought to us after having being run from pillar to post for the past year. He has been consistently unwell, with abdominal pain. We thought he had tb abdomen, and confirmed this with a diagnostic laparoscopy eight days ago, when we obtained a peritoneal biopsy. He was started on anti tb medicines while we waited for the report for confirmation.

He returned to us  yesterday with abdominal pain and distension and was admitted with intestinal obstruction. While in hospital he perforated. He was taken up for a laparotomy yesterday when four entero enteral fistulae were found (communications between the bowel which had happened a while ago). One of these had perforated. He underwent a resection and ileostomies. (The diseased part of the bowel was removed).

He is now on the ventilator, on inotropes (to support his blood pressure), and is fighting for his life. Please do pray. He still has a long way to go.

We are very grateful to God for Dr. Kaaren, visiting anesthetist who just happened to be here and helped get him off the operating table alive. Also for the many donors who have given us the equipment to handle emergencies of this critical nature… blood gas machine, ventilator, syringe pumps, etc.

We ask now for your prayers for him.