NEPAL: DAY THREE

Source: Blog Post

Namaste from Nepal!

This was our first day at Kirtipur Hospital.  We met up with Dr. Shankar Rai, Dr. Kiran Nakarmi, and the plastic surgery residents.  The day started with morning rounds, where we reviewed admissions from the day before as well as surgeries performed; Sunday is a standard workday for physicians in Nepal!  We then reviewed cases scheduled for that day; these included correcting a traumatic saddle-nose deformity and several burn cases (excision and grafting). 

 

Peter Letourneau, MD then gave a lecture on obstetrical brachial plexus palsies.  This was followed by a tour of the hospital, which fortunately was largely spared of damage from the April 2015 earthquake. 

 

This was our primary clinic day, where we evaluated 19 patients for potential surgeries.  Pathologies seen included burn contractures of the hand (flame, scald, and electrical); traumatic adult brachial plexus palsies; and remote flexor and extensor tendon injuries with adhesions and contractures.  We have scheduled 10 cases for the week, including burn scar contracture releases with grafting and/or flaps; burn scar excision and grafting; tenolysis with possible first stage flexor tendon reconstruction, and one free tissue transfer to the wrist and hand to correct a burn scar contracture.  Dr. Marshall Partington scrubbed in with Dr. Rai to assist with several cases including a rhinoplasty for the saddle nose deformity, and a small finger amputation in a 3 year old girl with an electrical burn.

 

Burns are incredibly common here, including scald, flame, and electrical burns.  Most cooking is done at floor level with predictable consequences for curious children.   The mortality rate for burns here is quite high; Dr. Rai says that only 20% of burn patients arrive to a burn center within 24 hours of the injury.  These patients do not receive fluid resuscitation prior to arrival to the burn center. The resulting statistics are startling.  The overall burn mortality rate is 20%; the mortality rate for a burn with 30% total body surface area (TBSA) is 50%, and the mortality rate for 50-55% TBSA burns is 100%.  Dr. Rai is hoping to change the standard of burn care in Nepal, and has a goal of achieving a 50% mortality rate for 70% TBSA burns by 2027.

 

The day ended with a presentation on unusual hand and wrist cases by Peter Letourneau, MD, and planning 3 surgeries for Tuesday November 7. 

 

Hospital staff, patients, and families are all incredibly gracious and friendly.  Our mission trip is being documented by a team from our gracious sponsor Skinceuticals, a subsidiary of Loreal.  An editor from the magazine Marie Claire is also present to interview our two women surgeons Drs. Farzana Ibrahim (plastic surgeon, Bangladesh)  and Parmela  Shakya (oral and maxillofacial surgeon, Nepal), the two inaugural Pioneering Women in Reconstructive Surgery.

 

Tune in later for an update on our 2nd day in Kirtipur Hospital!