Karaikal, India: Saturday, January 24

White caps danced to a morning breeze tickling the Bengal Sea as the sun climbed over the South India coast. A gaggle of kids from a fishing village clambered happily over the painted plaster deities of a beachside Hindu temple. Barefoot farmers ambled off to work in the rice paddies surrounding Vinayaka Hospital, about six kilometers from the Tamil Nadu town of Karaikal.

The Rotaplast surgical team was deep into its own work, fully deployed by 8:15 this morning (thanks to an early breakfast) in the hospital’s four operating rooms. In OR 1, anesthesiologist Joe Anderson kept an eye on the sedative drips and data curling across the monitor. A Vinayaka intern in scrubs stood barefoot on a box grabbing a videocam aerial shot of Dr. Ron Gemberling repairing the lip of eight-month-old Vaishnavy Rajendran. On board was Dr. Vivek, a local surgeon from Vinayaka’s sister campus in nearby Salem, along with nurse Geetha reaching for scissors, forceps and needleholders with each softly uttered request.

A few steps away in OR 2, Dr. Capozzi tugged firmly on a suture closing three-year-old Swarna Kumari’s cleft lip. Dr. Roland Minami, his Indian colleague Dr. Thulasi, and a nurse, worked alongside. Dr. Spira was working on another three-year old in OR 3, while Dr. Demuth tended to a one-year-old in OR 4.

On its second day, the mission had moved into high gear, everyone agreed. Better than yesterday when glitches, hitches and a certain amount of getting-to-know-you between the local Vinayaka staff and the Americans from Rotaplast put a brake on the action. Even so, the first day of surgery had yielded pretty good results.

DAY ONE SCORECARD:

17 procedures scheduled
1 no-show
3 canceled for medical reasons
1 surgery added
14 total operations performed

Volunteer June Minami (and wife of surgeon Roland) is a CPA; she estimates approximately $60,000 as the value in US rates of yesterday’s donated medical services, excluding hospital costs and supplies. The money raised by US Rotary clubs to finance this mission had been well spent.

The one unscheduled surgery was an especially expensive procedure. A boy with terrible burns from exploding kerosene – not the boy from yesterday with his lip fused to his chest, but another one nearly as bad – was taken into the OR just after 4:00 pm. Capozzi, Gemberling and Minami worked for five hours to slice away a ropy collar of scar tissue and free the boy’s head he will be able to look up, look to his left and look to his right.

The boy was sedated and supine this morning, neck swathed in bandages, on a bed in the cubicle serving as an improvised Intensive Care Unit. Ursula, one of the recovery room angels, led the boy’s tiny grandmother to the bedside. Grandma smiled at the boy, murmuring softly to him in Tamil, while Ursula gently caressed the boy’s hand. His eyes opened, took in his grandmother’s presence and, despite all his suffering, the boy managed to croak out a few words.

Ursula began to weep. Grandma’s arm encircled Ursula’s shoulder, reaching across the divides of culture, language and everything else. The Tamil Nadu woman – whose horribly scarred grandson had just survived a major operation – was comforting the woman from Los Angeles.

Just beyond the ICU cubicle, RN Monica Hartman whirled through the PACU room (Post Anesthesia Care Unit) dispensing oxygen and adjusting intravenous tubes under the direction of RN Paula Filari, lead PACU nurse.

From PACU, patients were wheeled down the white-tiled corridor past a row of windows looking out to the fields and beyond them, the sea. A healthy onshore breeze stirred the makeshift curtains and blew straight through the Post Op rooms. Parents were camped out here with their bandaged kids, many hooked up to an IV. Vinayaka interns hovered, conferring often with Rotaplast pediatricians Al Goldberg and David Rosenberg, as well as the hospitals own resident staff.

A vast unlit ward downstairs housed anxious families waiting with children scheduled for operations in the week ahead. Mothers tended to the kids inside with few toys, no TV and, yet, no sound of complaint. The fathers slept outside on mats sprawled along the cement sidewalks and corridor floors. At mealtime, white rice rationed from a giant pot supplied by the hospital was the only thing on the menu.

Across a sun drenched open space, more Vinayaka interns in yellow lab coats were assisting geneticist Marie Tolarova. Blood samples taken during the screening needed to be analyzed, referenced against background interviews. Marie called them her “Yellow Angels.”

So the day proceeded, and still the operation for the other severe burn victim was up in the air. Paula Filari, nurse at the St. Francis Hospital’s Emergency Burn Unit in San Francisco and a Rotaplast stalwart, had been working her cell phone. By midday she’d nailed down approval from St. Francis to ship over a Dermatome skin grafting device. She was also scrambling for a fiber optic scope to pull off the delicate trick of inserting a tube down the burn victim’s throat. His case would be much riskier than last night’s.

The proposal to ship down special equipment was controversial. India’s nationwide holiday blow-out on Monday could put a crimp in the delivery pipeline. And some of the team recalled a similar attempt during a previous mission to Latin America that resulted in the equipment arriving well after the team’s departure. But the team is here, and so is a rare opportunity to pull someone out of the shadow of his disability. That’s why many in the Rotaplast group are pushing for it; they believe it’s worth a try.

Meanwhile, tomorrow is the team’s one day off. The Karaikal Rotarians are planning a sightseeing excursion to some famous temples in the countryside and a Rotary lunch sponsored by the five Rotary Clubs in other Tamil Nadu towns between here and Kerala on the west coast that helped canvass the region for cleft lip and palate patients.

It will be a welcome break for the team after hitting ground running. All they’ve really seen, other than the scary road to K-town from Chennai, is the other scary road from the Paris hotel to the clinic. Beyond the rice paddies grazing goats and picturesque goatherd posed cleverly by Wayne in the fields around the Vinayaka Hospital, a much more picturesque world awaits the intrepid travelers from Rotaplast.

Rex Weiner
Wayne Schoenfeld