Surgical Camp

The Issues in Rural Nepal

Consultation with doctors at Trishuli District Hospital highlighted the limited surgical capability available on site in Trishuli. Patients requiring a substantial surgical intervention must travel to Kathmandu and a payment is usually required to cover the costs of the operation. This presents 2 regular problems for surgical patients; emergency cases, for example an obstructed labour requiring caesarean section, can prove fatal due to the length of transfer to facilities in Kathmandu (minimum 3 ½ hour journey in ideal conditions if transport is available) and patients with less urgent elective surgical cases, for example correction of the highly prevalent hydrocoele, often never undergo surgery due to the required expenditure of time and money.

Trishuli District Hospital is supported by irregular visits of surgical camps to the camps where surgeons from outside Trishuli District visit and provide limited surgical interventions for a short period of time. HPN have recruited a team of surgeons, nurses and students to run similar camps to provide free surgical intervention to the local community. The camps are also an opportunity for HPN to provide basic and specialist surgical and nursing training to the local healthcare workers.

Under guidance from staff at Trishuli District Hospital it is proposed that the camps will focus on interventions that require limited follow-up and which meet a large unmet local demand. Such operations will include correction of hydrocoeles and reductions of hernias and will require the skills of general surgeons. Obstetric and Gynaecological surgical services are generally unavailable at Trishuli District Hospital and staff report a requirement for caesarian section and correction of prolapse. Such operations require the skills of the obstetric and gynaecological surgeon.

It is the aim that the camps will be repeated in the same time period each year as a part of ongoing, sustained HPN activity. Where surgical interventions require follow-up, it is proposed that patients will be able to receive this at Trishuli District Hospital and that staff will be trained to provide such follow-up during the period of the camps.

Surgical Camp 2009

In April 2009, HPN mounted their first ever surgical camp over a period of 10 days at Trishuli District hospital. The team consisted of 8 surgeons, 4 nurse, 10 medical students from UK and NMCTH. About 80 operations were successfully completed which included both paediatric and adult surgical cases.

Our Next Visit in 2010

After the success of our last surgical camp HPN hope to improve and expand future camps. We are currently planning their next visit which include 2 or 3 surgical camps running in April 2010, and we are recruiting now. If you are interested please read on and contact us at jess@hpnepal.org for more details on how to participate.

Location          Trishuli District Hospital
Trishuli is situated in the Nuwakot district in the mid-hills region of Nepal 80km from Kathmandu. This journey takes approximately 4 hours by car, this is due to the mountainous nature of the terrain in the district and the general lack of infrastructure – outside of the main road from Kathmandu there are only dirt roads and tracks.

Trishuli district hospital has a surgical wing comprising of 2 operating theatres, a pre-operative assessment room, and post op ward with 6 beds within the wing. There are additional beds available in the main building for HPN to use.

Specialties

• Paediatric Surgery (2 weeks)
• General Surgery (1-2 weeks)
• Obstetric and Gynaecology (1-2 weeks)

The Team per specialty camp

Surgeons
1 x UK Consultant
2-3 x UK SpR
1x Nepali consultant
2-3x Nepali training surgeons

Anaesthetist
1 x UK Consultant
2-3x UK SpR
1-2 x Nepali SpR

Paediatrians
2-3 x UK SpR

Nurses (ward/ theatre)
3-5 UK nurses
2-4 Nepali nurses

Who are HPN hoping to recruit?
We are hoping to recruit staff who are willing to work in a resource limited environment. The focus is on surgical interventions that require limited follow-up and which meet a large unmet local demand. Such operations will include correction of hydrocoeles and reductions of hernias and working under local anaesthesia, therefore we will require the skills of:

• General surgeons (consultants, SpR)
• Paediatric surgeons (consultants, SpR)
• Anaesthetist (consultants, trainees)
• Anaesthetists, including specialisation in paeds, (consultants, trainees)
• Paediatricians – to help run the paediatric surgical clinic and provide post-operative care for the paediatric cases
• Nurses (wards and theatre)

In addition, there is a large number of cases of chronic and neglected gynaelogical problems such as vaginal prolapses, and there is lack of specialists who are able to perform caesarean sections. Thus we would like to recruit:

• Obstetricians and gynaecologists (consultants, SpR)

However, there will be the opportunity to provide surgical intervention for more complicated cases in the above mentioned specialties at NMCTH where safe and appropriate measures can be implemented.

Dates/ itinerary (provisional)

Surgical Camp 1: Paediatric Surgery (1/4/10 – 21/4/10)

Surgical camp 2: General Surgery/ O+G running parallel (15/4/10 – 4/5/10)

Teaching and Training
In order that this joint venture between HPN and Trishuli District Hospital achieves a sustainable year-round impact it is proposed that during the period of the surgical camps, time will be devoted to training staff in basic surgical and theatre nursing skills. This will be done in accordance with Nepali legislation on the training of surgeons. It will ideally encompass emergency interventions where the alternative to prompt surgical intervention is a fatal outcome for the patient, for example the emergency caesarian section.

During consultations and in the operating theatre, as well as Trishuli doctors and staff, medical students from NMCTH and SGUL will be taught in order that they can continue such work once qualified.

The visiting consultants will also provide a series of evening educational lectures on subjects related to the practice of their specialty, whilst at Trishuli District Hospital and at NMCTH in Kathmandu. These educational lectures will be open to doctors, students and healthcare staff from throughout the surrounding area.
It is also proposed that HPN, in partnership with providers of the national Safe Motherhood Programme, will extend the reach of the programme by offering training in measures to reduce perinatal mortality, to traditional and skilled birth attendants throughout the period of the surgical camps.

Future Projects

Orthopaedics and Club feet
HPN proposes providing a surgical service to treat clubfoot in children in partnership with the charity Feet First. During the period of the camp, surgeons from the UK would operate on a previously-prepared list of patients with club foot using methods which require minimal follow-up.

Traditional Healers
NMCTH has previously run a successful series of 3-day programmes aimed at training traditional healers in diagnosis and management of basic fractures and recognition of complications. It is proposed that HPN run the programme at Lalgadh Leprosy Hospital during the period of the camp in order to provide to further enhance year-round orthopaedic care in the area.