The How ; Why ; When and Where of What we Accomplished … · 16 Chopal December 52 72 124 17 Shillai December 68 60 128 1 Sarahan January 43 52 95 2 Banjar February 54 63 117 3 Karsog

SIMLA SANITARIUM & HOSPITALSIMLA SANITARIUM & HOSPITALCarton House, Chaura Maidan, Simla-171 004, Himachal Pradesh (INDIA)

Tel. : 91-177-281-1821 / 280-2248 / 280-5779 Fax : 91-177-265-5168 E-mail : [email protected]

The How ; Why ; When and Whereof What we Accomplished

during 2009 & 2010

The How ; Why ; When and Whereof What we Accomplished

during 2009 & 2010

The Simla Sanitarium & Hospital has continued to face the challenges of conducting Multi Specialty Surgical Camps in very remote and rural areas of the State of Himachal Pradesh during the calendar years 2009-2010. The specialties that were provided included:- General Surgery- Gynaecological Surgery- Ophthalmology- AnaesthesiologyListed below is the consolidated data for surgical interventions undertaken:

DETAILS FOR CAMPS HELD DURING 2009

DETAILS FOR CAMPS HELD DURING 2010

S.No. Place Month Gen & Gynae Eye Total

1 Chopal February 74 71 145

2 Shillai February 64 60 124

3 Rajgarh March 64 17 81

4 Sangrah March 75 19 94

5 Jubbal March 55 38 93

6 Chopal May 91 64 155

7 Shillai May 76 61 137

8 Kotkhai June 34 57 91

9 Rohru June 62 60 122

10 Killar July 74 50 124

11 Keylong July 50 44 94

12 Rekong Peo August 61 57 118

13 Kaza August 51 52 103

14 Rajgarh November 55 26 81

15 Dadahu November 66 62 128

16 Chopal December 52 72 124

17 Shillai December 68 60 128

1 Sarahan January 43 52 95

2 Banjar February 54 63 117

3 Karsog March 54 84 138

4 Bharmour April 54 48 102

5 Anni September 62 73 135

6 Udaipur October 31 7 38

7. Shillai December 72 51 123

TOTAL 1442 1248 2690Three tables for General Surgery and Gynae Surgery

function simultaneously.

The type of terrain we traverse to access camp sites

MODUS OPERANDI

TEAM ARRIVAL & FUNCTIONS

In each instance when a surgical camp location is approved by the State Government, we initially make a “logistical trip” to the site. During this time the following tasks are undertaken:Meetings with the CMO/BMO and their colleagues to discuss details of the camp to be conducted. These include:- Types of surgical cases to be screened and booked- Diagnostic tests to be undertaken- Date(s) of admission to be given to patients- Date and time of team arrival- Timing for pre-anaesthetic checks to be done- Format of surgical lists to be prepared, both at time of admission and during

surgery- Checking of infrastructural facilities available e.g. Operating Theatre,

Anaesthesia Machine, Cardiac Monitor, Oxygen & Nitrous Oxide, Overhead Lights, Post Operative Wards, Electricity back up (generator), Manpower Status (Doctors & Nurses specifically for night shifts)

- Booking of Rest Houses- Advertising by means of hand bills over a distance of at least 30 kilometers

on either side of the site. Placing of banners at strategic locations- Availability of food items at site so as to ascertain what rations need to be

brought from Simla

Our Surgical Team on an average constitutes 24 persons. This includes the following:- Project Director- Project Co-ordinator- General Surgeons- Gynaecologists- Anaesthesiologist- Ophthalmologist- Operating Theatre Nurses- Operating Theatre Assistants- Refractionists- Ophthalmic Assistants- Ward Nurses- Cooks- DriversUpon arrival at the site the following functions take place:The entire Team is taken to the Rest House where they check into rooms that have been pre-allocated. A 20 minute time frame is given for them to “freshen up” and then everyone proceeds to the Hospital.

Eye surgery in progress.

A cataract on its way out.

The Anaesthesiologist and Surgeons meet with the local Doctors and proceed to examine the admitted cases, undertake pre-anaesthetic checks and finalize the surgery list for the following morning.The Ophthalmologist and Refractionist check the already assembled Eye Patients and screen for surgery to be started the next morning.The Nurses (both ward and OT) ; Operating Theatre Assistants ; Project Co-ordinator ; Cooks ; Drivers unload all the equipment from the hospital bus and begin to set up the General & Gynae. Operating Theatre.The Ophthalmic Assistants locate all their equipment outside the allocated Eye Surgery, and first begin with carbolizing the Theatre. Following this they set up all equipment and consumables so that Eye Surgeries can begin the next day.After unloading and placing of all heavy equipment, the Cooks and Drivers go back to the Rest House and set up Kitchen to prepare the food for an early dinner.

Breakfast is served at 7:30 every morning. The team then leaves for the Hospital and the following functions begin:Ward Nurses bring the patients scheduled for surgery to the OT designated for General & Gynae Surgery. The Theatre has two operating tables; one for General and the other for Gynae surgery. The day begins.Lunch is always served in the Operating Theatre Suite, where the Team is fed in shifts so as to ensure continuity of surgical interventions.The Ophthalmic Team begins with an Out Patient screening and by noon Eye Surgeries begin. Eye cases are kept post operatively for just one day. During this time, post-op visions are checked and the patients may then go home.The General and Gynae Surgeries of necessity require longer. The effort is to discharge as many as possible prior to the departure of the Surgical Team.

On the last day of each camp, grand rounds are undertaken and those patients who require longer post-operative treatment are carefully, wisely, transferred to the Chief / Block Medical Officer's and their team of local doctors. Our Floor Nurses fill out a register with details for each patient, outlining exactly what is to be done during the days ahead. Besides this, cellphone numbers for the Surgeons and Anaesthesiologist are left behind with the local Doctors so that they can discuss any complications.

Team constitution for camps has included the following:- A very senior General Surgeon from Manali- Gynaecologists & Anaesthesiologists from New Delhi- Ophthalmologists from Panipat & New Delhi- General Surgeons from Christian Medical College Ludhiana- Volunteers from the United States of America

REGULAR CAMP DAY FUNCTIONS

CLOSURE OF CAMP

CONCLUSION

A Cleft Lip baby arrives at the camp. Too poor to go anywhere.

The Immediate Post Operative Result. Appearancewill improve as swelling reduces.

Supporting Programmes to the Base Hospital include:- National Rural Health Mission- Help Age India- Rashtriya Swastiya Bima Yojna scheme for below poverty line patientsHistory has been created in these 'back-of-beyond' areas where health care remains the need of the hour, despite the efforts of the State Health Department. In several places, such as Chopal, Shillai, Sangrah, Dadahu, Ani and Banjar, multi specialty surgical camps had never before been conducted. Following a snow storm, the team was stranded for three days in Udaipur without electricity and water. This made it impossible to complete the more distant planned camp at Killar because of blocked roads. To this brave team who so cheerfully face the dangers of travel, the discomforts of being away from home, the known anxiety of worried family and friends, the functioning with tremendous paucity of surgical and medical facilities goes my heartfelt gratitude. To each of them I can offer no greater satisfaction than a pat on the back and the words, “Thank you for what you have accomplished. You excelled, and have proven yourselves to be a “Crack Surgical Team”. As a team leader, I could not have asked for more.The largest number of Gynaecological cases in terms of 'Prolapsed Uterus' was found in Shillai, District Sirmaur. This resulted in the need for many time consuming Vaginal Hysterectomies. It has been our pleasure to serve the communities of these very remote areas of this Himalayan State. It brings us heartfelt warmth when we realize that it has been possible to serve those in need and has made life easier for them; a clientele that would have for reasons of poverty and family circumstance, never been able to access more distant surgical facilities.Just as much, it would be appropriate to mention that at each site mentioned above, the end of a camp has seen us leave behind scores of surgical cases whom it has not been possible to help because of paucity of time and lack of inpatient admission spaces. Some of these “necessary” refusals have brought tears to the eyes of the surgical team. In each case we have left with the promise of working in tandem with the State Government, a system that will ensure the availability of the services that they so badly need. To the National Rural Health Mission we offer our sincere thanks. Without their financial and moral support, it would not have been possible to “do so much for so many in a so-limited time.” Working together we have made a difference.

Dr G R BazlielPresident & CEO

Simla Sanitarium & HospitalSimla 171 004

Himachal Pradesh, IndiaA pre-surgical conference! Patients cheerfully wait their turn for surgery.

With the Gall Bladder removed she hugs her sons before leaving the OT.

The worst case of Prolapsed Uterus combinedwith Prolapsed Rectum ever seen.

She suffered for 51 years. The Postoperative Result

An emergency Caesarean Section. Fortunately the surgical team was there.

A Sebaceous Cyst on the forearm being removed.

An Abdominal Hysterectomy in progress.

A Prolapsed Fibroid in a Uterus.

Attractive, Countable Gall Bladder Stones.

We didn't even try to count all the stones from this Gall Bladder !

Collaborating Partners - Our grateful thanks to them for their support and commitment

A portion of the surgical team at Shillai, Sirmaur - they made it all possible.Udaipur, District Lahaul where the team was stranded for three days

Dr. G.R. BazlielTeam Leader

R JohnChairman

Praveen BobVice President