operationwalksyracuse

November 17, departure day

2011-11-21T15:04:00.001-08:00

So it is with mixed emotion that we depart. The team had a great evening last night hosted by the Orthopedic Department at The Nepal Medical College Teaching Hospital. The party was far more elaborate than our team had anticipated. The party was attended by the entire medical staff and their families as well as the Minister of Health of Nepal and other governmental officials. These guys are great hosts, well read scientists who merely lack the experience needed to become proficient in joint replacement surgery. They also are experienced and proficient drinkers who left us in the dust at the Johnny Walker dispensary.

The evening was filled with pomp and circumstance, mutual appreciation for the service and opportunity respectively. The food was served outside in a garden garnished with fire burning pits for warmth and tikki lamps. The fires were metaphorical warnings for the curry-laced delicacies that were served. There was an elaborate stage where all the Syracuse team members were recognized with a plaque.

We made final rounds this morning on our patients. They are all doing well and really getting mobile. The staff from Nepal has taken the reins and the patients are confident in their care with the homegrown staff so we all felt comfortable leaving the patients in their care.

On to the next stage!

Brett

Sent from my iPad

more images of Nepal some old some new

2011-11-19T02:31:00.000-08:00

Two New Hips and a Promise for the Future

2011-11-19T01:48:00.000-08:00

His name was Pramod Kumar Yadov. As we sat in the post screening clinic conference debating the risks and benefits for each patient before proceeding with surgical procedures, my mind flashed back to a day shortly after we arrived in Nepal. I walked the grounds with Dr. Saswat, the orthopedic resident assigned as our Operation Walk liaison. He pointed to a distant sight. Awkwardly making his way across the pavement, steadied by a set of crutches, was a young man of approximately twenty five. Saswat explained to me that he was a candidate for the Op Walk camp and had travelled from afar in hopes of undergoing bilateral hip replacements.

His hips were fused and he suffered from ankylosing spondylitis--a long term disease that causes inflammation of the joints between the spinal bones and the joints between the spine and pelvis. It eventually causes the bones to join together and mobility becomes progressively compromised, often to the point of complete incapacity. His mobility had steadily diminished over the years and was now at the point that he was unable to independently care for himself.

The team debated his case and discussed the potential for surgical success. From a medical standpoint, anesthesia would be a challenge. A successful spinal anesthesia modality would likely not be successful due to the anatomical challenges posed by his spine and rib cage. Although general anesthesia was a possibility, the anesthesia team lacked the critical equipment that might be necessary to safely manage the airway of a patient with major neck and spine abnormalities. After all, general anesthesia was not in our plan for any of the patients as a primary anesthesia route. From an orthopedic surgical standpoint, the procedures were not elementary, but certainly manageable. Orthopedic score-2 and anesthesia/medicine score-3. Discussion engaging everyone in the room ensued relative to the potential for success and a positive outcome.

After what seemed like an eternity, the team rendered its decision. It was neither wise nor prudent to proceed with these procedures. The inability to manage him from an anesthesia standpoint posed a serious threat and could possibly even result in his death. The team had made its decision and that would then be explained to the patient. Disappointment hung heavily in the room, but the correct and safe decision had been made; or was it?

From the front of the room I heard the quiet and calm voice of the LA surgeon who accompanied us on the trip. His presence on our orientation trip was intended to provide guidance and a means for an experienced resource to our novice team. He acknowledged that our assessment was completely accurate and the risks associated with proceeding with the procedures were high. He continued to engage us. Left untreated, this young man would be doomed to the effects of advancing disease with no way to mitigate the damage and destruction that would be left in it's path. It wasn't a matter of "if" he would become completely immobile, but "when"? He challenged us. Should the patient not be given the opportunity to make the decision if the benefits outweighed the risks for these procedures? Should he not at least have that modicum of control over his own future and destiny? And with that, the momentum changed. Enthusiasm mounted. The dialogue shifted to "how" this could be accomplished rather than "if" it could be accomplished.

Surgery day two dawned with a sense of accomplishment from our initial operative day, and eager enthusiasm to launch into the series of more complex patients that this day promised to bring. The team was buoyed by increasing confidence and the comfortable camaraderie that had begun to develop and solidify. Pramod had not only accepted the risks associated with his procedure, he desired to get in the OR as quickly as possible. His smile was ear to ear. There was no turning back for him. The day flew by quickly for us, but for him it was an eternity until his OR time arrived. We had agreed he should be the last case of the day so that additional team members would be available, as well as limitless surgical time. He finally arrived in the OR. That same dazzling smile greeted the team as the anesthesiologist worked his magic and by some miracle (or exceptional skill), the spinal slipped into place signaling the start of the surgical procedure.

The right hip replacement was completed, hemodynamic stability confirmed, and the anesthesiologist gave the green light to reposition the patient to the other side to commence the left side hip replacement. Everyone was excited about the realization that the second procedure could be initiated and therefore, the true therapeutic effects of the bilateral procedure could be achieved. We carefully began the transition to reposition the patient for the second procedure. This involved a brief stop in the supine (back laying) position prior to propping the patient up on the opposite side. Much to our surprise and delight, Pramod lifted his head, steepled his hands in the traditional Nepalese manner, and with his broad smile intact, greeted us with "Namaste" as we turned him onto his back. He deeply touched the hearts of all present in the room. I recalled how close we were to denying him this life altering surgery and silently thanked the surgeon for nudging us forward appropriately.

Before long the surgery was finished and he was in the recovery room having received two new hips. He was overwhelmed with emotion and joy. He

gripped Dr Saswat's hand and searched his eyes for an answer to the question on the tip of his tongue. "I marry now?" he exclaimed. As Saswat

answered in the affirmative, the grin broadened and was this time accompanied by dark eyes sparkling with hope for the future.

Early the next morning family, friends, and a group of team members crowded around him as he ventured into the hallway taking his first steps. Filled with exuberance and free from pain, he cruised the hallway, physical therapist at his side. Pramod became an inspiration to others (patients, family, and the Operation Walk team) for the remainder of trip. He touched the hearts of us all and impacted us in a manner that will not soon be forgotten.

We were drawn to him and nourished by the inspiration, hopes, and dreams that he symbolized. I visited him several times each day and never found him to be without that wide grin and unflappable demeanor. As our Operation Walk camp drew to a close, we assembled for the traditional team-patient photograph. He spotted me across the room and motioned to me. He patted the bed next to him and I sat. I remained seated near him for a few moments, both of us silent but aware of the powerful exchange that was in process. Before I realized what was happening, he had draped a vibrantly colored scarf around my neck and shoulders, pressed his palms together and with the smile that was now so familiar to me, nodded his head and exclaimed "Very Happy". Operation Walk Nepal a life altering experience for us? Perhaps. A life altering experience and a promise for a future for Pramod? Without a doubt. We depart Nepal content in the recognition that we made the right decision to proceed with his surgery. Sometimes the message present in your heart must overrule the logic of your head.

Kim Murray

more images from Nepal

2011-11-18T19:22:00.000-08:00

some random images from the week more to follow

2011-11-17T16:20:00.000-08:00

November 16, 2011

2011-11-16T09:11:00.000-08:00

We finished the surgeries yesterday and today had a casual conference with the Nepalese orthopedists, anesthesiologists , internists medical students. The conference took about two and a half hours and was followed by the customary lunch. We have learned to like the food more but we all approach it with the caution of experience and secretive alcohol wipes for the spoons. We had an amazing interaction with the patients and their families on the orthopedic ward.
This was initially rounds to chick the work of the team and then for some photo momentos for both us and them. Finally a huge group shot followed. There were emotional and heart felt thanks from the patients and their families for the gift of walking and thanks from us for the opportunity to use our wealth of money and skill to practice some medicine pure and simple. medicine without the fear of imperfection, without the fear of malpractice, with the only goal of getting a great result in the most direct way possible. it's why we all went into this business in the beginning.
The end of the afternoon was presentations of gifts from the patients and families to the team. We all got scarves. The team got several small and one giant Buddha that came in a heart felt presentation from a grateful husband who will no longer have to cook for himself! We will need a OpWalkSyr trophy case somewhere. We all plan to add another trophy to the case next adventure, hopefully next year.
Suffice it to say that the team leadership is looking into the next chapter!
Brett
Sent from my iPad

7th day in Nepal

2011-11-16T02:41:00.000-08:00

Brett Greenky

2011-11-15T07:13:00.001-08:00

The place , Kathmandu, is hard to describe. The city is a giant village that spurge up with absolutely no governmental guidance or control. No one has any money and all the peasants are simply trying to make a living enough to eat. Cows are sacred so they wander aimlessly all over the city . There is no traffic laws or light so the streets are total entropy. Stray street dogs wander eating anything that is dropped. Small children sit everywhere with the cutest faces and they accept candy from our team with expressions of disbelief and gratitude simultaneously. The pollution is mind boggling. Car have no emission controls and garbage is thrown literally everywhere. Much of it is burning so nearly half the population walks around with cloth make shift surgical masks. When someone dies their family assembles at the polluted but sacred river in the middle of the city. On the banks, the body is cremated and usually partially burned. Next the street dogs nibble on the semi charred remains and a family member can be seen whaling off with a severed body part. Next the remains are shoved with a giant pizza like spatula into the river which doubles as a sewer.
We finished the last cases at the hospital today and the patients are all doing quite well. We did the most joints of any previous Nepal Operation Walk mission and we are all very proud of that. The "Team from Syracuse" is made up of total stars who all brought their A game to the most challenging venue one could imagine. I think the guidance team from LA was blown away by the cohesiveness of our team in every position from instrument tech to surgeon. I feel we brought the Olympic contenders from Syracuse to compete on the worst running track in the world and we set a record. I am very proud of the effort of all of us! What a life changing experience to use the skills we have all honed to do something completely selfless in a totally random and foreign land. I suspect there are few if any team members who would not jump at the chance to participate on our next adventure!

Brett
Sent from my iPad

6th day in Nepal

2011-11-15T04:16:00.000-08:00

Making a difference

2011-11-14T08:47:00.000-08:00

The third day of surgery was filled with positivity reflected in the enthusiasm of patients showing success with physical therapy. This enthusiasm was also passed on to pre-operative patients and their families, who were encouraging post-operative patients during their ambulation and physical therapy. Family members were very supportive and willing to be involved in and participate in patient care and teaching. It was great to witness patients receiving such support and attentiveness from several family members at the same time.

Given the complexity of the case, we are very closely following the progress our patient with Ankylosing Spondyitis. He was phenomenally energetic and motivated for physical therapy, and walked several times with physical therapist with the help of walker. He expressed his excitement of being able to hope to be married and get better job now that he can walk better. We all were moved by his determination to get better, and move ahead in life.

We are collecting all these moments to build a hope of success for all our patients, and thanking our patients and families for touching our lives in many ways.

day 5 in Nepal

2011-11-14T03:51:00.000-08:00

day four of operation walk

2011-11-13T10:16:00.000-08:00

full OR day #1

2011-11-13T08:59:00.000-08:00

As expected, it was a busy and exciting day today. 12 patients had their surgeries today. We got to see the progress of patients who were operated on yesterday. Everyone in the team showed great cooperation and helped each other whenever needed, regardless of their specific roles. Credit must be given to the nurses of Nepal Medical College who put their best effort to coordinate with Operation walk team and keeping up with the challenge of the mission with us. Everything was all different to them just as much as it was for us. We are very grateful for their patience and collaboration, critical to the mission. Nurses and physical therapists of our team were very enthusiastic in teaching and learning from their counterparts from the hospital, just as much as the counterparts were in doing the same.

We had an opportunity to talk with a 25 year old patient with Ankylosing spondylitis, who had walked in to our screening clinic yesterday stooped over his cane, and his legs deformed because of the nature of his condition. This pleasant young man, who is a primary school teacher at a local school in a village in Southern part of Nepal, has an elder brother who is a labor and barely is able to support his financial needs. He sought help two years ago when his hip pain started to get worse, visiting orthopedic doctor in the capital city four times a year in hope of some treatment. He came to know about Operation Walk through Dr. Shah, an orthopedic doctor in Nepal Medical College. Dr. Shah says, a mission like this is adding “life to years” to patients like this gentleman, who has life full of opportunities ahead of him beyond this condition. This patient was very excited about the surgery, and hoped to get better paying employment to be financially independent after treatment. He said he had faith when nobody in his village believed that his condition could be treated. He had bilateral hip surgery today, and was feeling great when we left the hospital. To be able to provide hope and treatment to people who are in such dire need of them is satisfying beyond words, and we hope to be blessed with this kind of satisfaction throughout the remaining days of our mission.

Screening and OR day #1

2011-11-12T07:25:00.000-08:00

Today was our first day of surgery. We began by screening patients in our lists. We are very thankful to all the Nepalese doctors and residents who were tremendously helpful in translating for patients and families.Their willingness to help and eagerness to learn was indeed very supportive. With the coordination of the team, we were able to take more patients than originally listed. After discussion about every screened patient in a conference, the team proceeded by getting ready for surgeries. The OR team took up and handled the challenge of working with much less sophisticated and very different Operating Room settings and technologies. While preparing the patients for surgeries, nurses and physical therapists took the responsibility of pre-op teaching in patient wards. As we taught patients and families in a ward with about eight beds, we saw a common hope of getting painfree movement in every patient's and family member's eyes. This hope, excitement, and appreciation is acting as an incredible supply of energy to the team and is making all the challenges seem worth it.

first day of patients and surgeries

2011-11-12T04:34:00.000-08:00

Preparing for the First Day of Surgery Tomorrow

2011-11-11T07:24:00.000-08:00

The team visited Nepal Medical College as a whole today. Through the last couple days, team leaders and members from Syracuse and LA have been trickling in, with the last group from LA arriving today.

Surviving almost 22 hours or longer flight from NYC to Tribhuvan International Airport in Kathmandu and bumpy bus rides through busy traffics in Kathmandu, groups have been arriving in and staying at Hyatt Regency Hotel in Kathmandu. The team has been phenomenal in keeping up their enthusiasm through jet lags and time difference of almost 11 hours. While the Operating room prepared for upcoming challenges of surgeries behind the scene, many groups visited different sites of Kathmandu valley and outside to get a feel of people and culture.

LA and Syracuse teams met today to coordinate a plan for patient surgery and care tomorrow and to outline tentative plan for the rest of the week. The journey upto here has been long and exciting, and the team enthusiastically looks forward to the first day with surgery tomorrow.

more images from today

2011-11-11T06:51:00.000-08:00

Images from Bouddha Stupa

2011-11-10T23:36:00.000-08:00

more images from yesterdays trek and dinner

2011-11-10T19:25:00.000-08:00

here are more images from yesterday

images from the nepal country side

2011-11-10T10:49:00.000-08:00

early morning image

2011-11-09T20:02:00.000-08:00

the people of Nepal are very hard working and very friendly

operation walk syracuse is here

2011-11-09T13:15:00.000-08:00

we just arrived 2 hours ago here are more images of the trek

we are in hong kong more that half there

2011-11-09T00:28:00.000-08:00

here are some images

we leave on a bus

2011-11-07T22:22:00.000-08:00

we have just left on the bus to new york our first leg of the journey good byes were said and luggage stowed

we leave tonight

2011-11-07T17:32:00.000-08:00

tonight we leave on our trip to Nepal by way of New York City then 16 hours to Hong Kong. Take a deep breath and then 6 hours to Nepal.

Operation Walk Syracuse Fund Raiser at Benjamin's on Franklin

2011-08-19T06:46:00.000-07:00

Need I say more? The fundraiser at Benjamin's on Franklin was a huge success.

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2011-07-13T16:17:00.001-07:00

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