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.