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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

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