After a year of planning and with 200 kg of kit, eight of us flew to Katmandu to be the team for Working Hands, Nepal January 2019. We were; Donald Sammut (Consultant Hand Surgeon, Team lead), Sam Gidwani (Consultant Orthopaedic Hand Surgeon), James Roberts (Consultant Anaesthetist) Fadi Issa (Plastics/ Research Fellow), Jean Cahill (OT Hand therapist), Ann Garewal (OT Hand Therapist), Trudi Vaughan-
Brooke (Theatre Nurse) and Elena Hughes (Neurophysiology student, John Hopkins University). Jean and Ann had raised £4500 for the Working Hands Charity to provide much needed equipment for the centres we would visit. A huge thank you to all who donated, please read on to see how your donation made a difference at each location.
Lalgadh Leprosy Hospital
Delayed by bad visibility, we flew from Katmandu south east to Janakpur then an hours dusty drive to Lalgadh, which is in the flat rural plains close to the Indian border. Lalgadh is a Christian missionary hospital built in the 1990s on government scrub land, funded by the Nepal Leprosy Trust. All leprosy services are free. There are in and outpatient facilities.
Clinical Work
Arriving early afternoon we had a quick lunch and Donald immediately started his first clinic. A stream of pre-selected patients came through and naturally created a long list of surgery for the week ahead.
Patients are pre-selected by the local hospital staff to ensure they have completed their multi drug therapy at least ten months prior, cured of leprosy, have no ulcers or contractures on their hands and will be good candidates for surgery in that they look after their insensate hands. The surgery aims to restore function to hands that have had nerve damage affecting the balance of muscles and stability of the fingers. Work in Lalgadh was intense with surgery back to back from 8am to 8pm. Evenings spent debating how best to teach, splint, establish guidelines for therapy. Donald constantly teaching, mentoring, motivating, inspiring and leading.
Hand Therapy & Teaching
Valuable time was spent observing surgery in theatre, surgery we would rarely see in the UK. In therapy we worked with Shyam a very experienced physio technician. We taught him splinting skills, assessment skills, established guidelines for the surgeries being undertaken and made videos for skills we had taught. We were delighted to be able to donate equipment and materials that should support Shyam’s work; Shyam taught us the challenges of working with people living with the consequences of leprosy and the frustrations of not being able to follow peoples progress to see the outcomes of surgery and therapy.
Patients with leprosy undergo intensive self-care training when newly diagnosed with nerve damage. They are taught how
to cook, work and live safely without damaging their insensate hands and feet. They feel no pain and therefore are unaware of the danger innocuous repetitive tasks may have on their limbs.
Green Pastures Hospital
Quite exhausted, six days later we flew onto Pokhara, via Katmandu. Pokhara is in the west of Nepal, the gateway to the Annapurna Circuit. Touristy and vibrant with a majestic back drop of the Himalayas it couldn’t be more of a contrast from Lalgadh.
Green Pastures Hospital was established in 1957 by the INF (International Nepal Fellowship) a Christian NGO. It started out as a specialist Leprosy hospital
but now has expanded to provide rehabilitation for spinal cord injury, cerebral palsy, ear related disorders and general disability. It is also planning to become a major
trauma centre.
It recently has established Occupational Therapy and Physiotherapy departments. We worked with Dr Wim Brandsma, a Dutch physiotherapist who has worked with leprosy patients in Nepal, India and Africa for the majority of his long career. He has visited GP working with and teaching the local staff for many years in the treatment of Leprosy.
Wim’s trip and work was funded by the Working Hands charity.
Immediately reinvigorated by this dramatic change of scene and meeting a Hand Therapy guru, we set to work! We were able to bring our splinting skills and teach an eager group of therapy assistants and newly qualified physios.
GP were absolutely delighted with the provision of splinting kit and materials that will help develop the Hand Therapy Unit that is Wim’s vision.
Kirtipur Hospital
With the rest of the UK team returning home, Donald continued his teaching and surgical marathon. He flew onto Katmandu to visit Kirtipur Hospital where he taught an instructional course that had been organised for 40 surgeons, the Kirtipur unit and visiting students. The intensive course comprised a full day of lectures given by Donald and the rest of the week Donald operating on selected cases that were filmed and transmitted live to the audience with live commentary.
Again, kit was given to Kirtipur Hospital to enable ongoing surgeries using appropriate equipment.
Reflections & Future trips
After quite a brief but inspiring visit to GP and our longer stay in Lalgadh we feel we learnt a lot from our experiences. Future trips are needed to continue what we were only able to start, to provide a lasting legacy which will be self-supporting. We know now what the different centres most need from us. We can help support the local staff by teaching our practical skills and help them to develop the services they need to offer at the different sites. Providing ongoing support until needed.
All of what we achieved and the equipment we were able to leave behind would not have been possible without the generous donations that we and Working Hands charity received. Every donation makes a difference.
We are very excited about returning, learning more and giving more…
