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.