Nuzvid, India, February 2005
Gifford Memorial Hospital
Della Bennett, MD
5th Year Plastic Surgery Resident
Loma Linda University Medical Center
YesuYesu, a thirty-year-old male patient came asking for help to release a contracture of his right knee. He had suffered a severe infection in the back of his thigh and knee that had healed so that he was unable to straighten his leg enough to walk. Yesu had been stuck in this position for two years and was forced to crawl on his hands and knees, resulting in calluses on his outer left ankle. Because his contracture had been present for so long we were not able to release Yesu's leg completely because the nerve and artery in the back of the leg had also shortened. However, we were able to release his leg enough so that he could stand on one leg and toe touch with his left leg. So now he will be able to stand, and maybe more importantly, get a job again.
Sunitha, an 18-year-old woman came to us with severe burns of her neck, anterior chest wall, and left axilla. Sunitha had been married at the age of fifteen. She brought a picture with her that was taken on her wedding day. We were told that when she was seven months pregnant she became severely depressed and attempted suicide by burning herself. We were able to release her burns at the neck, axilla, and anterior chest wall. Sunitha's husband stayed with her despite the tough times of the past year.
Lalita is an eighteen-year-old female who was arranged to be married at the age of seventeen. She wanted some clothing and jewelry for her wedding, but her father refused. She had a heated argument with her father, and when he refused, we were told that she became suicidal and tried to kill herself by lighting herself on fire. The man she had been arranged to marry came to see her twice after she was burned, but ultimately rejected her.
Lalita had a severe contracture on the back of her right wrist, pulling her fingers back so that she could not make a fist. We were able to release her wrist and give her improved function in her right hand. Lalita is currently in school to get her bachelor of science degree in math, a three-year degree in India.
Of the 20 surgeries, remarkably, we had no wound infections--this is surprising as so much of what we consider dogma in the United States is neither practical nor practiced in Nuzvid. For instance, the preoperative and postoperative antibiotics given so often as a precaution in the US are too expensive for patients to buy.
The gowns and drapes we used to create a sterile field are far from a comprehensive sterile field. The instruments were "sterilized" in an autoclave but the indicator showed the autoclave was not reaching sterilization levels. So much of what we deem as mandatory precautions in the US is not mandatory.
As surgical residents we act as an apprentice to many surgeons during our training. We have a large variety of instruments to assist us in surgery. In Nuzvid, there is not the luxury of having some of these special instruments, and my realization was that a surgeon can operate, under most circumstances, with a minimum of tools available.
Each day as we left the operating room, there would be a new crowd of people waiting around the doors hoping to be selected for surgery. Children, clothes held back to expose wounds, were pushed forward by parents pleading with us to help them. Faces lit up with joy when we agreed to help their child and the disappointment was palpable if we were unable to meet their child's need.
One young man, named Rao, with a cleft lip was told on our first day we didn't think we could fix his lip because he had such a wide cleft. He returned two days later in hopes we would reconsider. It must have taken so much courage to come back a second time and risk another disappointment.
We had operated on a seven-year-old girl, Rajini, that morning with an incomplete cleft lip deformity, and since that went so well, I advocated to operate on Rao's lip. It was a milestone in my development as a surgeon to see the progress that I had made in my residency. I was not only able to offer Rao this operation, but I could, in turn, plan it and carry it out from start to finish. This was something that would not have been possible even two short years ago.