Plastic Surgery Camp January 2010 (Bangladesh)

Report by Corien van Rijswijk

Team members:
Cees Spronk, leader of the team and plastic surgeon
Paul Spauwen, professor plastic surgery and his wife Elizabeth Spauwen
Aafke Lautenbach, assistant anaesthetist
Steven Bannink, physiotherapist
Corien van Rijswijk, anaesthesiologist

My second plastic surgery camp was more professionally prepared. I knew what I could expect and I knew what the hospital in Faridpur lacks. Aafke had brought much equipment. All the intubation materials such as scissors, McGills, tweezers and feeders were given a coloured tape. Aafke removed all the packing material from the tubes, suction hoses and gloves so that we could carry more things in our suitcases. We removed the intubation materials, tubes, suction hoses, gloves, medicines and line-sets which were no longer good. After three hours we all had our suitcases apart from Aafke who had our intubation equipment and tubes! Finally also Aafke’s suitcase arrived. From now on we will divide these materials among ourselves.

Fortunately no opening ceremony, no speeches, just a cup of tea and biscuits in the manager’s room. The screening of the patients started around ten. Cees and Aafke mainly saw burns and contractures. Paul and I mainly saw problems with lips and palate. Some of last year’s patients came for a new treatment: a boy who was successfully treated for burn contractures now came for a follow-up operation, accompanied by relatives and four new patients.

Hardly anything had changed in the operation theatre. Fortunately the hoses of 2009 were still there as one of our new hoses had a faulty pressure valve. Doctor Alam, the local anaesthesiologist, gave us a working saturation gauge. He was glad to see us again. The two suction devices work much better, as we no longer have to move them from one table to the other.

We had fewer power cuts, although electricity remains a problem with sockets all over the place for all the devices. Often the plugs do not fit so we need a shoe and tape to connect plug and socket.

The plates of the two coagulation devices also cause problems regularly especially during operations on the palate and venous deformities. The devices for the anaesthesia had not had their annual check. The connections made too much noise even for the locals! Too much leakage and the gas-flow was increased so that we lost much gas. One moment both devices were hissing and general anaesthesia could no longer be given. We used local anaesthesia instead and ketamine.

A ”new” device had the same problem. A mechanic opened the dirty machine and replaced the sealing rings by making new ones out of a flexible thorax-hose. Aafke showed us how to repair things provisionally and Cees’ multi-tool (bought for five euros) worked miracles.

The replacement of the OK-lamp was done after an operation and not fortunately not during as it broke so that glass was found everywhere. Blunt tweezers are not thrown away but used time and again.

I found surgery on the palate more exciting than last year which I did together with Paul. If the wound remained wet we gave some Tran examine-acid, which functioned well as we had less blood loss. This year we operated upon many patients with ketamine and local anaesthesia. For children up to fifteen and operations of less than one hour this works fine. For adults and longer operations it is not ideal as the patients start to move.

This year we had again many no-shows. We do not know why: the cold, the long waiting? We did not work on three tables as before: Cees and Paul nearly had to do all the operations with assistants who barely speak English. Orders for the ward, bandages and medicines did not arrive. Some patients left without having seen anyone. In previous years dr. A.C. Paul was responsible for this, but this year he was absent. Fortunately he was able to assist us the last two days. The next day we left Faridpur.

Total operations: 194:
66 hare lips, 88 deformities by burns and 40 other operations.

Corien van Rijswijk.