Archive for the ‘travel blog’ Category

I only have eyes for Kuppam

July 30, 2008

The next week in Palamaner, Dr. Jacob decided I could use a change of scenery, so he arranged me to go to Kuppam. I wrote this post offline a couple of weeks ago when I was there:

Today (Tuesday, July 8 ) I travelled to Kuppam, a small town about 70 km from Palamaner, where the Emmaus Swiss Eye Hospital is located. The head doctor there is an ophthalmologist named Dr. Olga David. On Tuesdays, they have their outpatient clinic and also admit people for surgery for the following day. Since I have a very light background in anatomy, I didn’t have a very good grounding in the eye or diseases affecting it (my physiology background only really deals with rods and cones and some stuff at the cellular level). But Dr. Olga and the workers and nurses there were very helpful and explained a lot about the eye, eye problems, and the work they do there. Over the week I was introduced to a lot of different conditions and devices that to the untrained eye (i.e. mine, and a slight pun perhaps) closely resembled medieval torture devices. As some of you may know, eyes usually make me a bit squeamish. A. Rita’s eyelid flipping did not impress me when I was young. So some of the stuff I saw this week did make me a bit uncomfortable, but as with everything during this entire trip, I am remarkably able to get over a lot of my squeamishness. (I hope it carries on into the rest of my medical career.)

On Tuesday, a lot of the cases Dr. Olga looked at dealt with cataracts. A cataract is when the lens of the eye stops being completely clear. Sometimes it is cloudy, and sometimes there are small regions that are cloudy or even brown. Cataract also means waterfall, and they have the same word origin. There are also a few people that have glaucoma, where the pressure inside the eye is too high, which can cause damage to the retina. There are both drug and surgical treatments for this condition. The majority of the cases however are people with some sort of refractive error: their eye lens does not focus the image of what they see directly on the retina. They may suffer from myopia (near-sightedness, where you can see near objects clearly, but far images are focused in front of the retina), hypermetropia/hyperopia (far-sightedness, which is pretty much the opposite), and presbyopia, the natural aging and stiffening of the lens which prevents it from changing shape enough to focus on close objects (i.e. reading). They test for these conditions with standard eye tests (i.e. read the following letters), and then also have this pretty cool device, an autorefractor that looks at your eye, and by focusing on the back of your eye, or something like that, it is able to figure out where your eye is focusing, and as such what strength of glasses/contacts you need. I’m not sure exactly how they measure intraocular pressure (pressure inside the eye) in Canada, but here they basically just push a pressure gauge against your eye ball. They also had a device which they pressed against your eyeball which was able to figure out the power of your lens. This is required to figure out what kind of synthetic lens to put in your eye when they replace the lens for cataract surgery.

The next day was surgery. That day there were 7 cataract surgeries followed by two extraocular (not involving the eye) surgeries. The cataract surgeries were pretty quick and followed a kind of rhythm. First the patient has their eye anesthetized so that they can’t feel it or move it. This involved sticking needles into the eye socket area that made me squirm a bit. Once that is all done, they are covered with sheets so that all you can see is the eye. A kind of spreader is used to keep the eyelids back (brought up memories of brainwashing movies where they keep you from closing your eyes, i.e. Clockwork Orange. That picture I think has pretty much the same device). Now one of the reasons I find eyes gross is probably because I see them as being quite sensitive, more like a balloon waiting to pop and spew eye goop everywhere. Not the case at all. Actually the day before, I saw a suture on an eyeball, which I didn’t even know was possible. Anyway, back to the surgery. Dr. Olga then threads some thread through the top of the eye ball, and then clamps down this thread to immobilize the eyeball. With the assistance of a microscope, she cuts around the top of the eyeball, pretty much around the rim of the pupil. In most cases she says she usually cuts into the posterior chamber (I think) to get to the defective lens. Once the incision is made, she sticks in a needle and irrigates the area, loosening up the lens. She then uses a tool to push down behind the lens pretty much squeeze lens out of the opening. I got to see some of the lenses up close after they had been removed. Pretty cool. They were pretty brown and almost opaque for the most part. Reminded me of Ms. Yun-Lee’s Grade 10 bio class when we dissected a cow eye and took out the lens, looking through it. Anyway, after that, Dr. Olga cleans out any other gunk in that compartment, and then inserts a new synthetic lens. She then sutures up the opening with some thread that looked about as fine as human hair, released the holding thread and other instruments, squeezed some antibiotic stuff in the eye and bandaged it. Meanwhile, the next patient has already been anaesthetized and prepped in the adjacent bed, and Dr. Olga can start on that patient. As such, there is pretty quick turnaround, with the actual surgery part taking only about half an hour. It was all very interesting, I am getting over my squeamishness, and once again awed by the resiliency of the tissue of the human body.

After that, the first extraocular surgery involved a young man who had a condition from birth where he had an extra set of eyelashes on his lower left eyelid that were irritating the cornea of his eye. To treat this, Dr. Olga first clamped down on the lower eyelid (a bit squeamish again here). She then split the lower eyelid, cauterized the follicles and then cut most of them out, it looked like. She sewed the lid back together and bandaged him up. After that there was an old man who had a lachrymal duct that was blocked and kept getting infected or something like that, so it had to be removed. She made an incision between the eye and the bridge of the nose, and after a fair bit of cutting and blotting of blood, was able to cut out the lachrymal duct/gland. And so ended a fairly long day of surgery. Very interesting.

The next day is reserved specifically for post-operative checkups, both for surgeries done the previous day, and also those done in the previous 6 weeks. That night, one of the ophthalmology technicians who lives in the quarters here took me around Kuppam. It’s actually fairly large, seems larger than Palamaner, about the same size as Calangute I’d say but less touristy, so fewer clothing shops, restaurants and hotels, but still a lot of little shops and roadside stalls. Managed to even check my mail at an internet cafe.

Friday is another one of the regular clinic days, and my last day. Dr. Olga had some very nice words for me and gave me a bible, in which she wrote a nice message to Dr. Jeff Mascarenhas. That evening I took a train to Bangalore. There were no seats available, so I ended up sitting on the floor, somewhat near the open door where more adventurous people were sitting with their feet hanging out of the train. At one fo the stations, a samosa vendor got on and I decided to take a risk on some possibly sketchy food…they were cold, and egetable, with a little too much cabbage, but at 4 for 10 rupees (25 cents), how can you go wrong? Well it could have gone wrong if I started violently ejecting fluids from all orifices, but luckily that didn’t happen. I got back to Bangalore in one piece, though there was a bit of a disturbance in the area near Nandi’s where apparently some people threw some pigs heads into two mosques which incited a bit of a riot, but it had died down by the time I got back. Apparently this was done in order to scare up some votes in an upcoming election. It’s been almost three months now, and I still don’t quite understand Indian politics. I do know that eveyone is worried about inflation, which is why oil is subsidized here even as prices and demand for oil increase. Predictably, the selectively free market West is not too pleased about these subsidies.

That night I had dinner at Nandi’s with U. Cecil, A. Brinda, Tara and Diya. On the menu, amongst other things, was bheja fry, which up to that point I thought was just the slogan for Indian 7-Up. Turns out it mean brain fry, but in this case not metaphorically speaking. While Nandi pestered me to try some and A. Brinda told her to stop bullying me, I had a very small taste. Not terrible, it had a pate-like texture, but I decided one taste was enough. I’d rather not have any prions running around my body…Speaking of folding proteins, check out Fold It, a project that is trying to figure out how proteins fold by using a human’s puzzle solving intuition rather than an algorithmic way…

Anyway, the next morning, I went with Tara down to Commercial Street, one of the main shopping areas in Bangalore. I was hoping to get a sweet Indian suit, and maybe do some toher shopping, while Tara had to get some last minute stuff done before she headed out to California. We went to a few shops but they were all a bit too expensive. One said I could choose the colour and amount of embroidery, and the weavers or whatever would do something “suitable”, which didn’t really sound that great…But the realy crazy (at least for me) was riding behind Tara on her motorbike through the crazy traffic and roads of Bangalore to get down there. Motorbikes are definitely one of the fastest ways to get around in Bangalore, but as a newbie, I was still pretty scared of falling off. Though once I realized I could hold on to the back, I wasn’t as scared of cracking my head on the road every time Tara accelerated. Childhood memory: Hey Jeff, get in the wagon that you can barely fit in so I can pull you. [as wagon is pulled forward, the handle causes the wagon to tilt upwards, tipping me out so that I crack my head on the ground. But anyway, I got the hang of it, and it was pretty cool. Eat it Joanna. 😉


Palamaner – Maggots!

July 28, 2008

So this week (June 30th-July 4th) was my first week after Ajay left to go back to the States. I got into a routine of going to the ulcer ward after breakfast (the best thing to do on a full stomach, I know) for ulcer cleaning and bandaging. After that I’d go to surgery if there was one that day. I saw some more claw surgeries and skin grafts. In the afternoon, I’d hang out at the school, sitting in on lessons and playing games with the kids during their free time. One morning in the ulcer ward, I was removing the bandages from an old man’s hand. When I removed the last piece of gauze I found a whole bunch of maggots wriggling around the bony stump of one of his fingers, which the patient regarded with disinterest. While some people find maggots awesome, it was pretty gross. Maggots can be used for cleaning wounds, but the nurses didn’t think this was a good development, so they poured some very smelly turpentine into the man’s hand. The next day I saw the man again and decided I’d let someone else deal with him, though there were luckily no new maggots that day. My shoulder was very sore that week from playing dodgeball with the 9th grade kids. I gave their class a Canadian quarter, and when given the conversion rate they were pretty quick to figure out that it was worth about 10 rupees.

That weekend Tara’s friends Diya and Vignesh threw Tara a going away party for her second last weekend in India. They cooked most  of the food which was very impressive:

I was most excited about the asparagus, which I haven’t had at all during my stay in India and have been missing. Everyone else didn’t think they were a big deal – I guess they like their Indian veggies better. The next day was the O-Show at Shiva’s restaurant Opus, which consisted of some vendors with stalls and a lot of bands performing (mainly cover bands consisting of a few people with guitars) that played lots of great chillaxing music while we drank sangria… Also picked up a pretty nifty Indie (get it? I crack myself up. crack crack crack crack crack) t-shirt.

Long overdue update….I got in!

July 28, 2008

Well it’s regretably been more than a month since I updated this blog. But anyway, the big news. I got in to med school! I’ll be attending the University of Western Ontario’s Schulich School of Medicine at their new Windsor campus. There’s some more info about how this school will operate here. Above is an illustration of what the new Medical Sciences Building should look like. Interesting trivia tidbit – if you head north from Windsor, what city/country will you hit first? (Answer). I found out when Joanna and my dad called me together at around 12:30 AM my time. I had already turned in for the night because I had an early morning the next day – we were to go out for a site visit with the TB team at 7 in the morning. It took them a while for them to spit it out, but they finally told me and congratulated me. I didn’t have much money on my cell phone at the time so I wasn’t able to chat long. Needless today, it was hard going back to sleep after that, and I lay awake int he dark for quite a while with excitement and anticipation of med school, and all it would entail.

The next morning we took a van out with a TB field coordinator and some of the nurses. We went to a village first, and there they weighed and measured the height of the children they are tracking in the program before administering the first part of the two stage Mantoux TB skin test.

The village was an interesting sight, with some powerlines haphazardly strung up in certain places, 5 year old kids with their half-naked siblings on their hips, old women doing the laundry, grinding chutney and making chapatis outside, and cows, goats and chickens wandering about.  After that we drove to an elementary school the nurses did the same thing, and after that we headed back to the Hospital. Since this was Ajay’s last week, we spent most of Friday with the kids at the school. The ninth and tenth grades have really taking a liking to us and when we came, they all wanted our autographs….and then wanted us to write our names below, and our phone numbers and emails. I really hope they don’t try calling us long distance for what will be a pretty expensive call. Of course, we couldn’t just write this down for one person and then have them get the information from that one person…they all wanted their own personal copy, which was nice though a little tiring. After that, we played some more soccer. Since we had both the 9th and 10th grades, we had a 9 vs. 10 soccer match…I forget now what the results were, but it was pretty fun. We also played a bit of dodgeball with the girls, and I think some of the less cricket-crazy boys decided that maybe the girls were alright to play with after all and joined us.

I also brought out a frisbee that my cousin Miki had, and fulfilled my goal of tossing a disc around in India…though we didn’t get around to playing a game of ultimate. We returned to Bangalore the next day.

That weekend was another Sessions party at the Ugly Duckling. I had been craving some sweet corn (most of the corn here is not as sweet or as juicy as north american varieties) and got some fo that in one of the snacks, and I had also been craving pesto, and got some of that in a make your own pasta thing that I made with the works. That along with drinking and dancing was a great way to celebrate me getting in to med school. Of course the family couldn’t wait to celebrate either and was quite happy/relieved themselves, so they had some champagne themselves.

June 19 – Return to the Ulcer Ward

June 19, 2008

Well Dr. Jacob was right, it does get easier. After breakfast we went back to the inpatient ulcer ward for the daily dressing change. There were some pretty intense cases. One man had a big hole where his big toe used to be, and you could see some bone in the hole. To clean some of the wounds, they pour hydrogen peroxide in which usually results in a big eruption of pink foam, kind of like a baking soda and vinegar volcano. After observing for a bit the nurses got us involved slowly, first bandaging the ulcers after they had already been cleaned and covered with gauze. Then I cleaned a skin graft with gauze (which looks pretty gross, just a big expanse of pinkness). After that I even cleaned with gauze one of the deep wounds, sticking my forceps right into this person’s foot to clean everything out. The nurses were all very helpful and showed us everything to do. The other good thing is that the patients more or less have no feeling down there, so they’re pretty detached from the whole procedure and you don’t have to worry about hurting them. There was also an interesting case with a young boy who has had a recurring ulcer on his foot, but was also quite swollen around the ankle. They made a small incision to let out the fluid. It turned out it was synovial fluid that was building up there, which kind of looks like vegetable oil. Dr. Jacob took some pictures of ujs while we were working which I’ll try to get a hold of.
In the afternoon, we tried figuring out the scheduling program, and then we went to see Deepak (one of the young outpatient clinic doctors) do skin graft surgery. This surgery was a partial skin graft surgery, so only the top layer of skin was removed, in this case from the thigh, about an inch square. This was then transferred to the ulcer on the foot, and stitched into place over the large hole. It’s a relatively straightforward procedure. We talked to Deepak a bit afterward about the surgery and about medical education here in India and in the United States. He also said that on future graft surgeries he may let us assist in some way…I’m not sure, how, but should be interesting.

For the rest of the day, we struggled with that Scheduling Database program. It’s not the most fun to use, and deleting things is usually bad news and not handled very well, and copy things is impossible as far as I know, which makes for some repetitive data entry. Boo. Joanna would love it.

June 18th – Ulcer Ward

June 19, 2008

Today we met Dr. Jacob and first looked at a piece of software called Supertime 2000 that he’s trying to use to schedule teachers, classes, and resources. It’s basically a big database, and I think we implemented something like this in one of my CS classes at UW. The program isn’t all that intuitive though. I suppose if I was one of my CS friends I could just write my own program that might be better, but since I’m not one of my CS friends, I’ll just try to figure out this program. If anyone knows of a better free program we can use, please let me know.

After that we went into the inpatient ward and got our first experience observing the ulcers that leprosy patients have. They’re mainly on the feet, but some also have it on their hands and shoulders. Basically the patients lose the sensation in this area, so they are unable to tell when they are damaging their skin, and they develop blisters which develop into these ulcers, and what you basically have is a big open wound, no skin, just flesh. It’s definitely a lot more intense than any of the surgeries I’ve seen so far, because in surgery everything is precise and clean, where as these are large gaping holes in their flesh. Some people have really big holes in their bodies that the doctors and nurses have to clean out and cut out all the dead flesh before they can bandage it up. Dr. Jacob thought it would be a good experience for Ajay and I to learn how to clean and dress these wounds, but we’re not sure if we’re up to the task right now. If you want to see what they look like, just do a google picture search of leprosy ulcers. There were a few times I had to walk away and sit down because it was a little too gross for me, though Dr. Jacob says it will get better with time. I hope so.

June 17th: Swiss Emmaus School, 9th Standard

June 19, 2008

Happy 30th Anniversary mom and dad! Today we went back to the school after breakfast and this time spent time with the students in the 9th standard. After we introduced ourselves, we asked the students to tell is their names and their hobbies, and most of them decided to tell us their career aspirations as well. These students spoke a little louder than the 10th grade, but it’s still a little hard for us to understand everything they say. Still, we were able to communicate with each other well enough. A lot of the students said they wanted to be software or aeronautical engineers, and there were also a couple aspiring doctors. In our talks with some of the young doctors here we found that being a doctor is not nearly as lucrative here as it is in the States and Canada, and as such I don’t think as many students are pushed in that direction as you might find in Canada. Mario even told me that he got paid more when he was working and studying in Australia many years ago than he does now. Anyway, after we went through introductions, we got to hangman. That was fun and helped break the ice more, and then their teacher came in and said that we cold go outside for some games, and the students all asked me and Ajay to please come out and play with them. There is a large dirt field with a couple of cows tied around the outside beside the school. As soon as we got out there, it was segregated into boys and girls, which probably would happen in Canada as well. The boys first played a bit of cricket but then moved to soccer, and Ajay and I played on opposite teams. That was fun, but then an errant ball I was chasing landed right in a fresh cow patty. Gross. I tried rolling some of the poo off but that didn’t help too much so I figured I might as well just kick it far away from me. Not the smartest idea. Though I did kick a clean part of the ball (I think), the poo on the rest of the ball decided to spray on my shoes and new green khakis (which were about the same colour). I went back to the room to change my pants and clean off my shoes and when I returned the boys had started playing cricket. Not really my bag, so I joined the girls in dodgeball. That was fun though quite the workout in itself. After that I played a little cricket, managing to get an out while fielding and hit a single while batting before the equivalent of striking out. That cricket bat is heavy. I saw the girls were playing Dog and the Bone, one of my favourite games, so Ajay and I decided to play with them too and we all had a lot of fun. For those unfamiliar with the game, the rules are somewhat like the ones explained here. After that the kids went home but asked us to return soon, and we went back to have lunch, quite tired, sweaty and dehydrated after a morning out in the hot Palamaner sun.

June 16th: Emmaus Swiss School

June 19, 2008

Today we went to the Emmaus Swiss School in the morning, which is now in session during the mornings. We visited the 10th grade class and introduced ourselves and then asked the students a few questions. They were all pretty shy at first and didn’t want to talk, so Ajay and I had to try to open them up again. It’s interesting that here, it seems the students will always stand up when the teacher enters or exits, and also when they are answering a question. Anyway, I tried to remember all the ice breaker games from when I was a frosh leader. We started off with them one by one telling us their names and what they liked to do in their free times. A lot of them like to play cricket, and wrestling, so I got to tell them about how I saw Shane Warne in Goa and the Great Khali in Paris. They also said they liked western music so I asked them if they knew Avril Lavigne (they didn’t), but they did know Bryan Adams and Celine Dion. The children mostly spoke quietly, I think because they were shy, and they also have accents that made it hard for us to understand them. I’m sure it was hard for them to understand us as well. We decided to play hangman which worked out pretty well, with lots of different categories including geography, movies, sports teams, periodic elements, etc. They’re not too familiar with hangman and as soon as we put the word up and they counted the number of characters, they would all shout out words, and I had to keep asking them to guess letters which they would also all yell out at once – pretty chaotic. Still it all worked out in the end. Towards the end we did a bit of a trivia challenge, splitting the class into two teams, and got through a few questions before we realized that school was over for the day. It was a lot of fun though and so we’ll probably return back soon.

Outpatient Clinic and TB Lab

June 19, 2008

This morning there weren’t very many people in the physiotherapy place, so we decided to shadow two of the doctors that work in the outpatient clinic, who see more than a hundred patients some days. Both doctors are fresh out of med school and have been here for about a year, and were really nice and explained all of the conditions that the patients came in with and about the way these conditions are treated in India. Over lunch we had a nice chat and talked about the various medical systems here in India, in the States and in Canada. It’s kinda weird too because out of 12th grade  at age 17 they started at St. John’s Medical School and finished in 2007, so they’re about my age, but they’re full doctors while I just finished my undergrad am applying to med school now.

Since the hospital is mainly focused on leprosy and tuberculosis, a lot of patients came in with conditions arising from this, but most of the patients I saw had various skin ailments and allergies (a fair bit of psoriasis) – very different from the patients I saw while shadowing my family doctor in Toronto, who had a lot of people with high blood pressure and some with depression.

The next day, we walked around and went to the lab run by the TB team. It’s interesting that there, like in surgery, you have to change into flip flops that do not leave that area. We got a tour from the head of the lab, George. They have a pretty nice setup there with some very good equipment, lots of centrifuges and freezers for their samples. I was actually very impressed, it looked very similar to the labs I was working in last summer in Guelph. We also looked through the window of the mycobacterium lab which contains some nasty bacteria and requires additional precautions and protection to enter. That afternoon we were planning on taking a bus back to Bangalore instead of waiting for the shuttle van the next afternoon, but it turned out there was already a car going with packages and people to St. John’s, so we hitched a ride with them. The Bangalore traffic though was pretty gross and probably added at least a half hour to our transit time. That night I had a nice dinner with Miki, Mario and Niharika and relaxed. The rest of the weekend was pretty chill, I went over to Nandi’s for dinner the next day and got to see Indran again, who is now finally walking, and doing a lot of that, though he’s still learning that he can’t walk through some obstacles and is liable to wipe out on stuff. It was also funny because Nandi tried sticking childproof protectors onto the sharp corners of her table, but of course the protectors are not baby proof so Indran just rips them off and gives them to Nandi. He is also learning to speak better and is getting smarter every day. I also just found out that after I left on Sunday, Indran had a bit of a spill and cracked his collarbone and is now in a sling. Here’s hoping he has a speedy recovery. Tara’s husband Jay has also had a spill and is requiring surgery, and I hope he recovers well.

Palamaner: Surgery (May 11)

June 18, 2008

Today we got to observe Dr. Jacob perform surgery to repair the claw-like hands and the foot drop that people with leprosy get. For the non-squeamish, I randomly found a photo album of another doctor performing a similar surgery that you might like to look at. The following is my understanding of the surgeries we saw today, and is as correct as my limited understanding of anatomy and leprosy allows. The nerves that innervate the muscle that straightens the fingers of the hand is attacked by the leprosy bacilli, and so the muscle dies, and the person cannot straighten out their fingers. The surgery to repair this is quite interesting, though it also seems to have its drawbacks. The patient is put under local anesthesia on the entire arm and hand for the side that is being operated on. Then, incisions are made on the first segment (closest to the palm) of each finger (not the thumb though), and on the middle segment of the middle finger. The muscles and tendon that operate the middle segment of the middle finger still work, so this tendon is cut. Then an incision is made in the palm of the hand, and the tendon from the middle segment of the middle finger (that was just cut) is then pulled all the way through the finger and out of the palm. Dr. Jacob then splits this tendon into four equal pieces (still attached to the arm muscle). He then inserts a tool through the incisions he made in each finger and out the hole int he hand, grabs one of the newly cut tendons, and pulls it back through to each finger. This looks pretty cool/weird. Then he stitches this tendon to the intact tendon of the first segment of the finger. In this way, the tendon that was used to straighten the middle segment of the middle finger is now split into four and is used to straighten the lowest segment of each of the four fingers, and as such the patient can now straighten their four fingers.

After watching two claw surgeries, Ajay and I skipped the beginning of the third one to set up the wireless for our laptops before we returned for the foot drop surgery. When we returned, Dr. Jacob was just finishing up the claw surgery on a young girl I had remembered from the previous day. Her surgery was more complex, as she was also getting her thumb repaired. For the thumb, they cut out a tendon that goes to your ring finger middle section. To get the opposable movement, they first pull this tendon out near the wrist, then they feed it around the lower corner of the palm (the pinky side), split the ligament, and attach one piece to a tendon at the front of the thumb and one to the back of the thumb. When we arrived I was surprised because the first two surgeries were relatively bloodless due to their arm being tied off, while there was a fair bit more blood in this one. This was because of the increased complexity due to the thumb surgery. Dr. Jacob said they had to untie the arm after 20 minutes otherwise there is unbearable pain in the arm. I was also surprised because this girl who seemed pretty happy the day before was in some pain, due to the length and complexity of the surgery. It’s weird, seeing her in pain was the only thing that made me feel sick in the OR that day. Finally though Dr. Jacob finished the stitches and bandaging and that surgery was over.

Finally, the foot drop surgery. In this condition, the nerves innervating the muscle that allows you to lift your foot towards your shin is dead, and so for these people their foot is permanently pointed and slightly turned outwards. If this is not corrected, they get used to walking on the outside/top of the foot, and their bone structure changes. To correct this, Dr. Jacob first makes a large incision on the inside side of the foot (for the football/soccer fans are, the place where you are supposed to receive the ball). The tendon here is cut (the person will no longer be able to swivel their feet as well anymore because of this I think). An incision is made above the ankle, and the tendon from the inside of the foot is pulled out to here and split in two. Then two incisions are made on the top of the foot, one more to the inside and one more to the outside. Similar to the hand surgery, Dr. Jacob pulls the tendon from the ankle through to these new incisions, and stitches them to tendons at this site. In this way, the person is now able to use their functional muscle to pull their feet up, and have a more natural stride. For both the claw and the hand surgery, there is extensive pre-operative and post-operative therapy required. Now that I have seen the surgery I am even more interested to see the differences in mobility and function between pre-op and post-op patients.

It got a bit surreal when they put on the music, and the first song was Livin’ La Vida Loca, followed by some Backstreet Boys, Venga Boys, Barbie Girl, and got even weirder when the Can-con started: Avril Lavigne’s Complicated and Summer of ’69 (which I think is probably one of the more popular Canadian songs worldwide).

Another thing that re-struck me during the surgery was the toughness and resiliency of the human body. During surgery what I thought were some pretty harsh things were done to human tissue. Though I have very little experience with taking apart a chicken or raw meat, so that might be why I am so surprised at the toughness of flesh. Still, I remember when I saw my first surgery, a quintuple bypass 7 years ago, I was amazed that you could just punch holes in an artery on the heart around a blockage, and then attach a bypass vessel with a sharp needle and thread, and yet the heart could be restarted and would keep on pumping, and not even care about the apparent torture it had been through. Similarly, I was impressed with the integrity of human tendons and skin. Dr. Jacob would just pull out the finger tendons through the palm, they would be clamped and then he would cut that one tendon into four and then sew it onto another tendon, and the tendon’s integrity remained. Similarly, when he was using his tools to go in and pull tendons where he wanted them, the body was surprisingly yielding and it all worked out. The human body is quite remarkable.

Palamaner: Physiotherapy and Rehab

June 18, 2008

On the second day we met Dr. Auburn and got to talk to him and his wife about the hospital and the school who his wife runs there. We also got a more in-depth tour and explanation of the physiotherapy and rehab centre. Joanna and Marsha, you would have really appreciated some of the stuff they do there. Most of what they do is pre and post-operative physical therapy. Leprosy can affect many different parts of the body, so there are different treatments to try to combat its effects. For example, it can damage the nerve that is responsible for innervating the muscle that causes your eyes to close. These patients cannot close their eyes, but do blinking and winking exercises to try to ameliorate this. There is also electrotherapy which can help stimulate the nerves and muscles. Leprosy patients also often have a claw-like appearance in their hands where they cannot straighten their hands because of damage to nerves and tissues. There is surgery to correct this, but before they do that, they have to stretch out their muscles and tendons in their hands so that they will be able to straighten out their hands. One treatment is to dip their hands into a paraffin wax mixture, which helps soften their hands. They also coat their hands in vaseline, then lay them on a table and stroke and press down across their fingers to straighten out their hands. After surgery they do various hand and finger strengthening exercises. I also noticed a poster on the wall recommending that leprosy patients not handle hard objects without a soft cloth. Since they lose the sensation in their hands, they will not know if they are holding objects too hard or too long, and will develop blisters which develop into ulcers. If these ulcers reach the bone, the bone can become infected and then it may need to be removed. If you’ve ever had sore fingers after writing too long or handling some bad scissors, just imagine if you couldn’t tell your hands were sore and continued without a break or massaging your fingers – that’s when you develop the bad blisters. As such, leprosy patients are always recommended to hold a soft cloth to cushion their hands when handling hard objects.