Friday, February 5, 2016

Experiencing the instant life change...A day in the Operation Room

Orlence who had a contracture release to his neck 
Patients travel from far and wide to come get the health care they are so badly needing. These trips can take days and often a few months salary. They go through a screening process where it is decided what surgery they will have and then they get the all important surgery date.

I, as a hand therapist, work with all the plastic patients to ensure that the life changing surgery that they have is not a waste and they regain the function they had previously lost or in some cases never had. I see the patients the day before their surgery and the excitement and nervous butterflies are palpable in the room. During this time I take measurements and videos in order for us to track their progress and improvement from surgery and therapy. Normally after this pre-op (that's the technical name for it) I wave them off and only get to see them after their surgery.
This little joy is Elina who had a neck, axilla and elbow contracture release.

The actual operation has always interested me as I had seen the incredible changes in a person's spiritual, emotional and physical aspects just from an hour or two on a opertaiton table. We are lucky enough on this ship to be able to observe surgeries. Exactly a week ago I was in the OR with the talented Dr Tertius Venter (he is from SA). They were running late on one of the surgeries so I was lucky enough to observe 2 surgeries that day. The first surgery I observed was an axilla (armpit) contracture release. In order to release the contracture they make use of skin grafts. In this instance he used a split thickness skin graft which was taken from her thigh. If you are easily affected by blood I would not suggest you watch one of these surgeries as they take what looks like a cheese slicer and strip a piece of skin from the thigh. They then stretch it out with a special machine. The surgeons make it look so easy that I was ready to go up and offer my hand at it (I am well aware that it takes alot more skill than what it seemed). The sugery took just over half an hour and a woman who before wouldn't of been able to functionally used her arm because it was stuck to her side is now able to use her arm freely.

Dr Tertius Venter, our plastic surgeon straight from SA :) 
The next surgery I watched was extra special because I had done his pre-op. He was a really sweet man who was so excited for his surgery. He suffered from a condition called syndactly which can be a congenital condition (birth) or in his case was cause by a burn to his fingers  which when they healed got stuck together. He had previously had surgery to try correct this but the surgeons that did it bandaged his fingers together after the surgery. This is just an example of the healthcare that majority of our patients receive in Madagascar. This specific patient was nervous about the surgery and had every right to be with his previous experience. He was light in skin colour and was very aware of how his scarring looked and was desperate to get his hand looking and functioning as normal as possible. For his surgery they used the same method as the other surgery mentioned above but it was a bit different because it was his fingers. He had to cut the stretched skin and carefully place it over the places where he had cut. In the surgery before they used staples to attach the skin but here they used sutures to attach the skin inbetween the fingers and on the palm. Watching sutures is quite magical as they require such skill and precision, the surgeon just moves his tools and suddenly the skin is attached where it needs to be. Because of the burn he had also lost movement in his MCPJs (metacarpal phalangeal joints), basically his knuckles, so during the surgery Tertius stretched them out alot after cutting and releasing the fingers. This was quite gruesome to watch as he was able to get a full fist where before the man couldn't even bend down close to his palm. When the surgeon is done and has closed he now needs to splint the patient in the position he is aiming for. In this case he splinted his fingers into a fist using casting material. In some countries the Occupational Therapist/ Hand Therapist would be splinting in surgery but because of time constraints here and also the success of the casting a splint is only made after the second dressing change with most clients.
Me all scrubbed up to observe surgery

Watching these surgeries was so educational for me as I understood what had gone on in between the times I had seen the client. It also helped me realise the work that had gone into changing their lives and what a responsibility I had to make sure that I contiuned the process and gave the client the best chance they had of a functional life. The majority of the patients I have been seeing are burn contractures. One of my clients was burnt when he was 6 months old and only now at the age of 31years has he received the surgery he so badly needed. This can only happen by the donations from all of you and the amazing people on the ship that give up their time to come serve these people. I am so privledged to be here and to be receiving such amazing experience and working with the best surgeons in the world. There are only 3 weeks left but I hope to find the time to share with you more about my journey here. It is so hard to put into words the life change that occurs on this ship.




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