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MICROSURGERY TRAINING AND OBSERVERSHIP
GANGA HOSPITAL DEPARTMENT OF PLASTIC, HAND AND RECONSTRUCTIVE MICROSURGERY
COIMBATORE TAMIL NADU INDIA
OUR PLEASANT EXPERIENCE
BY DRS. OBADY, IRENE AND JOSEPH
MUST MMED PRS FINAL YEAR, CORSU REHABILITATION HOSPITAL
February 10th 2019 – March 3rd 2019
ACKNOWLEDGEMENTS
We are forever grateful to: -‐
Interface Uganda for providing full funding for this fellowship without which it would not have been possible.
Drs. Andrew and Sarah Hodges for their dedication at coordinating all activities aimed at making this fellowship a success.
The Ganga Hospital management and staff for accepting and offering us an opportunity to learn from their facility
Residents and Hand fellows at Ganga hospital for their kind orientation to Ganga hospital facilities, continuous case discussions and educative presentations that kept us up to date with ongoing activities all the time.
The Almighty God who protected and sustained us well during our stay in Coimbatore India.
PREAMBLE
Microsurgical skills are essential for the reconstructive surgeon to enhance their ability to provide holistic surgical care and management of complex defects especially during secondary reconstruction but most importantly primary reconstruction in the setting of acute trauma.
To acquire these skills, one needs training as well as application of the principles and for starters like us, a microsurgical skills laboratory is a necessity before one can gain confidence and expertise to safely manage a patient.
Due to absence of adequate facilities to provide comprehensive microsurgical training in Uganda, it was important for us to find a suitable place beyond the borders to learn these skills.
With the wise guidance, coordination and collaboration between Dr. Andrew Hodges, CoRSU hospital and Ganga hospital and with full financial facilitation from Interface Uganda, we managed to turn our dream into a reality.
“Our visit to Ganga Hospital Coimbatore, Tamil Nadu, India”
EXPECTATIONS
Right from the beginning, the excitement that comes with change of environment could not be resisted.
We’d had Lots of discussions and experience sharing from our colleagues who had been to Ganga Hospital before and we had actually seen a positive difference in their practice following this visit therefore we could not for their stories to turn to reality.
We expected to find a variety of challenging cases, new technologies given the Ganga hospital’s reputation in trauma surgery
We also expected to learn microsurgical skills and their routine application day to day patient care.
L-‐R: Drs. Obady, Joseph and Irene aboard Ethiopian Airlines from Entebbe to Mumbai via Addis Ababa Bole International airport.
ACTIVITIES
Every other day begun with an early morning meeting at 07:30 hours with a variety of presentations as scheduled.
Ward rounds; were mainly done by the firm on call the previous day as other surgeons reviewed patients on their firms shortly before starting theatre work or seeing outpatients.
Theatre Activities
Awake-‐anesthesia under regional blocks was the order of the day in the OT.
Planning of flaps (local, regional, distant and free)
Microsurgery training: -‐ This was the epitome of our trip; we could not wait to start.
We had a humble beginning with video demonstrations each day but each day became harder initially and then upon learning the principles it became much easier with the kind and patient guidance of Mr. Ravi, the Micro lab instructor.
Micro laboratory: Busy week under the microscope with different challenges each day
Joyous moments after the successful micro anastomoses.
The rats that sacrificed their lives for us to learn the Art of Microsurgery!
Top: A light moment with the very skilled Mr. Ravi, the micro lab instructor. Below: Certificate giving Ceremony: Finally awarded certificates upon successful completion of the training by the founder and CEO of Ganga Hospital.
Meetings: -‐ We were privileged to attend a wide range of daily early morning meetings ranging from the tutorials, trauma and case review, consultant talks among others.
Special meeting with the Ganga Hospital Director and world renown Senior Consultant Dr. Raja Sabapathy during which important issues pertaining teamwork, sustainability, efficiency, cost-‐effectiveness and collaborations were discussed.
The other International fellows we met at the department of plastic surgery hand and Micro Ganga Hospital having a good time.
LESSONS LEARNT:
Preparation is key to success in every surgical procedure especially microsurgery
One of the Acland principles that MUST always be remembered by any micro surgeon! This was placed on the notice board just above the screen in the microsurgery laboratory.
Continuous learning from everyone involved in patient care right from the patient to the consultant is important.
Light moments with Dr. Praveen, the Brachial plexus surgeon shortly after an intensive intraoperative teaching session
Ganga hospital is a perfect choice for training for anyone aspiring to be a hand and micro surgeon especially in a resource limited setting like Uganda given its location in an environment that mimics similar conditions and resource availability, high volume patient load and turnover. This makes transfer of learnt skills to our settings seemingly easy as minimal changes are required to achieve similar results.
A Variety of cases ranging from fresh trauma cases to secondary reconstruction created new memories each day
A toe -‐to -‐hand transfer case.
The presence of a hands-‐on microsurgery laboratory offers the best experience for anyone beginning his or her career in microsurgery
Well-‐equipped microsurgical laboratory
With plans to start super-‐microsurgery training, there is no doubt that Ganga hospital will soon be a one stop training center for any micro surgeon.
CHALLENGES
Time
Every day was a brand-‐new experience however time was never enough for us to watch and appreciate each and every principle; we were always torn between being in one place or another
Theatre Observations: The number of observers was overwhelming on most occasions resulting in difficulty watching procedures!
Food, Weather and Culture
We found the hot and extremely spicy Indian food unpalatable, leaving us with numerous bouts of gastritis after each attempt.
The weather was extremely hot and humid; the scorching sun was unbearable. We had to drink water excessively to and keep indoors to survive these harsh conditions.
We had a bit of a cultural shock, language barrier was always a problem but we had to get by never the less.
Spicy Indian breakfast at one of the Coimbatore Plastic surgeons’’ meeting at the Ganga Hospital Conference Hall.
RECOMMENDATIONS
The duration of stay ought to be increased overtime for subsequent fellows/residents to better appreciate and learn more from the dedicated team of consultants at Ganga Hospital but also this would be a richer experience if it were a hands-‐on rather than a total observership.
There is need to have an official long term partnership with Ganga Hospital but also other centers of excellence around the globe that would allow for exchanging of faculties to boost capacity building for surgeons in resource limited settings like Uganda.
CoRSU Hospital could look into acute trauma care as well as setting up a state of the art microsurgery laboratory that would attract surgeons from Africa and beyond.
East or West, Home is best: Long layover at the Mumbai Airport as we await our return home in the company of Lee a Fellow from Harvard, USA.
CONCLUSION
The ganga trip remains a worthwhile one given the tremendous volume and diversity of cases received and worked on by the facility and we recommend that this tradition be carried on for upcoming residents, fellows or faculty based at CoRSU Hospital.
Thank you Interface Uganda for a wonderful opportunity.