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Pangi Surgical camp.

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




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



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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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




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!