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DAMOH, INDIA

SAMARITANSAMARITANOPERATION GOOD

LOMA LINDA UNIVERSITY DEPARTMENT OF SURGERY DIVISION OF PLASTIC & RECONSTRUCTIVE SURGERY

February 2004

MISSION TRIP REPORT

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AuthorsAndrew Wongworawat, MDand Georgeanna Huang, MDare both residents in PlasticSurgery at Loma LindaUniversity.

“For even the Son of Man did not come to beserved, but to serve...” Mark 10:45

And so our mission team approached the journey to theCentral India Christian Mission as an opportunity to serve,and to “give back” some of what we have so abundantlybeen blessed with—technical skills, knowledge, technicalequipment. What we did not know was that we received somuch more than we could possibly give to these people.

The humility, graciousness, and hospitality, with which wewere met, even at 3 am in the morning, were the livingtestimony the people at the Mission were to us. Ourpatients were not the only ones to be privileged with a“once in a lifetime” opportunity. In the two weeks spentwith these people, we saw how abundantly God blesses andanswers prayer when you only open the door and allowHim to. By making themselves available to Him, the CentralIndia Christian Mission showed us that, indeed, with God allthings are possible. It was our privilege to have been intheir midst, and to be blessed alongside them as they soughtto do God’s will for the people of India.

Faith At Work

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A man was going down fromJerusalem to Jericho, and he fellamong robbers, who stripped himand beat him, and departed, leavinghim half-dead. Now by chance apriest was going down that road; andwhen he saw him he passed by onthe other side. So likewise a Levite,when he came to the place and sawhim, passed by on the other side.But a Samaritan, as he journeyed,came to where he was: and when hesaw him, he had compassion, andwent to him and bound up hiswounds, pouring on oil and wine;then he set him on his own beast andbrought him to an inn and took careof him. And the next day he took outtwo denarii and gave them to theinnkeeper, saying ‘take care of him;and whatever more you spend, I willrepay you when I come back.

from the Gospel of Luke,Chapter 10, Verses 30-37

The Good Samaritan

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To provide direct patient care inunderserved regions of the world

To train local caregivers in thesedeveloping regions

To inspire our residents to alifelong commitment ofinternational service to promotehealth, healing, and wholeness

Operation Good Samaritan missiontrips bring treatment to children andadults in underserved regions of theworld who are suffering withcongenital or acquired deformities.At the same time, the programprovides international outreachexperience through medical messiontrips for residents and attendingphysicians in the Division of Plasticand Reconstructive Surgery.

Since it’s inception in 1987,Operation Good Samaritanvolunteers have provided care andtraining around the world, freelydonating their time and efforts “tomake man whole.”

Operation Good Samaritan

Mission Statement

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The Mission TripFebruary 2004Operation Good Samaritan iscommitted to providing free surgery inunderserved regions of the world forindividuals who through no fault oftheir own were born with terribledisfigurements or experiencedtraumatic childhood accidents.

On January 29, a team from OperationGood Samaritan departed from LomaLinda, USA to Damoh, India.

Damoh is smaller than the state ofConnecticut and has a population ofover 1 million. Infant mortalilty is 123in 1000 births compared to just 6.9 inthe United States.

Plagued by drought and earthquake,and with very few natural resourcesdue to it’s landlocked location, Damohremains poor, with 55% of itspopulation living in poverty.

The target of this mission trip was theCentral India Christian Mission.

Statistics of Damoh

District: Madhya PradeshArea: 7,306 km2

Population: 1,081,909Infant mortality rate: 123/1000 birthsOne in 9 children dies before age 5

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Central India Christian Mission (CICM)was established by Ajai and Indu Lall in1982. Interestingly, Mrs. Lall’s father wasa plastic surgeon missionary who workedat a leper’s colony.

The primary task of the mission isEvangelism and Church planting. Overthe past 20 years, they have established375 churches throughout India and intoNepal.

They have also focused on Leadershiptraining with the Central India BiblicalAcademy and the Mid-India ChristianServices.

The mission has a burden for thechildren, who are often sold intobondage. Over 44 million childrenbetween the ages of 5 and 14 areemployed as child labor.

Although slavery is illegal, thegovernment turns a blind eye as parentsare forced to sell their children to makerugs, marble arts, and other things.

Central India Christian MissionThe mission has made a commitment tobuy these children back—some of whomhave grown up to work for the missionand become strong church leaders. Oneof their early rescuees will be startingmedical school this year.

More recently, they have developed theircommitment to medical care as a meansof serving the people and evangelizing.In addition to this Mission Hospital, theyhave an eye hospital, outlying clinic, andprovide periodic cancer screening andwellness camps. At the facility we wereat, they had an ultrasonographer,radiologist, two gynecologists, EKG, anda surgeon.

CICM Mission Statement

To provide compassionate competentand quality health care to all regardlessof religion, community and socio-economic status with focused emphasison the poor, discriminated andunderprivileged.

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Financial Summary of Mission Trip

Patients seen: 400+Surgeries performed: 61

Investment: $11,000Worth of surgeries: $300,000

Types of surgeries performed: Cleft lip and/or palate repair Release of burn contractures Hand surgery

Our partnership with Central IndiaChristian Mission began when Dr. LindaD’Antonio responded to an email fromthe Lalls on the American Cleft Palate-Craniofacial Association website, whichasked for someone to train their surgeonto do cleft repairs.

Dr. D’Antonio met Dr. Rajesh, MedicalDirector of CICM, for the first time inOctober 2002 while she was in Chennai(formerly Madras) in Southern India. Shewas impressed by the compatibility oftheir needs with our goals and so inJanuary of 2003, she asked Dr. AnilPunjabi to go for a site visit. Heperformed the first 15 cleft lip and palaterepairs in Damoh.

One year later, we were able to send afull team of four attendings and tworesidents. The trip was structured so thatwe residents stayed for the full two weeksfor continuity, while the attendings tookshifts according to specialty. Dr. AndreaRay screened and operated for the firstfive days, then Dr. Duncan Miles camefor two days. Dr. Anil Punjabi arrived forfive days following Dr. Mile’s departure.

OverviewThe two residents were Dr. GeorgeannaHuang and Dr. Andrew Wongworawat.

The Operation Good Samaritan teamarrived at Damoh on Monday, February2, 2004. Over the next two weeks,more than 400 patients were seen andexamined. Of those, 61 surgeries wereperformed. Types of surgeries rangedfrom cleft lip repair, cleft palate repair,release of burn contractures, and handsurgery. The combined worth of thesurgeries exceeded $300,000 for aninvestment of only $11,000.

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Although we arrived at the Damoh trainstation two hours late at 3 o’clockMonday morning, we were greeted by acrowd of over 50 people. After theformalities, we were taken to our quartersto unpack and get ready for clinic laterthat day.

Before starting clinic, a welcomeinaugurational ceremony was conductedfollowed by a tour of the facility.

A large tent had been set up for familieswho had walked several hundredkilometers. Some had come from as faraway as Delhi.

Many patients stayed for the full twoweeks of our stay, waiting patiently,

First DayMonday - February 2, 2004

hoping to meet the criteria for surgery.

Several weeks prior to our arrival, theMission Hospital had put upadvertisements and sent teams of peopleto remote places to spread the excitementthat we were coming.

Over 500 people registered at thehospital to been seen.

Inside the hospital, a ward consisted often or more patients sharing the sameroom. There was a general ward, as wellas one for women, and another forchildren.

Poster advertising Operation Good Samaritan

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At first, triaging the patients seemed easy.Young women should have the highestpriority because the stigma associatedwith their deformities prevent them fromgetting married. Older children camenext in line, followed by the youngestkids who may have future opportunitiesfor repair. Adult men was placed in thelast category.

After the first hour, it became apparentthat the criteria system was under strain.As more and more patients streamedthrough the door, it literally becameimpossible for us to categorize.

We constantly had to re-prioritize the list.Patients who were told that they mayhave their surgery done had to be locatedand told they would have to wait.

As the day continued, the patientscontinued to stream in. For over fivehours after clinic was scheduled to haveclosed, we were told that this was the lastpatient--only to find out that twenty morejust showed up at the door.

We worked way into the night and finallyhad to end clinic around 9 o’clock in theevening. Exhausted, we had dinner andreturned to our quarters to get ready foranother full day.

After the ceremony and tour, which wasaround 1 o’clock in the afternoon, westarted setting up for the clinic. Anelectronic database was created to keeptrack of patients seen. Dr. D’Antoniowas designated as our official recordkeeper.

Once we were ready, the doors wereopened for clinic. It didn’t take longbefore we were overwhelmed by thesheer number of patients and types ofdefomities that we encountered.

In the first day alone, we screened over200 patients, diagnosed them, andentered them into our database. As wesaw each patient, we had to categorizethe severity of their disease as well asprioritize them in order select cases forsurgery.

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We spent a total of ten days operating.The operating room there is called theOperation Theatre.

The operating suite consisted of one mainroom with general anesthesia capabilitiesand a minor local anesthetic room.

Operating DaysThe condition was somewhat primitive.Surgical gloves were washed and driedso that they can be reused. Gowns andtowels were handwashed outside, hungto dry, and soaked in formaldehyde forsterility.

Machinery littered the operating room.The anesthesia machine was an oddcollection of bottles and tubes.

Even with these conditions, the operatingroom ran smoothly and with greatefficiency. Turn around time in betweenpatients was remarkably quick.

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Our primary goal was to teach Dr.Ashish, the local surgeon at the MissionHospital, the technique of cleft lip repair.

Although hesitant at first, he soon gainedconfidence. By the end of our time atDamoh, he was confident and proficient--booking his own cases for the followingweek.

After surgery, the patients were admittedinto the hospital for recovery. They werestarted on some food and their pain wascontrolled. After the first few days, therecovery room be overwhelmed by thenumber of surgeries, patients had to sharebeds with those waiting to have surgery.

In addition to cleft lip repairs, we weremet by a number of burn patients. Oneparticular surgery was especially difficult.

There was a man whose burn was sotraumatic, that his lip had turnedoutwards and attached to his chest. Hisneck was severely scarred to the pointwhere he was unable to turn his headand could barely eat.

Because his chin was stuck to his chest, itwas impossible to intubate him so thesurgery was conducted under localanesthesia with some sedation.

The neck contractures were first releasedand then skin grafts were obtained fromthe patient’s thigh.

In our ten days of operating, weperformed a total of 61 surgeries on awide variety of cases ranging from cleftlips and palets, release of burncontractures, and hand surgery.

Not only was our primary goal ofteaching Dr. Ashish how to repair cleftlips achieved, but he also learned theskills needed to reconstruct burncontractures.

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Every morning to start the new day, wevisited patients in the hospital who havehad their surgeries done.

Wounds were checked and dressingsremoved. Questions were answered andmany times, the parents needed to bereassured.

After SurgeryThe surgeries we have done, while theyseemed basic and routine for us, weremiracles for the people at Damoh. It wasextremely humbling to see the faces ofgratitude and disbelief that they actuallylook normal again.

What do you say when people push theirway through the crowd just so that theycan bow and touch your feet?

What we take for granted, these peoplesee God at work.

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The Division of Plastic andReconstructive Surgery enthusiasticallyupholds the humanitarian mission ofLoma Linda University “to make manwhole,” and Operation Good Samaritantangibly supports this commitment. Allwho participate in the program’s missiontrips contribute their services, but thereare still significant costs to providemedical and surgical supplies, totransport the team, and to providehousing.

We welcome you to our team. The“ripple effect” of your contribution willbe far-reaching.

How You Can Help

WARNINGThe following pages contain

photographs of patients seen inclinic and may be quite graphic

Support for Operation Good Samaritancan be given in many ways. The greatestneed is for gifts of cash for direct supportof the program. Gifts of appreciatedstocks, property, and real estate also helpto ensure continuation of OperationGood Samaritan far into the future. Allgifts are tax deductible.

To extend a helping hand, send your giftsto:

Operation Good SmaraitanLoma Linda UniversityDivision of Plastic & Reconstructive SurgeryLoma Linda, CA 92350

Or, you may call at (909) 558-0999

The next few pages show photographs ofpatients before and after surgery. Inaddition, there are photographs ofpatients seen in clinic that could not bescheduled for surgery due to variousfactors such as the severity of thedeformity, lack of available resources, orthe most common factor of simply nothaving enough time.

Photographs

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Loma Linda University and MedicalCenter are known around the world forexcellence in medical education andhealth care. Founded in 1905, theinstitution has a vision of teaching andhealing that emphasizes what is nowknown as “whole-person” care”--the heartof Loma Linda’s stated mission “to bringhealth, healing and wholeness tohumanity.”

Today, Loma Linda is fulfilling that visionin ways the founding leaders could nothave imagined. Opening with only anurse training course, what has become aprominent University has grown to offermore than sixty degree and certificateprograms. A medical center specializingin many areas of advanced care, achildren’s hospital, a behavioralmedicine center and a rehabilitationcenter are part of a vast array of healthcare services. Medical research, at boththe basic science and clinical levels, isrecognized worldwide.

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