Surgical Camp at Rolpa in Nepal

28 April 2015
Pic 1 map

The International Nepal Fellowship (INF) surgical camp for 2015 was held at Libang, in Rolpa in the mid- west of Nepal from 29 March - 8 April.

Head of Surgery, Associate Professor Ian Bissett and his wife Jo, were part of a surgical team of volunteers in Rolpa and escaped the ravages of the recent earthquakes that began on 25th April.

Ian had left a week earlier to return to work in Auckland, but Jo and family members were sitting in a plane on the tarmac at Kathmandu airport, waiting to depart when the earthquake struck. They were able to fly out after a delay to check the runway was useable.  

The following is a report from Ian about the recent surgical camp in Rolpa which he believed would be largely unaffected by the major earthquakes as it is well west of the epicentre. He is now on standby in case he is needed in Nepal. The INF camp team has now been deployed in Gorkha, near the epicentre of the earthquake, offering assistance to local services.

Ian writes;

Libang, the capital of Rolpa district, was the town where the Maoist insurgency was initiated and we had carried out a previous general surgical camp there in 2006. The road is now sealed and there has been major development in the area with new buildings and operating theatre for the hospital and a doctor posted there performing caesarean sections.

The surgical team included the INF camps team lead by Eka Dev Devkota assisted by Robin, Rabi, Indra, Anandi, Ganga, Prithivi, Min, and Govinder.

Image of Rolpa District Hospital Entrance
Rolpa District Hospital Entrance

The teams of visiting volunteers included; nurses - Bronwyn Taylor, Yvonne Morgan, Rachelle Phipps and Alois van Flue; ultra-sonographer - Alan Williams; anaesthetists - Maurice Lee and Neil Fergusson; general practitioners - Ian Ferrer, Al Sommerville and Gary Parkes; surgeons - Ian Bissett, Colin Wilson, and Jonathan Masters; interpreter - Jo Bissett; and observer/assistant- Mandy Masters. New Zealand, Nepal, UK and Switzerland were all represented.

The trip to Rolpa required an internal flight to Bhairawa followed by a seven hour Land Rover drive along a scenic and continuously winding road.

The next morning we got going in earnest with 150 patients being seen and surgery starting immediately on the first day and it did not let up for the week.

The camp was essentially free to the people with operations and medication costs covered by the INF Camps Programme. The extent of the work carried out is demonstrated in the ‘Numbers’ table.

 

Patients treated
1051

Patients operated

129

Major  Operations

85

Ultrasounds performed

379

Haemorrhoid banding

43

This included many ultrasound examinations which identified a very high incidence of urinary and biliary stone.

The operations included 20 cholecystectomies, 11 open renal stone removals (four of which were in children), 11 ureteroscopic procedures including lithotripsy in nine, open removal of two bladder stones and 26 hernias. Two ovarian cysts were removed one of which was acutely twisted and a mastectomy with nodal clearance for a breast cancer.

Other patients with unusual pathology included a thyroglossal cyst, a branchial arch remnant and neurofibromatosis.

Image of Patients returning for postop assessment
Patients returning for postop assessment

One really encouraging aspect was that the local medical officer, anaesthetic assistant and operating nurses were in the operating theatre and actively involved in surgery with us.

During our stay the medical officer performed a caesarean section for twins and we were also able to scrub in with him. Provision of safe caesarean section is one of the top priorities in rural Nepal and I was really heartened to see how well this was performed.

The anaesthetic assistant remained with us throughout the camp and demonstrated that he was very competent at managing spinal anaesthetics and patients under a general anaesthetic.

The highlight was the last day of the camp when all the patients who had had operations returned for follow-up. Encouragingly, there was just one wound infection (treated later) and only two minor wound haematomas, two minor wound breakdowns and four spinal related headaches as complications. A further child had persistent drainage from the renal drain which required transfer to Pokhara for further observation to ensure the leakage stopped.

 

Ureteroscopy meant patients avoided open surgery
Ureteroscopy meant patients avoided open surgery

One of the most difficult things was to have so many people that we could have helped still untreated at the end of the camp.

We could advise them where they could go for treatment and invite them to our camp next year, but some needed surgery sooner than that and had little resources for travel and management at another site.

 

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The success of every camp relies on the skills and hard work of the INF camps staff.

They are the real heroes of these endeavours. They ensure that everything is in place and ready for use before the patients arrive each day and keep working well after the last operation is finished.

They deserve a big thank you for their dedication. Libang town is the district capital but the only flat ground for the hospital was 3 km down the hill meaning we had a good walk before and after work each day.

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The team after the final ceremony provided by the medical superintendent