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Free Orthopaedic Surgical Health Camp at Taplejung

Free Orthopaedic Surgical Health Camp

(2069 Falgun 25 / March 8, 2012 to Chaitra 2, 2069/ March15, 2012)

 

Place – District Hospital, Fungling-3, Taplejung

Time- Falgun 25, 2069 / March 8, 2012 – Chaitra 1, 2069 / March 15, 2012

Organized by – Nepal Orthopaedic Hospital, Jorpati

Co-Sponsored By – Klinic Crutz, Switzerland

Local Partner – Women’s Technical Support Group, Taplejung

Coverage Area – Panchthar, Taplejung, Illam, District hospital (4 districts)

 

               Surgical Team

 

  1. Dr. Saju Pradhan –  Team Leader and Medical Director /Senior Consultant Ortho surgeon, Nepal Orthopaedic Hospital
  2. Dr. Kailash Bhandari – Consultant Orthopaedic Surgeon
  3. Dr. Katrin Hagen – Hand  Surgeon, Switzerland
  4. Dr. Samyukta Acharya – Anesthesiologist
  5. Dr. Ujohn Shakya – Medical Officer
  6. Dr. Mangal Prasad Hirachan – Medical Officer
  7. Laxmi Khatiwada –  Sr Staff Nurse
  8. Sapana Shrestha – Staff Nurse
  9. Sushma B.K. – Staff Nurse
  10. Srijana Joshi – Staff Nurse
  11. Pratikshya Gurung – Volunteer Staff Nurse
  12. Mr. Loknath Badal – OT Assistant 

 

Logistical Support Team

 

  1. Mr. Gajendra Kumar Lama – Chairman, Nepal Orthopaedic Hospital
  2. Mr. Shyam Rupakheti – Administrator, Nepal Orthopaedic Hospital

 

 Volunteers (from Kathmandu)

 

Mrs. Yangkila Sherpa

Mrs. Karine

Mrs. Maggie Shah

  

Purpose of Health Camp

 

Selection of place – Taplejung District, Fidim, where orthopaedic and hand surgery services are unavailable and unaffordable.

 

  1. To give free and comprehensive orthopaedic and trauma care in effective and safe way.
  2. Provide good opportunity for learning to junior officers, and nurses and to develop skill of surgeons while working in low facility setup.
  3. To enhance public awareness about the damage prevention measures after trauma thereby preventing deformity and disability.
  4. To teach local health care team about plaster care, post operative care and ward care after the surgery.

 

Goals

 

  1. To carry out at least 50 free surgeries which include deformity correction, fresh trauma and hand/reconstructive surgery.
  2. To carry out at least 700 OPD check-ups and provide all medicines and supplements free of cost.
  3. To publicize Nepal Orthopaedic Hospital as the best and cost effective center for orthopaedic and trauma management.

 Shedule

 Day 1( Falgun 25, 2069 / March 8 , 2013)

A team of 16 members headed by Dr. Saju Pradhan Medical Director, Nepal Orthopaedic Hospital took flight from Kathmandu to Bhadrapur through Yeti airlines and reached  Bhadrapur at 12:30 Noon.

OT logistics and medical supplies were sent in a truck with OT assistant Mr. Loknath Badal two days in advance. From Bhadrapur an 18 seater microvan was hired to carry the team to Taplejung. The team took one hour break at Charali for lunch at Mandro restaurant and continued the journey toward Ilam (68 km from Bhadrapur). Mid way to Ilam after 1 hour’s drive from Charali, the bus broke down.

Fortunately it was possible to arrange two jeeps from Bhadrapur which arrived two hours later and the team continued its journey. The team took a short break at Kanyam for tea and headed to Phidim,Panchthar for night halt.

 Day 2 (Falgun 26, 2069 / March 9 , 2013)

After breakfast the team started at 8 AM for Taplejung (85 km from phidim). The team took a short break of 40 minutes at Bhalu Chowk for tea (45 km from phidim) then reached Taplejung at 12:30 noon. The health team received a warm welcome from local partners there.  All members stayed at the Jara hotel and after lunch, discussed the how to go about doing business. OPD check up started at 2 pm the same day and 150 patients were seen in OPD by the orthopedic surgeons and Medical Officers. Meanwhile the anesthetist and nursing staff and OT assistant were engaged in setting up OT facilities. The same evening 5 patients were operated.

Day 3 (Falgun 27, 2069 / March 10 , 2013)

 OPD was started from 8 AM and two medical officers were scheduled to carry out OPD check-up. Chairman Gajendra kumar lama and local volunteers assisted them to manage the crowd and queue and registration work.

Day 4 (Falgun 28, 2069 / March 11 , 2013) and Day 5 (Falgun 29, 2069 / March 12 , 2013)

Routine OPD Check-ups and surgeries were done.

 

A total number of 954 patients were seen at OPD during the camp in 4 days. Out of them 72 cases were scheduled for surgery, 25 cases received steroid injections. 10 patients had frozen shoulder, 7 cases had tennis elbow, 3 had De Quervain’s tenovaginitis, 3 had plantar fasciitis and 2 had trigger finger.

OPD was closed from Tuesday afternoon. The actual no of patients seen in OPD was higher than the total registered cases as some patients came without registering. During the pre-visit, about 1000 patients were expected to be seen in OPD. The medicine taken for OPD patients were completely consumed in 3 days OPD. Local medicine purchase had to be done to cover for the deficiency.

 

Below 6 years

7-14 years

15-40 years

41-60 years

Above 61 years

Unknown

Female

Male

Female

Male

Female

Male

Female

Male

Female

Male

Female

Male

5

9

31

57

202

166

183

120

42

38

49

52

                                                                                                                                    Total=954

 Most common problems seen at OPD were age related back pain, osteoarthritis of knee, hip, lumbar disc prolapse lumbar spondylosis, cervical spondylosis, rheumatoid arthritis, diabetic neuropathy, osteoporotic pain and aches, tennis elbow, Dupuytren’s contracture, frozen shoulder, trigger thumb, trigger finger, Dequervain’s tenovaginitis, golfer’s elbow, plantar fasciitis, fibromyalgia, bursitis, chronic osteomyelitis, post herpetic neuralgia, gouty arthritis, post trauma deformity, joint stiffness, post operative joint stiffness and complications of patients which were operated in big city hospitals earlier.

Similarly other common problems seen in OPD were carpal tunnel syndrome, entrapment of ulnar and peroneal nerve, congenital deformity eg, club foot, polydactyly habitual patella dislocation, congenital radial club hand, tibial hemimelia. Madelung deformity, post burn contracture, post-CVA complications, lipoma, sebaceous cyst, ganglion, lumps and bumps were significant in number. One 10 year old boy had suspected  soft tissue carcinoma resected from his leg and the specimen was preserved in formalin and sent to Kathmandu for histopathology examination. His contact address and telephone number were recorded for follow-up and further treatment. 10 cases seen were of fresh trauma. Out of them 5 were operated and rest were managed with plastering and conservative management.

 

Medicine dispensed at pharmacy:

 

  1. NSAID (painkiller)

Declofenac, Aceclofenac, Ibuprofen, Naproxen, Nimusulide, piroxicam.

  1. Aspirin, paracetamol, tramadol
  2. Proton pump inhibitors

Ranitidine, famotidin, omeprazol, pantoprazol rabeprazol, antacid syrup

  1. Antibiotics: cephalexin, cefadroxil, ciprofloxacin, ofloxacin, cefexime, azithromycin.

Anti Protozoal: Metronidazol, Tinidazol

Anti helminthes:  albendazole syrup and tablet

  1. Vitamin B-complex: Methylcoblamin, gabapentin
  2. Diacerin, calcium, glucosamine
  3. Anti emetics: Metachlorpromide, ondasetron donperidon.

Anti vertigo: cinnarizen

Antidepressant: Alprazolam, amitriptalin

  1. Antihypertensive – amlodepine
  2. Laxative: cremaffin, lactulose
  3. Antigout:  colchicine, Allopurinal, fabuxate
  4. Steroid – methyl prednilsolone, Triamcinnolone.
  5. Bronchodilator-salbutamol
  6. Cough syrup
  7. Antihystamine and anti allergy - fexofenadine, cetrizine and levocetrizine
  8. Pain killer gel: D.F.O. gel and diclofenac gel
  9. Iron and folic acid supplement

 

The surgical team comprised of two senior orthopaedic surgeons and one hand surgeon from Switzerland and one versatile and energetic anesthesiologist and five smart nurses and one OT assistant. Two OT tables were operated on simultaneously from 8 AM to 9:30 PM almost each day. A recovery room was set up at nearby vacant room and one staff nurse was posted on duty. Small cases that required only local anesthesia were operated in the   recovery room by medical officers.

 

 Due to limited and primitive resources available at district hospital, a temporary post op ward was needed to be set up in one vacant store room in OPD block. Floor mattress were used as beds and metal rods found in store room as drip stand.  ANM’s from the district hospital were mobilized to stand night duty for the make-shift post-operative ward.

 

 A regular ward round was carried three times by the operating surgeons and anesthesiologist and logged by Medical Officers and nurses. Each morning, wound inspection and dressing was done by surgeons and medical officer.

 

One orthopaedic surgeon was always made available for opinion, consultation and screening for surgery at OPD turn by turn.

 

 Sterility of OT and infection control measures was maintained strictly during the whole surgery camp using all the resources available there.

 

The main difficulty faced during surgery camp was power supply. NOH-team carried its own power generator but it was not enough because of frequent load shedding there. After seeking help from local partners and Red Cross, two extra power generators were hired and made available. Local available cooking gas was used to autoclave OT instruments, implants and linen.

 

The Taplejung Orthopaedic and Hand reconstruction surgical camp was possible from funds made available through Dr Katrin Hagen (money donated from a clinic in Switzerland) and funds from Nepal Orthopaedic Hospital.

Date: 9/3/13 (069/11/26)

 

         

SN

Patient Name

Age/Sex

Diagnosis

Procedure

Anaesthesia

1

Amrita Gurung

40/F

Trigger Thumb (L) hand release

Release and plaster

LA

2

Nilam Dahal

2.5/F

TA Contracture

Release

GA

3

Laxmi Prasai

58/F

D3 Radius # (L)

CR with Plaster

 

4

Amrit Limbu

30/M

# Olecranon (R) with screw + K-wire in situ

Implant removal

LA

5

Dipa Gurung

14/M

(L) hand polydactyly

Excision

 

           

Date : 10/3/13 (2069/11/27)

     

SN

Patient Name

Age/Sex

Diagnosis

Procedure

Anaesthesia

1

Tika Maya Bista

10/F

# S/C (L) Humerus

ORIF with K-wires

IVA/Block

2

Milan Tamang

4/M

PBC digit II (R) hand

Release

IVA + LA

3

Lok Psd. Dangi

8/M

Club foot B/L

PMR

 

4

Saraswoti Kedem

6/F

PBC (R) hand

Release and plaster

IVA

5

Asmita Poudel

11/F

(R) Cubitus Varus Post Traumatic

corrective osteotomy

BB

6

Khem Nath Puri

39/M

(L) hand Polydactyly

Excision

BB

7

Chandara Kala B.K.

28/F

Ganglion (L) Volar Asp Hand

Excision

LA

8

Dil maya Khatiwada

21/F

PBC (R) Hand

Scar Release correction of contracture

LA

9

Bhumika Basnet

11/F

F.B. (R) F/A

F.B. Removal

LA

10

Tika Maya Baraili

44/F

Lipoma (R) lat. Chest wall

Excision

LA

11

Shanta Maden

24/F

S/C # (R) humerus with pin in situ with infection

Implant removal

LA

12

Amar Bdr. Palungala

44/M

Med. Malleolus # (R) with implant in situ

Implant removal

LA

13

Prabin Rai

4/M

Cubitus Varus (L)

corrective osteotomy

BB/IVA

14

Paras Baral

40/M

10 years od F/U # tibia(R) with implant in situ

plate removal

SAB

           

Date :11/3/13 ( 2069/11/28)

     

SN

Patient Name

Age/Sex

Diagnosis

Procedure

Anaesthesia

1

Pawan Gurung

9/M

? Cong. Trigger thumb

Release

LA

2

Srijan Gurung

10/M

? Osteo sarcoma (L) dis. Leg

Excision

IVA

3

Dil Maya Khatiwada

21/F

Post burn contracture (R) hand

PBC Release

BB

4

Rabindra Shrestha

5/M

Malunited (L) condyle

Excision

LA + IVA

5

Sangam Tamang

12/M

Cubitus Varus (R)

Corrective Osteotomy

IVA + BB

6

Anjana Gurung

7/F

Burn Contracture (L) index finger

Release

IVA + LA

7

Ganga Bhattarai

15/F

PBC digit 3-5 (R) hand

Release

LA

8

Roshan funglan

8/M

Cubitus Varus (L)

Corrective Osteotomy

IVA

9

Bhim Ku. Limbu

38/F

Radial head # injury (R)

Cast application

 

10

Rupa Sunuwar

 

Ganglion (R) wrist

Excision

LA

11

Diwas Khadka

4/M

Isolated unla (R)

Cast application

 

12

Bishnu Bayalkoti

18/M

B/L habitutal patella dislocation

Relocation by medial plycation lateral release and tibial tuberosity transfer

SAB

13

Bhim Bdr. B.K.

10/M

Burn Contracture (R) hand

Contracture release

IVA + LA

14

Ram Matilimbu

45/F

Δ ganglion (L) F/A + lipoma

Excision of sebacious cyst thigh (L)

LA

15

Chetana Limbu

13/M

Medial Epicondyl # with implant in situ

Removal

LA

16

Niraj Gurung

11/M

Syndoclyty (R) ring and middle finger

Cont. release

 

17

Ful Maya Limbu

63/F

(R) distal tibia #

ORIF with Narrow DCP

SAB

18

Ful B. Gurung

40/M

Ganglion (R) wrist with cyst (R) thumb

Excision

LA

19

Tulasha Thapa

31/F

Lipoma ? Ganglion over lumber region

Excision

LA

           

Date :12/3/13 ( 2069/11/29)

     

SN

Patient Name

Age/Sex

Diagnosis

Procedure

Anaesthesia

1

Yangkasa Sherpa

9 month

(R) CTEV

P/C TAL

IVA

2

Hangma Limbu

8/F

Burn Contracture

Release

IVA

3

Lok Psd. Limbu

8/F

Club foot (B/L)

Plaster changed

IVA

4

Kiran Sanba

12/M

6/12 malunited B/B # (L)

osteo clasis ORIF with Rush nail

BB

5

Magesh Rai

10/M

Burn hemaer contracture (R) hand

Release

BB

6

Ashish Limbu

6/M

# Lat. Condyle (L) humerus

ORIF with K -wire

IVA

7

Nara Maya Limbu

50/F

B/B # (R) leg

Plaster

 

8

Ful maya B.K

45/F

Massover (L) scapular region

Excision

LA

9

Asmita Guragain

10/F

Cubitus Varus (R) hand

Corrective Osteotomy

IVA

10

Gupti Bdr. Gurung

64/M

Ganglion (L) big toe

Excision

LA

11

Tara Limbu

40/F

(R) Trigger thumb

Release

LA

12

Mithun limbu

7/M

cubitus varus (L)

Corrective Osteotomy

BB

13

Nirmala Bhandari

5/F

Burn contracture (L) little finger

Release

BB + IVA

14

Kumar Tamang

15/M

B/B # (R) F/A

CR with Plaster application

 

15

Phurba Lama

8/M

PBC (R) hand Vth finger

Release + SSG

BB + IVA

16

Nisa Karki

7/F

Cubitus Varus(L)

Corrective Osteotomy

BB + IVA

17

Devi Bista

70/M

Duputren contracture

Fasciectomie

BB + IVA

18

Susmita Limbu

14/F

Cubitus Varus

Corrective Osteotomy

BB + IVA

           

Date :13/3/13 ( 2069/11/30)

     

SN

Patient Name

Age/Sex

Diagnosis

Procedure

Anaesthesia

1

Ful maya Limbu

63/F

(R) Distal tibia #

CR with Cast Application

 

2

Buddha Rani Limbu

6/F

Post op 8/12 for (L) hip dislocation K-wire in situ

K-wire removal

IVA

3

Bhim Ku. Limbu

15/M

B/B #  (R) F/A

ORIF with K-wire

BB + IVA

4

Junu Maden

10/F

Polydactyly B/L hand

Excision

IVA

5

Binita Maden

10/F

Polydactyly B/L hand

Excision

IVA

6

Prasant Limbu

6/M

Cubitus Varus (L)

Corrective Osteotomy

BB + IVA

7

Neha Sherpa

14/F

PBC B/L Medial 3rd finger

Release

BB + IVA

8

Pasang Shrepa

37/M

Fibroma (L) thumb

Excision

LA

9

Mausam Anchhangba

14/M

Cubitus Varus 45o (L) elbow

Corrective Osteotomy

BB + IVA

10

Bhabana Limbu

10/F

PBC Digit 3-5 left hand

Release and PTSG

 

11

Tara Kumari Gurung

32/F

5th MT # (R) with implant in situ

HWR

LA

12

Pawan Ku. Rai

14/M

Cubitus Varus (L)

Corrective Osteotomy

BB + IVA

13

Priya Maden

12/F

Polydactyly B/L hand

Excision

LA

14

Punita Limbu

28/F

1/12 old (R) elbow dislocation

closed relocation + posterior slab

BB

15

Yoshodhara Adhikari

50/M

2 year post op prox. Tibia # (R) with med. Malleolus # with implant in situ

HWR

SAB

16

Rammati Maden

40/F

Secaceous Cyst

I&D

LA

 

 Day 6 (Falgun 30, 2069 / March 13 , 2013)

 On the last day of surgery camp on Thursday, a felicitation ceremony was organized by the District Development officers in their office to the team members. Mrs. Maya Gurung hosted a farewell at her home the same evening.

 Day 7 (Chaitra 1, 2069 / March 14 , 2013)

 On the 7th day (Friday) morning all team members after packed up and the left hotel and the medical team went for a final ward round. A local health assistant was handed over the responsibility of further dressings. OT materials were also packed and loaded onto trucks for dispatch next day.

Three jeeps were hired and the whole team left Fidim in the late morning and reached Bhadrapur in the evening after nine hours of drive.

Day 8 (Chaitra 2, 2069 / March 15 , 2013)

On Saturday morning after breakfast in the local hotel, the team members boarded Yeti Airlines and reached Kathmandu at 1:30PM same day.

Summary

This was one of the best camps ever conducted by NOH. People from far remote areas who were deprived of orthopaedic and hand reconstructive surgery facilities in their area benefitted most.

Mrs Maya Gurung, a local contact person and partner for ensuring the smooth running of the camp was most instrumental in ironing out most of the difficulties faced during the camp. The hospital would also like to acknowledge all help from all quarters for the successful outcome of the camp.

Reported by:

Dr. Kailash Kumar Bhandari

Consultant, Orthopaedic Surgeon

Team Member, Taplejung Camp

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