On invitation from the Medical Director (Dr. Saju Pradhan) of Nepal Orthopedic Hospital (
www.noh.org.np) in Kathmandu, Nepal, the Healing the Children Oregon and Western Washington chapter (
www.htcoregonwashington.org) sent a Foot Surgery Team for the fourth year in a row in November, 2011. This team of 17 volunteers committed to sacrificing precious time from their busy work schedules to help the poor and needy people of Nepal consisted of 4 surgeons, 2 anesthesiologists, 2 residents, 1 family physician/team physician, 3 nurses, 2 scrub techs, a team administrator, a logistics assistant, and an IT/photography tech. Although most were from Seattle and Anacortes, Washington team members also came from Santa Rosa, California; Atlanta, Georgia; San Francisco, California; Toronto, Ontario, Canada; and, Hambrg, Germany. The Team Leader was Stephen Miller, DPM.
The Nepal Orthopedic Hospital (NOH) was conceived and built by funds raised by over 130 Rotary Clubs in Nepal, the United States, Canada, Belgium, Holland and France under the direction of Jim Sinclair (US/Canada) and Luc Salens (Belgium). Under the direction of Dr. Anil Shrestha during the 10 years 1998-2008, the NOH achieved financial self-sufficiency. The mission of the hospital is to provide quality orthopedic surgical care to both paying patients and well as to the needy and indigent of Nepal by its staff of 8 orthopedic surgeons. This year, under the guidance of Medical Director, Dr. Saju Padhan, the hospital was able to expand its outpatient facilities and add another ward of 30 beds, making it 100-bed hospital. This will qualify it to receive more funding and hopefully become a teaching hospital.
On the first mission here from HTC the need for an ambulance was recognized to replace their aging vehicle. Since that mission, the Rotary Club of Fidalgo Island of Anacortes, Washington and the Rotary Club of Lynnwood, Washington in partnership with the Rotary Club of Kathmandu West obtained a Matching Grant of approximately $31,000 USD to purchase a new van. That ambulance, a converted Hundai van was deliverd shortly before the team arrival and the keys were ceremoniously handed over to the hospital by Dr. Stephen Miller (RC of Fidalgo Island).
The staff at NOH all were gracious hosts to the HTC Team. They included all the orthopedic staff surgeons and house staff as well as the follwing personnel:
Hospital Director: Saju Pradhan, MD
Local Mission Liaison: Dinesh Shrestha, MD
Hospital Administrator: Shyam Rupakheti
Assist Hospital Administrator: Santosh
Director of OR: Meena Gurung
OR Supervisor: Anita
This year the team evaluated 41 patients, 20 of whom were accepted for surgical intervention, 15 for the correction or revision of talipes equinovsrus (clubfoot) deformity. Eleven of these patients presented with neglected clubfoot deformity and three of them had bilateral corrections, while three patients underwent talectomies, two bilateral and on unilateral for a total of five feet. The local orthopedic cast technician was observed to have greatly improved skills in correcting clubfoot deformities with the conservative Ponseti casting technique. By the end of the week a total of 55 procedures had been done on 25 feet. Nepali surgeons scrubbed in on 11 patients and observed on the majority of others, so there was much more interactive education. Most interaction was with Dr. Dinesh Shrestha, the NOH liaison surgeon, who is developing specialist skills in foot/ankle surgery.
One observation and appreciation was that NOH provided a lot of coordinated staff assistance for the work done by our team. Our appreciation was expressed at the team/hospital staff dinner/social.
A 5-hour educational seminar was provided by the team surgeons and anesthesiologists. Topics included surgery, pain management and regional injections. There is a plan to have an ultrasound machine acquired and donated to NOH now that the surgeons are more comfortable with using it. There were fewer touring arrangements although the team attended a local Rotary District Foundation Seminar dinner. For cost-containment the team/hospital staff dinner/social was co-funded in place of the traditional two dinners. Many accolades and expressions of gratitude were received from the doctors and staff of NOH plus gift exchanges with an invitation to return for at least two more years. The dates proposed for 2012 are November 2-9 as they fall in between the Dashera and Diwali Hindu religious festivals.
As on previous trips, a generous amount of medical supplies and some equipment were donated to NOH including internal fixation devices, a Stryker small bone power saw/drill set to complement the existing power equipment previously donated, as well as some new batteries and many attachments to support that equipment.
In summary, the team felt well-received and appreciated and that the local surgeons were certainly improving their skills in foot and ankle surgery. We feel the groundwork has been laid to take much smaller surgical teams to Nepal in the future.
Stephen Miller, DPM, Team Leader
