DEPARTMENT OF PLASTIC SURGERY

International Outreach  

Nuzvid, India, February 2005
Gifford Memorial Hospital
Michael Pickart, MD
Assistant Professor, Plastic Surgery
Loma Linda University

Since commencing an assistant professorship in Plastic Surgery at Loma Linda University almost two years ago, I have noticed that most discussions have not focused on the practice of medicine, its impact on our community, or the education of students and residents.  More often than not, the business of medicine intrudes upon its practice. And it is easy to become jaded.

With my first vision of Gifford Memorial Hospital (GMH), in Nuzvid, India, in February 2005, I would not have guessed that one week spent there would help to reinvigorate my social goals.  Holes line GMH's back walls, and the homeless crowd into its anteroom to escape the weather. Trash disposal consists of launching the debris out the windows so that the crows can carry it off.  Monkeys, literally terrorize the nursing students as they return from the cafeteria to their dormitories. Mosquitoes, potentially carrying malaria, hover in the hallways.

The needs of the people are many.  Hinduism's caste system is officially outlawed, but it flourishes nevertheless. The lowest caste known as the Dalits or Untouchables suffer unimaginably - socially ostracized, economically abused, and medically discarded. The women and children of this group are the saddest of all; without an education, without rights, and without voices, they are sinfully neglected.

I met wives who were burned-almost always with kerosene-usually by the husband or his family. Without medical care, most die, and the survivors suffer horrible scarring of their faces, necks, breasts, and hands. They are no longer marriageable, employable, or wanted.

Uncorrected, surgically correctable, congenital deformities of the face are another source of suffering. I met women in their 20s and 30s whose cleft lips were never repaired and whose unsightly appearance had kept them housebound their entire lives.

Worse yet were the injuries to the children. I was sick after meeting a 2-year-old girl who was burned with sulfuric acid by an aunt for having been born a girl; a nephew would have extracted a dowry from a bride, but this niece would become a financial liability. This girl had never received medical care, and the keloid scarring of her upper lip had become an impossible secondary problem.
 
At Gifford Memorial Hospital, there are not the equipment and support staff to provide complex reconstructive surgery. Nonetheless, simple techniques proved powerful:  Skin grafts restored finger, elbow, shoulder, and neck motion. Releases and resurfacing of facial scarring erased tragedy. Cleft lip repairs would enable routine socialization others take for granted.

To provide care for my 24 patients was just the tip of the iceberg. I was heartbroken to turn most people away, some of whom had traveled for days on foot just for a chance to see a surgeon. I was honored to have had an enthusiastic host; Dr. K. L. N. Rao, a general surgeon of seemingly limitless energy.  He was eager to learn the intricacies of burn reconstruction, and I hope that my team and I were able to provide him with a solid education for future treatment of his community members. Via electronic mail, he consults with me regularly regarding burn care, and I am confident that his newly learned abilities will benefit Nuzvid's underprivileged.

As important as the care provided, the trip inspired the trainees with whom I traveled.  Dr. Della Bennett, a fifth-year resident in plastic surgery, experienced the Third World for the first time, and she gained the confidence and maturity to return.

Mr. Loren Seery had lived in Nuzvid for seven months prior to medical school, and this return trip solidified his intention to pursue missionary work in the Third World after his post-graduate training.

The trip was one of those rare situations when everyone grew. Despite the lack of equipment and trained staff, I am reinvigorated. I better appreciate the high quality care that is possible in the United States, and I have renewed my commitment to make it better.