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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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