A cultural and medical 'mission:' Seventeen volunteers from John
Muir Health in Concord spend productive week at Indian hospital
By Lou Fancher
A 14-year-old girl with a leaky heart and a 10-year-old with a faulty heart valve today run free and easy in Vijayawada, Andhra Pradesh, India, thanks to the big-heartedness of 17 medical professionals from John Muir Health in Concord.
Led in January by surgeon Ramesh Veeragandham on a cardiac surgical mission to this largely Hindu, Telegu-speaking community Westerners rarely visit, the team included surgeons, anesthesiologists, a physical therapist, operating room and intensive-care nurses, perfusionists and surgical and physician assistants.
Coordinating the team -- all volunteers paying their own way -- and the equipment they would need at the 750-bed NRI Hospital opened 10 years ago was no small feat.
"We were there 5 1/2 days and did 16 open-heart surgeries and one vascular surgery," Dr. Veeragandham said, as if the paperwork, native guides, translators, and cultural sensitivity necessary for a medical mission were not adequately impressive.
Veeragandham is the first in his family to leave his native India, and said the country's medical system includes many patients without insurance that must pay out-of-pocket for medicine and treatment. To provide universal health care for the country's billion people -- roughly one-seventh of the entire world's population -- is nearly unimaginable. Untreated rheumatic heart disease (resulting from what is known as strep in America) is a prevalent condition. The effects of the problem leave patients malnourished, unable to breathe and suffering debilitating disabilities.
The demand far outpaces the capacity of the local doctors,Veeragandham said. "The wait list and need for surgery is enormous."
Veeragandham said the mission's goal was not only to transform the lives of the 17 patients, but to train local surgeons to care for hundreds of future heart valve patients.
"They saw firsthand the importance of a team approach and how patients with the most complex problems can be taken care of seamlessly," he said.
The American team demonstrated procedures that had never before been performed at the NRI Hospital, and also learned a few things themselves.
"We were humbled to see how much work the Indian team does with minimal resources," Veeragandham said. "As the patients in India have to pay out-of-pocket, the team is very careful not to waste even a single thing."
Susan Kell, a nurse traveling as part of the ICU team, said the nurses and doctors know the price of everything from a pen to a roll of tape to medication.
"There is zero waste. I so admire how much they accomplish with so little," she said.
Arriving with suitcases packed with stethoscopes, monitors, pacemakers, surgical tape, masks, gloves, shoe covers and more, Kell says a Fast Facts binder with critical-care information served as a teaching tool. But caution was also a vital part of the visiting team's approach.
"If you come into a situation thinking, 'I'm here to show you the right way to do things,' you are definitely in for a surprise, and probably not a pleasant one," Kell said. "But if you are genuinely curious and there to learn and share as well as to teach, you'll end up having a great experience. It took me a week to realize that any answer other than 'yes' actually means 'no.'"
Kell and her colleagues also grew to accept the "flip flops" shoe policy. No street shoes were allowed in the operating room, only flip flops. Stepping into the ICU, everyone stands on a towel to have their feet sanitized, then dons specific ICU flip flops, or goes barefoot.
"I had no problem going barefoot in the ICU but it was hard on our OR staff -- such a dramatic change from our norm," Kell said.
Hospital staff also performed most procedures and patient care without gloves. Even with good hand-washing, Kell said going glove-less was "shocking" and "kind of like getting into a car without seat belts."
The Internet and ease of global communication is allowing the John Muir team to stay connected with the nurses, doctors and patients at NRI Hospital.
Veeragandham reflected on the elements that make the team's supreme effort a success.
"Most of what you do in the operating room should have a long-lasting result," he said. "If you take a car to a good repair shop, it should have a long-standing result. We were in touch with the local team after we came back to make sure all of the patients who underwent surgery are doing well and were discharged without any problems."
There are no specific plans for the team to return. But Kell said she would return "in a heartbeat," and Veeragandham said it was "a moving experience and everyone wants to do it again."