Indian doctors reach modern surgical techniques to Madagascar
I got a small example of what Rotary can do when I participated in a Rotary medical mission from India in Madagascar recently. I went to understand how these missions work,” RI Director C Basker said recently, addressing incoming district leaders at Disha, a training event in Kolkata. There he saw Rozanne, a 10-year-old girl whose teeth were so badly arranged (see pictures) that she smiled rarely. And when she talked, she kept her palm in front of her mouth so that others could not see her ugly teeth. “Madagascar, I found, is like India was, several decades ago, a very poor country with inadequate medical facilities. In that medical mission, 19 doctors from India did corrective surgery and other procedures. A corrective procedure was done on Rozanne too, and for the first time she was able to smile before others without any embarrassment.”
Basker added: “This is the kind of opportunity Rotary gives us, to change lives. And guess who supports these medical missions? Our own Foundation.”
PRIP Rajendra Saboo, who first conceived in 1998 this idea of service beyond borders, particularly for a country which has been a “receiver” for several decades in the last century, said a team of 19 doctors from RI Districts 3080 and 3070, along with 13 Rotary volunteers, had successfully treated 3,500 patients in Madagascar, RID 9220, during a recent 12-day medical mission, in which RI President Barry Rassin had also joined as a volunteer, apart from RID Basker and his wife Mala, and RI Director Yinka Babalola from Nigeria.
Saboo, who along with his wife Usha, has been volunteering his service at these medical missions, beginning with the first one in Uganda, said, “We had gone to Madagascar the first time in 2004 and realised that this is a country that needs to be revisited for serving humanity, particularly in the health sector. At that time, Shelly Oukabay was the coordinator and I told her that when you become governor, we will come again. And hence this trip.”
The most significant part of this trip, he added, was that it was timed in such a way that RI President Barry Rassin could also join the medical mission as a volunteer. Antsirabe, about 180 km from the Capital city Antananarivo, was chosen. That these 180 km take about four hours of travel gives you an idea of the condition of roads in this African country.
The mission’s venue here, except for ophthalmology, was the civil hospital which had very basic facilities. “But thanks to the local team headed by Shelly and her resourcefulness, our mission got maximum support. For an entire week the civil and the eye hospital became our work place. The Director of the former made available to us all the five operation theatres,” he said.
While most of the emergency cases were attended to by the local surgeons, the Indian surgeons helped the more complicated cases and on
PRIP Saboo’s request, the hospital director organised an additional table which helped the Indian doctors to take up additional cases, particularly of plastic and ENT disorders which required local anaesthesia.
On the human side, there were many poignant cases; Saboo recalls the case of a 14-year-old boy who required a major surgery, and Dr Ravjit Singh and Dr Ramesh Paul were working on him, having put the teenager under spinal anaesthesia. “The surgery lasted about two hours and no one except the operation team could enter the room. I was communicating with the boy through the glass door, telling him through signs how the surgery was progressing. He was smiling all the time and gave us a thumbs-up. I have not seen this kind of positivity in a patient! When the surgery was finally over, I gave him a double thumbs-up signal, which he returned with a broad smile. As we were transporting him on the trolley, I felt his positivity transmitting to me and all the others around me.”
Within a couple of days, the surgeons had to stop further registrations because the list was getting longer and yet there were some cases which could not be refused. An unusual number of hernia cases, including in children between 2–4, were seen and the surgeons decided to give priority to the children, as they felt the local surgeons wouldn’t be able to handle these cases.
“It was remarkable how our surgeons did their best to get the local doctors to perform the surgery with their guidance to make the work sustainable,” said Saboo. He added that the dental department was extremely small with just two chairs “and there were over 100 patients waiting every day and our surgeons worked very hard to take up the complicated procedures, in the process training the local surgeons.
Thus, in the most trying of situations, 163 eye operations and 73 general, 36 plastic, 34 ENT, 35 orthopaedic, 8 gynaecology, and 576 dental surgeries were performed by Indian doctors in Madagascar. The dermatology department attended to 1,250 patients and distributed free medicines to them. Bone infections, hernia, goiter, clubfoot and burn injuries are common problems in the region.
“I was incredibly impressed with the entire experience of being with the medical mission for a few days. To see the dedication of the Indian doctors to the patients in Madagascar with the significant hours of work they put in, was truly inspiring,” said President Rassin, adding that he felt renewed as a Rotarian to participate with them and feel the spirit of “doing good” permeating the entire team.
“To be close to the patients and see their deep appreciation as they knew this may be a rare chance to get the help they need made me proud to be a Rotarian. I wish every Rotarian could experience a medical mission as I know they will understand what it means to ‘be the Inspiration’, ” he said.
Recalling the first medical mission which was to Uganda, Saboo said that Rotary has since then sent more than 500 doctors to treat patients in
43 countries and Indian surgeons have so far performed an impressive 63,000 surgeries in Africa.
It was while doing eye operations that Indian “jugaad” came in handy. To deal with a non-functioning small-capacity autoclave, the surgeon (Dr Nivedita) bought two large pressure cookers and used them to sterilise the surgical instruments, said Saboo.
On the participation of President Rassin, RID Basker and Mala, as well as PRIP Saboo and Usha, DG Praveen Goyal, who along with his wife Basu, was part of the volunteering team, said, “It was heartwarming to see senior leaders moving patients in stretchers from the OT to general ward, trying to calm anxious patients with soothing words and assisting the specialists in their work.”
This mission was a global grant endeavour with RID 3080 being the lead district, and it was supported by international partners — Districts 6200 (Louisiana), 6880 (Alabama) and 6760 (Tennessee) — and TRF. The Health Ministry of Madagascar extended support to the visiting team. “The project cost was $87,000 and we had carried with us 1,300 kg of medicines and equipment which we donated to the hospitals in the African country,” said PDG Ranjit K Bhatia, Project Chair. PDG Raman Aneja was in charge of the logistics and administration. PDGs Manpreet Singh Gandhoke and Dhan Chand, accompanied by their wives Poonam and Meena, were among other volunteers.
Antsirabe, where the mission was held, is the third largest city in Madagascar with a population of over 2 lakh, and is economically backward. Most of the people are employed in a brewery which makes the ‘Three Horses Beer’ better known locally as ‘THB’. “I couldn’t meet a person there who has three meals a day. A majority of them survive on rusk and tea,” said Goyal.
He related how an Indian gynaecologist helped in the successful performing of a C-section delivery. “The doctors were struggling with the operation for over 90 minutes and our gynaecologist, Dr Nirlep Kaur, helped them out.” Medical facilities are almost nil, he said. But despite that, “the discipline among the waiting patients was amazing. There was no queue-jumping, quarrels or arguments. The people organised themselves so well.”
He added that when primary health care was launched in the 1970s, health aides in this African country would visit various places on foot, bicycles, mounted on oxen and on carts to deliver healthcare. “Very little has changed since then as many people still have to walk 10 km or more to receive treatment, though mobile health centres have been introduced in remote and sparsely populated areas. The high cost of prescription drugs is also a major impediment to primary healthcare.
The local Rotarians and Rotaractors helped with translations, as the common spoken languages here are French and Malagasy. They also helped the doctors in the OT.
Some of the doctors from India included eye surgeon Nivedita Singh, dermatologist Vanita Gupta, plastic surgeon V D Singh, general surgeon
N S Sandhu, orthopaedician Ravjit Singh and ENT specialist Ramon Abrol. The medical team also included dentists, anaesthesiologists, ophthalmologists and pathologists. Besides treating patients, they trained local doctors modern medical techniques.
General Surgeon Dr Karan Singh, the mission’s Medical Director, said, “Each of us trained at least one doctor and recently when I heard that one of the doctors we trained has independently performed 10 surgeries, I was so happy.” This was his 17th medical mission, and “this is the first time I have worked 12 hours at a stretch from 8 am to 8 pm. But I never felt exhausted. We were energised when we had senior leaders like the RI President, Director and PRIP Saboo in our midst.”
Indian doctors are respected in the African island and admired for their ability to work under difficult conditions for long hours, and adapt their treatment techniques with available facilities, said Dr V D Singh.
Dental Surgeon Dr G K Thakral, a PDG, who was accompanied by his wife Dr Rashmi, also a dental surgeon, said this was their eighth Rotary medical mission. “It gave us an opportunity to relieve hundreds of suffering people from pain, misery and agony due to various dental diseases.” These patients were suffering in silence for two reasons — absence of quality dental treatments and inability to afford whatever was available at the local hospitals.
Some of the latest procedures undertaken to treat them included “root canal treatment, surgical extractions, gum surgeries and Light Cure restorations of badly mutilated teeth. Young children who were shy of talking and smiling due to ugly-looking painful dental problems in the mouth, were all smiles and talking, full of confidence and self-esteem, once treated.”
These included the two girls Rozanne and Nancy, whose smiles, as also faces, were dramatically transformed by the intervention of the dental team. “The drastic and positive transformation of their personalities was the biggest reward and appreciation of our skills as specialised dentists. We feel that working as Dentist Volunteers at such missions is more fulfilling and satisfying than any of the other Rotary assignments that have been done by us,” added Dr Thakral.
Dr Vanita said that the region lacked trained dermatologists and skin diseases such as scabies and fungal infection abounded. She treated 1,250 patients and distributed free medicines to them. “Most of these are curable cases but neglected due to absence of trained doctors.”
PRIP Saboo added: “We were privileged that President Barry Rassin joined us and worked as a volunteer and stayed with us in the same hotel. In the hospital he pushed trolleys, wheel chairs and helped in transferring patients from the bed to the operation table. He was accompanied by RID Yinka Babalola. Both of them would sit in the medicine store where doctors and volunteers had a quick working lunch, and they’d join us, eating whatever came for our VTT team!”
He thanked Director Basker and Mala for joining and serving as volunteers for three days. “Basker suggested we give them a permanent gift and our team has offered to set up a dental department there,” said Saboo. Once the government provides a building, “Rotary in India will provide total equipment and training for the doctors. The proposal has been given to the Madagascar authorities and we need to pursue it further.”
The next Rotary medical mission has been planned for May 5–17 at Mongolia and 17 doctors have signed up for the programme.
