India 2019 Medical Mission
Dr. Jeffrey Segil and his son Ben are currently on a Medical Mission in India. We are updating the fascinating reports as we receive them. Please follow along .
Sunday Jan 20th, 2019
It is now 5 pm Sunday afternoon. Ben and I arrived at 02:00 on Saturday morning into Mumbai via Paris. Our Medical Mission started a little prematurely due to an in-air medical issue on our first flight to Paris. What started off as chest pain, and a possible cardiac event, was quickly triaged down to severe dehydration. It was a pleasure to watch Ben triage through the possibilities, access the situation and rapidly put in an IV, all at 35,000 feet. A proud father moment and we had yet to even start the mission work.
We made it to Kashturba Hospital by 2 pm Saturday. We have both been here two years ago with the same medical group. It was great to see old familiar faces of my fellow mission workers as well as meet new members to the group.
This is the third visit to this location for Operation Medical. (follow us on Facebook please). Operation Medical is celebrating its 5th year this year and is committed to Global Healthcare. In the past I have traveled with them to Haiti, India, Nepal, and most recently Rwanda. This trip is the largest I have been on with approx. 37 of us. Surgeons, Anesthesiologists, Residents in training, medical students, OR nurses, and Ancillary staff.
We were once again warmly welcomed by our hosts, with a formal ceremony Saturday afternoon, and a chance to set up our equipment for ‘surgery camp’. Specifically, this is a free surgery camp, as one of the pretenses of our missions is that the patients are never charged for our services. We are partially sponsored on this trip by the local Bayer Pharmaceutical company as well as local benefactors, the Patel Family. Both of their generous contributions cover the majority of room and board locally as well as equipment purchases of surgical equipment needed for the trip.
When we were here in 2017, we completed 265 surgical procedures in 6 days. We hope to top 300 this year if possible. We have General surgeons, Hepatobilliary, Colorectal, Breast, Plastics, Gynecology, and Dentistry represented.
I worked with our local GYN last night reviewing cases for today. A most efficient local GYN who manages the hospital care on a daily basis, very busy private practice, but for several weeks prior to camp she examines and pre-Ops all the GYN so it is here and waiting for us when we arrive.
We started today with 9 procedures, 3 Hysterectomies, and 5 laparoscopies for infertility and ovarian pathology, and 1 enlarged vaginal cyst. All went smoothly. My partner in crime here is Parul, a GYN in Harrisburg PA, whose family still resides in Mumbai. We have worked together before and thoroughly enjoy each other’s company as it is so good to have a colleague to bounce ideas off and to assist each other on difficult cases. For the most part we both operate at the same time on different patients to keep the flow going.
Tomorrow promises to be a little busier (today was the warm up, with 41 cases total).
We have 14 GYN cases booked for tomorrow with 9 hysterectomies and 5 laparoscopies, so far on the schedule. Today we were able to start teaching. Both the Residents and students who are traveling with us, as well as the local RNs.
One of the unique qualities of this particular mission is the commitment from the local staff to learn and improve. Kim, who is an RN has been assigned to the GYN OR. It is wonderful to see her take the initiative to educate as we went, improving the local practices of sterile technique. The local willingness to learn is addicting, and despite the frenetic pace at which we work, operate, and turn the rooms over they are learning new skills. By the end of today the simple process of putting on sterile gloves proceeded from not really passable to a solid acceptable. (Baby steps).
That’s it for tonight. Still exhausted and jet lagged, therefore it must be time for another meal (yes they feed us well), and time for evening drinks, for although we finished by 4 pm today, tomorrow promises to be much longer.
More to come on team members as well as patients.
Hope you are all well, and those in the Northeast are not getting to buried in the storm..
Day 3 Kashturba Hospital, Valsad, India, 2019
Sorry for lack of photos, the internet has been more than challenging this trip.
Yesterday was full of cases. As a camp we completed just over 40 cases, 11 of them GYN. I am working again this trip with Parul, a GYN from Harrisburg, originally from India. We love working together and continuously have each other’s back. She is the Queen of the vaginal hysterectomy. A lost art for many new American grads due to availability of Robotic surgery. Parul will perform vaginal surgery on very large uteruses that most surgeons would perform an abdominal procedure on. It is a pleasure to watch her operate. Being our second day we started to hit our groove, working well with local staff, and really increasing the training of the OR personal. They are very receptive, but it takes lots of time to change established practices.
Today we have once again 14 cases scheduled for GYN. There are lots of Infertility patients. A GYN surgical work-up includes Laproscopy, looking in through the belly button, as well as Chormotubation, evaluating patency of the Fallopian tubes by injecting dye through the uterus and watching it spill out of the ends of the tubes in the abdomen, while looking from the umbilicus. Our four surgical residents that are traveling with us and enjoying themselves, doing case after case after case, high volume.
I am going to try and describe my understanding of healthcare delivery in our region.
This info was gleaned from Paratosh, our Hospital’s CEO.
Kashturba is a Charity Hospital. This means that it gets absolutely no government funding. Revenue comes from Patient Services, as well as donations. The hospital is designed to live on its own patient charges, to cover its daily expenses, but any expansions, major equipment purchases need money donated from local charities as well as benefactors. Patient charges are very reasonable, about 70 Rupee, or $1, for a patient clinic visit. When seen in clinic the patient is only seen for one problem per day. A med is added or removed, a test is ordered, and about 1-2 min later the doc is onto the next patient. Yes, 30-40 patients per hour, no exaggeration! For under $20 US a complete work up of EKG, cheats X-ray, multiple blood panels, Echo Cardiogram, etc. is completed on most patients.
There are government hospitals that provide absolutely free care, the patient volumes are even larger than where we are. And there are private practices and even private hospitals, Very expensive by comparison, and catering to luxury. In a private clinic the patient might get 5 min with their doctor, instead of 1 min.
Paratosh, our CEO, arranged to drive me over to the local medical school campus for a tour. He wanted me to meet the Dean, and see the new facility. This is a 5-year-old facility, about a 15 min motorbike ride away. It accepts 150 students per year at the age of 17. They study for 5 years, and then go directly to a mandatory internship in the adjacent hospital. This is a 1500 bed hospital. It is HUGE. They have yet to develop residency programs but are working on that as well. This is a government hospital, meaning all care is free. The staff and students live on campus. The medical school is a 7-story building as well as the hospital. There are 5 five-story apartment complexes adjacent which house students, nurses, all employees, staff, doctors. It is a little city within the city, and there are plans for expansion.
Upon meeting the dean, he asked if I was ready to speak with the medical students. I had been set up :). I was walked down to the lecture hall and asked to speak for 5 min on GYN, and to give the students an overview on what GYN is and what is involved with it as a specialty, as well as Operation Medical in general. A very polite and courteous reception from medical students that do not look old enough to drive a car. I concluded with the dean with an invitation for us to return and provide lectures to the interns in the future years.
The OR today was busy, we had 10 cases booked, almost all hysterectomies. My GYN partner was a machine, cranking out 3 cases for my 2 cases. I did get an advanced prolapse case as well as a chance to teach our local GYN some incontinence procedures. Also got to scrub with one of our surgery residents and teach abdominal hysterectomy as well a myomectomy (removal of fibroids). At the end of the day we had time for a brief shopping trip to a local clothing store for new waist coats and shirts.
I will try and send out some captioned photos if wifi allows, this is the first time I have had wifi since last email. Midge, our photographer, is amazing, a long-time personal friend who also went to Rwanda with me. She loves being in the OR and watching surgeries. She has found her new passion. Midge has done interviews as well as photo exposes on multiple surgical specialties while here. Check out ‘Operation Medical’ Facebook page to see the posts.
More to come, but really no time now. Off to the hospital.
Mumbai, Saturday Jan 26th, 2019
We drove south from Valsad to Mumbai last night after closing festivities. Ben and I checked into the Four Seasons for the night, and spent today touring the city. Amazing! We fly out tonight on a 1:45 AM flight, via Paris. We are both exhausted and a little under the weather, mostly just from exhaustion, and looking forward to getting home.
The last few days in camp where a continuation of the week. On Thursday I was able to help with two more C-Sections. A routine surgery, but made fun as I was able to have our medical students, pre-med, and surgical residents scrub with me. All people who for the most part had never done or seen a C-Section. I love teaching, the one thing that is missing from my daily practice back home, so to be able to walk a potential future surgeon through all the anatomy and process of C-Section was a fun treat. Also, just to see the smiles on the faces of at least two of them who had never seen a baby born, albeit by surgical intervention, was thrilling. I hope it will be a lasting experience for them. The patients themselves where uncomplicated, repeat C-Sections, failed labors, nothing urgent. I was able to visit the next day with the women and their babies, all doing well, and looking great. The patients here are amazingly resilient to surgery. There are virtually no opioids used in any post-op patients. Once they leave the surgery, it is only Tylenol and Advil for pain, no matter what their procedure is.
We paid a visit to the NICU, NeoNatal Intensive care Unit. It is at the end of the hallway from the OR. All babies go there for one hour after birth for confirmation of stabilization. They had received the transfer of a baby prematurely born at 27 weeks from another hospital earlier that day. Normal is 40 weeks.
The baby was doing well, and it was impressive what this small unit is capable of doing.
A visit to the maternity ward was a little depressing as it brings back images of our system over 30 years ago, where women labor on delivery beds that look slightly medieval. Once delivered, mom and baby go directly to the wards and mixed in with all the other patients, no separation. It was nice to see that there is no Nursery, and that the babies truly stay with mom 100% of the time, (10 or more patients on a ward).
Not sure I had a chance to tell you about doctor staffing at Kashturba hospital. They only have the one OB/GYN that I work with. Dr Hersha is amazing. Young woman, with two children of her own, she is on call 24/7, 7 days a week for all C/Sections and OB complications. She lives near the hospital, and drives her motor scooter into work. If she wants to take a vacation she arranges with another OB from another hospital to cover her, and vice versa. I am guessing that she alone performed almost 250 C-sections yearly, as well as assisting with complicated deliveries. An average day for her starts with 2 surgeries, followed by Out Patient Department (OPD) where she will see 50-100 patients daily, possibly more.
There is a local general surgeon, Dr Dasia, who has a similar practice at the hospital. The same applies to Internal medicine, pediatrics, orthopedics, etc.
There are plans to expand the hospital by over 150 beds in the next 1-2 years, if donations proceed as planned. This is the local community hospital for thousands, and they are committed to the local indigent population.
As we wrapped up the week there were lots of heart-felt goodbyes to local staff, as well as to each other as you quickly bond with your fellow mission participants. Many of us have traveled and worked together before, and many of us will do so again on future trips; yes this is addicting! We made wonderful new friends, and thanks to Midge will have amazing photo memories. Please check out Operation Medical on Facebook to see her photos.
We are off to the airport. Thank you all for tolerating my rambling.
And I hope to see all of you soon.
Jeff SegilBack to blog