Experiences of Orthopaedic Camp in a Mobile Surgical Unit (Life Line Express) in Central Part of India

Abstract We present our experience organizing an orthopaedic camp in rural part of India in a mobile surgical unit (Life Line Express) on a train. The camp was held for 15 days from 25th may to 10th June 2009. We performed deformity correction surgeries; corrective plaster castings and follow up the cases for the next six month. We assess the pros and cons of this orthopaedic camp on a train where minor and major procedures were carried out.


Discussion
The goal of every medical mission is to fulfil a child's greatest wish: THE CHANCE TO BE NORMAL 2Their unique and successful medical mission model is the foundation for providing safe surgeries for children around the world and building a long-term sustainable solution. Every year 35,000 children in India are born with clefts -a gap in the upper lip and/or palate. Though completely treatable, less than half get the treatment they desperately need -only because they are too poor.2Without corrective surgery, these children are condemned to a lifetime of isolation and suffering. Department of orthpaedic Jaipur4has mobile surgical unit. They are conducting for physically challenged people lot of patients come to the camp and benefited, this shows .They are doing various surgeries such as PMSTR, muscle the trust people have in MSU. Moreover a totally free and release ,tendon transfer, osteotomies for polio corrective smooth service of MSU attracts patients naturally. operations, Osteotomies for varus ,valgus and recurvatum deformities of knee Z-plasty for flexion contractures of Dr Rahul Khare, Dr AK Agarwal, Dr Ratnesh Kumar, finger , Excision of accessory fingers in polydactyl , Slab or (2004)6 studied Twenty two surgical polio camps were caste application for acute fracture cases , Excision of organized in 8 districts of Uttar Pradesh and Madhya ganglion.
Pradesh from January 2000 to May 2006. Over 8000 children were screened, and three groups were made for It is a frequently asked question that in the physiotherapy, calipers and those who needed surgical present circumstances whether MSU5 is required or not, correction for their deformities. 3370 patients were Some people think that nowadays medical facilities are so advised physiotherapy, 2920 were given calipers while improved that utility of MSU is doubtful such views shows 1250 patients were operated. By and large bony operations their ignorance about ground realities in countryside area.
were avoided. 96 % of cases had full correction of Only attending a camp of MSU can answer their question deformities and only 4 % of cases needed further .In every camp of MSU a huge number of patients comes to physiotherapy before fitting of orthoses. Such the camp irrespective of the place, some of the camps are rehabilitative surgical polio camps offer a ray of hope for organized over district headquarters or tehsils where these illiterate, ignorant and unfortunate patients to lead medical facilities are said to be good even on these places a ignorantly but as these surgeries are possible only at big centers they are not admitted hence they feel disappointed.
To conduct the operative camp of large magnitude in mobile surgical unit requires proper planning for the venue for the operations, follow ups. . In the beginning of the camp, we had organised the pre assessment camp during which the patients were examined. They were called on the camp dates. During camp dates patient were admitted, they were registered. These patients were kept in pre operative wards.
As train had come to Jabalpur this time ,which is divisional headquarter ,where medical college ,Regional Spinal Injury Centre, intensive care unit, blood banks are available ,we are able to do major and supramajor surgeries. While train was at Jabalpur we had full back from district administration.
Lifeline Express has the facility of running three operating table at a time. We had made full use of this opportunity. Lifeline Express has its permanent staffers such as the cook, technician incharge maintaining pathology lab, computers, an operating theatre assistant and a driver.
Lifeline Express has its own sterilization system in the form of autoclave .Sterilization standards of the train are excellent, very few of our cases got post operative an independent respectable life.
infection. Operative camp of such magnitude requires Publicity plays a major role in the success of the camp good infrastructure. To hold such camp, one should have so they advise organizers and government machinery of back up of tertiary health centre which we had got in the the area to reach even remote places but the most form of Medical College, Jabalpur. important thing is that over publicity is also as dangerous Consultant from our dept and Regional Spinal as lack of publicity. This means that with excessive and Injury Centre assessed the patients. They had examined unwise publicity people think that every condition will be the patients thoroughly, their deformity was assessed, and treated in the camps. It is seen that patients of valve power in the limb was checked. This really helped post replacements cardiac surgeries, tumors also come graduates to learn deformities and their management. Night before the operation, these patients were labelled with tag containing patient's name, date of operation, side of deformity. Major camps deals with problems of wrong "The rural poor people in India often slip through the gaps identification of patients, wrong side, wrong procedure, in the public health system," Lifeline Express is like a wrong casting, wrong follow-up. We had paid special magic train to them and fills that gap. The mission of attention to this problem. We ensured identification of Lifeline Express is to vanquish avoidable blindness, each patient preoperatively. Patients were given an deafness and physical handicaps. Perhaps the greatest identification tags before being transported to the train for advantage Lifeline Express has over other health services surgery and double checks were done in the OT.
for the poor is its ability to reach "the doorstep of the As day progresses sterilization status of the O.T. patient". will not be maintained. So that major surgeries should be Physically disabled is considered to be teacher done on priority at the start of each day. So that the of Orthopaedics. They teaches Orthopaedic surgeons infection rate in these case will be minimized. We found about careful examination, muscle charting, gait that instruments in Lifeline Express are excellent. We had evaluation soft tissue handling and much more found minimal hesitation while operating the patients.
.Primarily it teaches us to carefully observe and think Lifeline Express has its own sterilization system in the about the patient and effects of treatment. form of autoclave. Sterilization standards of the train are Adequate training is not available for young surgeons excellent, very few of our cases got post operative to understand and tackle the problem effectively. The infection.
camps may play important role in such problem, in which We could not find the documentary evidence of adequate training in correcting deformities can be given to follow up of operative camp. We not only carried out camp young surgeons and load of physically disabled patients successfully but we had followed the cases in systematic manner over period of six month. Some cases of supra major surgeries are followed till now. And we are getting good results. can be reduced in project wise manner.
the tertiary health care by conducting follow up in tertiary centre. But this could happen when mobile surgical unit is Surgeons comes from nearby places also to attend camps conducting camp near to tertiary health centre. There are when such surgeons get opportunity to work with mobile still hundreds of polio-affected children in need of team and with some experienced surgeons from medical surgical correction of their deformities so as to stand on colleges who also attend these camps regularly they take it their own feet. Such orthopaedic deformity correction as great opportunity to improve their skills.
camps offer a ray of hope for these illiterate, ignorant, To improve functioning of mobile surgical unit unfortunate patients to lead an independent respectable better instrumentation and latest techniques should be life. Department of Orthopaedics across the country is introduced. In addition, there should be a strong back up already over burdened with trauma patients. Physically from nearby teaching institution for necessary challenged people are neglected and do not get priority for investigations, which cannot be done in the camps. There surgery. Being poor they cannot seek corrective surgery in should be a proper publicity to avoid dissatisfaction to this private hospitals. Camps in mobile surgical unit are poor community of patients which even cannot afford.
therefore required for correcting deformities in physically To conduct the successful operative camp, it challenged people. requires proper planning and assessment camp. Preoperative assessment is must to avoid the complication like residual deformity and faulty procedures. Tertiary health system back up is necessary to conduct operative camp in mobile surgical unit and it can be a follow up centre where complication like infection can be taken care of. Preferably those surgeons operating at camp should do the follow up. One operating team of the surgeons should be posted for the follow up. Camp of this magnitude requires good infrastructure like in patients' wards, dressing room, plaster room, operating theatre.
Poor and needy people get an opportunity to have