Top Menu

REPORT ON ACTIVITIES OF WORKING HANDS: 2016

  • Working trip organized to Lalgadh Leprosy Hospital November/December 2016
  • Delivery of some 200kg of kit and consumables including a new sterilizer to Kirtipur.
  • Teaching trip organized to Kathmandu Kirtipur Hospital, December 2016 and developing ongoing teaching and training commitments, including planned Fellowships.
  • Fundraising
  • Plans and development/ongoing programme

Civil strife particularly in the South East, Terai prevented travel to Lalgadh Leprosy Hospital in 2015 (see 2015 report). The blockade was resolved in mid 2016 and we were able to resume work in the Terai, Lalgadh Leprosy hospital.

The working trip was organised for the period 15th November to 3rd December 2016.

Members of the team:

Wim Brandsma (WB): Senior Hand Therapist, Utrecht, Holland

Sam Gidwani (SG): Consultant hand Surgeon, London

Susan Louie (SL): Hand therapist, Seattle, Washington

Nola Mackie(NM): Senior Plastic Surgery Trainee, Oxford rotation

James Rogers (JR): Consultant Anaesthetist, Bristol

Donald Sammut (DS): Consultant Hand Surgeon, Bath

In addition:
Non medical members:

Linden Coppell (LC): Sustainability lead for Etihad, Abu Dhabi – accompanied the team for the first half of the trip and was able to observe first hand the work that Etihad so crucially supports. Etihad is to publicise this work with a major piece in the January inflight magazine and this may yield donations and further support.

George Butler (GB): Established Reportage Artist (many working trips including Afghanistan, Palestine, Syria). GB accompanied the team producing remarkable sketches and paintings of the work in Lalgadh. In return for accepting and funding him on the trip (supported by Etihad who provided flights) GB will make available these illustrations for the website and in fundraising activities. (see www.georgebutler.org)

Part 1

The first half of the trip was spent in Lalgadh Leprosy hospital which had not received a visit by our team for some 2 years. Consequently we found a large backlog of leprosy cases, mostly ulnar, median and combined paralyses. In addition there was the usual number of severe burns contractures causing hand deformities, as well a few congenital hand malformations. We were able to operate on all those who presented for surgery, and who were suitable.

As ever, one principal aim of the visit was the training and teaching of local surgeons. One Hand Surgery trainee from Kirtipur, Kathmandu, Bishal Karki, who has previously come to the UK as BSSH Fellow, observed all operations and was assisted in performing others. In hand surgery, he has reached expertise approximately equal to a UK ST3. The local surgeon, Krishna Lama, as well as the UK team members NM and SG, all performed surgical procedures, including a number of complex tendon transfers, assisted by DS.

JR (anaesthetist) also taught one new nurse from Lalgadh who has been singled out for anaesthesia training (no general anaesthesia is possible and all surgery is performed under brachial block and/or ketamine sedation). WM and SL also taught and supervised the hand Therapists from Lalgadh and one senior Hand Therapist, Mohan Dangol, from Kirtipur. Mohan has previously been sponsored by the BSSH on a UK Fellowship. Application has been made to BSSH for funding of a UK Fellowship for Nhashala Manandhar, the second Hand Therapist in the department.

Some 200 kg of equipment was delivered to Lalgadh on this visit, including diagnostic kit, stethoscopes, Physiotherapy equipment, new instruments and quantities of consumables (some left over from the generous donations and BSSH funds related to the 2015 earthquake). LC of Etihad transported some 40 inflight blankets which were distributed in the Lalgadh wards and used to keep patients warm during surgery in theatre.

Part 2

At the conclusion of the Lalgadh part of the trip, the team departed for the UK, while DS travelled on to Kirtipur Hospital, Kathmandu, where he stayed for one week. An instructional Hand Surgery Course was organised to coincide with this stay (DS the sole member of Faculty). Some 12 major lectures were delivered in 5 days as well as a number of operative cases chosen for their teaching potential, performed with the local Hand Trainees in the team led by Prof Shankar Rai.

There is much activity in progress in collaboration with Prof Rai’s team, notably the setting up of a Hand Fellowship in Kathmandu, in which DS, in his capacity of Honorary Senior Lecturer in the Kathmandu University, will play an active part and which will include a regular stint in the UK as sponsored Fellow.

Kirtipur also received a number of kit items including a major purchase – a new Eschmann Little Sister Steriliser; new handpump operated tourniquets; Inditherm underblanket for peri-operative use; Flowtron machine and supplies of leggings; BairHugger warming overblanket system and supplies of consumables.

Fundraising and revenue

As in previous years, team flights was once again provided by Etihad – Etihad continues to support this work and provides five return flights for our team. The recent inclusion of Linden Coppell in the team has further consolidated our working relationship with Etihad.

Etihad also provides, free of charge, unlimited baggage allowance which permits us to carry all kit – the steriliser, weighing some 35kg, was transported as hold luggage as part of our allowance. Some 200kg of equipment was delivered this year. This also permits us to avoid losing equipment by sending it through unaccompanied channels (we have lost valuable equipment in the past). The relationship with Etihad remains crucial to the viability of this project since it defrays what would be, by far, the biggest expense – flights.

BSSH has renewed the annual grant for a further three year period. Once again there were numerous donations and solicited funds, some regular standing orders from patients and supporters, and some more substantial one-off donations. Special mention of two donations:

Rosie O’Mahony, a 17 year old congenital hand patient of DS, was sponsored to climb Ben Nevis and raised the money used to purchase the steriliser (£2500).

Aviva Healthcare which made a substantial one off donation enabling the purchase of considerable instrumentation, tourniquets, heated underblankets and Flowtron machines for the Kirtipur theatres.

Plans for 2017

  1. Two Fellowships are being explored:

a: Nashala Manandhar, Hand Therapist from Kirtipur Kathmandu to spend six weeks in a UK unit shadowing therapists, learning rehab regimes and splint making and also to shadow DS

b: A fellowship of 3 weeks for members of Prof Shankar’s team (including Shankar Rai himself) to observe Burns unit organisation and resuscitation. This is likely to be organised at a Burns unit in India

Application will be made to BSSH (Hands) and BFIRST (Burns) for support of these projects. 

Longer term vision for this project:

With regard to Lalgadh, the plan is for two surgical camps per year: One will be conducted by Shankar Rai’s team. The second will be our visit, each November. This should provide most of Lalgadh’s surgical needs and also enable better distribution of cases throughout the year with the more complex operating and teaching occurring on our November visits.

This plan has been agreed and confirmed by Shankar Rai’s team, in exchange for DS’s continued intensive involvement with teaching in the Kirtipur Unit. The first such camp should be conducted in the spring of 2017.

With regard to Kirtipur there is plan for a dedicated Hand Fellow in the rotation and we are discussing whether a 2 month training visit in the UK can be made a permanent feature of that Kirtipur Fellowship. Application for this Hand Fellowship has been made to the University in Kathmandu.

2. The next trip, with the same core team, is planned for November 2017

Donald Sammut

Bristol 22nd December 2016

Report Working Visit Nov- Dec 2015

Bristol 29th December 2015

REPORT ON WORKING HANDS ACTIVITIES IN 2015
Summary
Main achievements:
1. Three Kathmandu juniors organized to undertake Fellowships in the UK:
a. Bishal Karki, Middle grade Plastic and Hand Surgeon; six weeks Bristol/Bath January to March 2015
b. Mohan Dangol, Hand Therapist; six weeks Bristol/Bath January to March 2015
c. Pramila Shakya, Cleft surgeon; six weeks Oxford/Bristol March to April 2015
2. Delivery of some 300kg of kit and consumables
3. Working trip organized to Kathmandu November/December 2015
4. Fundraising.
5. Change of Trustees – Seamus MacDonald (accountant) has resigned and Nola Mackie has been assumed as Trustee. James Lowther appointed as Charity Accountant

1. Fellowships
Funds were obtained for two Fellowships, one from the BSSH and one from BFIRST, and these were supplemented by funds from Working Hands to enable us to organize three Fellowships.
Suitable candidates were identified by personal contact – the regular work with the team in Kathmandu has provided good first hand information of the needs of the unit and the team members most likely to benefit from such trips.
BSSH Fellows:17th January 2015, for six weeks:
Bishal Karki: Middle Grade Plastic Surgery Trainee
Mohan Dangol: Senior Hand Therapist
Apart from Clinical duties shadowing DS in Bath, and attendance at Southmead Hospital Hand Unit (Bristol) both were awarded places on The Anatomy Dissection Course (Glasgow, February) and The Instructional Course on ‘Tendon transfers and Paralysis’ (Manchester, January)
BFIRST Fellow:8th March 2015 for 6 weeks:
Pramila Shakya: Senior Trainee, Cleft lip and Burns
This surgeon was attached to Marc Swan, Cleft Surgeon, in Oxford and was also awarded a place at the BAPRAS Burns Meeting (Manchester, March) and the Cleft and Craniofacial Meeting (London, April)
Reports and Thanks letters from the BSSH Fellows have been circulated to BSSH Council.

2. Delivery of Kit and Consumables
In the immediate aftermath of the earthquake we were unable to travel to Kathmandu since only recognized relief teams were allowed in. We concentrated on assembling and delivering essential consumables (the Kathmandu team sent a wish list). BSSH Council kindly assigned a one off award of £20000 for purchase of these items, which included microsurgical kit, antibiotics and analgesics and consumables.
Etihad provided generous free cargo allowances and we sent out 100kg of kit with Sarah Tucker, Consultant Hand and Plastic Surgeon In Oxford, in June. A further 200kg was sent out with Mark Cole, a UK based businessman who was travelling to Nepal in October and kindly delivered to Kathmandu.
To date, some £14000 of the allocated 20k have been spent on kit.

3. Working Trip/Surgical programme
The scheduled working trip to Kathmandu and to Lalgadh Leprosy hospital, scheduled for November 2015, was disrupted by a different crisis:
A new proposed constitution was rejected by the southern regions of Nepal which called for a transport strike. This was backed by India, which instituted a blockade to fuel and gas across the India/Nepal border. This has resulted in a relative paralysis of the country, severe shortages of daily goods, gas, fuel and medical equipment and a trebling of prices that coincided with dramatically reduced revenue (This blockade further added to the decline in tourism consequent on the earthquake). The blockade has been in place since early August and is still enforced at time of writing.
We were unable to travel to the south of the country. Janatpur, close to Lalgadh Leprosy hospital, was the focus of some of the worst social paralysis and violence (55 deaths to date). We would have been unable to reach Lalgadh (Internal flights suspended and roads blockaded) and patients would have been unable to come to meet us.
The Lalgadh trip was canceled and instead the team consisted of DS and a Burns Team (Peter Dziewulski and Bruce Anderson). We were able to operate and teach in Kathmandu. The widespread purchase of fuel on the black market, kept in open containers in the combined with obligatory cooking on open fires has resulted in numerous burns.
The civil strife, boycott and blockade are ongoing at time of writing (29th December). This is likely to result in deferment of the next surgical visit until the autumn of 2016.

4. Fundraising activities
Major Income:
The project continues to be supported mainly by Etihad and by the British Society for Surgery of the Hand (BSSH).
BSSH kindly provided the regular sum of £2000 per annum (This is renewed on a three year cycle)
Etihad once again generously provided free flights (which would otherwise represent the biggest expense of such trips).
Aviva Healthcare provided a particularly generous donation.
Nola Lloyd/James Mackie wedding June 2015: Numerous benefactors donated to the Charity in lieu of wedding gifts

Other donors large or small, provided a steady income. Other income came from remuneration for DS artwork, from patients and individual donors and from lecturing in schools and to other Charitable societies.

5. Change of (pro bono) Trustees
As above.


Donald Sammut
29th December 2015

Report: November/December 2014

Team 2014

Trip: 15th November to 3rd December 2014
Team Members:

SAM GIDWANI: Hand Surgeon, London
NOLA LLOYD: Specialist Trainee Plastic Surgeon, Bristol
JAMES ROGERS: Anaesthetist, Bristol
DONALD SAMMUT: Hand Surgeon, Bath

The visit once again consisted of two halves.

The first half was spent in Lalgadh Leprosy Hospital and consisted of intensive, daily operating (total number of cases 53) and, importantly, teaching of the local surgeons. Kirin Narkani and Bishal Karki, surgeons from the Kathmandu team, and Krishna Lama, from Lalgadh, were present at all clinics and operating sessions each of which was, in effect, a teaching session. The team benefited from the addition of James Rogers, Consultant Anaesthetist – his inclusion enabled more complex surgery than would have been possible. James also took on the teaching of anaesthetic principles and techniques to local staff. The repertoire, once again, consisted mainly of the reanimation of hands paralysed by leprosy, the severe contractures from burns and miscellaneous conditions such as instabilities, congenital hand defects, infections.

The second half of the visit was spent in Kathmandu where DS lectured to the Kathmandu Plastic Surgery team led by Prof Shankar Rai. No surgery was performed in Kathmandu or Kirtipur on this visit.

On the journey back from Kathmandu, DS and NL stopped over in Abu Dhabi at Etihad Airlines headquarters and lectured on the leprosy surgical programme to the volunteers of Etihad, trip sponsors.

Once again the main sponsors of this trip were Etihad Airlines which has generously provided our flights since 2011, and the British Society for Surgery of the Hand which continues to provide an annual grant.

November/December 2013 Trip

TEAM FOR TRIP TO LALGADH HOSPITAL, NEPAL
22nd November to 12th December 2013

The Hand Surgery team was expanded by the addition of Fiona Ormerod, GP and Ian Pearson, Dental Surgeon. The trip included treatment of patients and teaching in both The Kathmandu Model Hospital, Kathmandu, and Lalgadh Hospital near Janatpur, in South East Nepal. Ian Pearson conducted dental surgeries in Lalgadh, while Fiona Ormerod ran the outpatient clinic, seeing up to 400 patients per day, in collaboration with the Lalgadh team, whom she taught on various techniques.

Donald Sammut and Nola Lloyd operated daily in Lalgadh, teaching the local surgeons and two visitors from the Kathmandu team. They then transferred to Kathmandu and conducted a lecture  and tutorial programme to the team directed by Prof Shankar Rai, in Kathmandu Model Hospital and at Kirtipur Hospital where Prof Rai has established a new unit. This was, as in previous visits, as part of the Hand Surgery  training of the Plastic Surgery programme led by Prof Rai.

 Medical Team: Nov 2014 

Fiona cropped 2

FIONA ORMEROD: General Practitioner in Bristol with an interest in Tropical Diseases. This was her 4th trip to Nepal, providing and teaching Primary Care.

Ian Cropped

IAN PEARSON: In private Dental practice in Cambridge specialising in implant surgery. This was his 3rd trip to Nepal to provide dental welfare.

Lalgadh Hospital

NOLA LLOYD: Junior in Plastic Surgery in London and a Diplomate in Tropical Medicine. Member of the Working Hands team, organiser and fundraiser since 2010

donaldsammut-196

DONALD SAMMUT: Consultant Hand Surgeon in Bath, Reading and London. Founder of the Working Hands project, Surgeon and Project Organiser, since 1999. www.donaldsammut.com

Website by MW