Sunday, January 10, 2016

Sweeping leaves on a windy day

When I look at you I believe I can see the sun shine out of your eyes.

I want to believe that forever.

If I had my rathers I would choose faith over reason. I’m not sure that I get any choice in the matter and, for better or worse, it is not how I see the world. So be it: I may as well live a life informed. But it’s funny how that turned out. I’m pretty sure that for most of my childhood, and, indeed, when I was born, it was quite the other way round.

Tuesday 29 - Wednesday 30 December. The madness of the Christmas season is over but the dawn of another year awaits. With me are hand therapist, Justine, and theatre nurse, Jessica. Justine attended the camp with us last year. This is Jessica’s first trip to India. We leave Brisbane just before midnight to fly to Singapore and then on to Mumbai. Disembarking at the Mumbai International we shuttle across to the domestic terminal. The flight to Nagpur is on time and arrives in Nagpur five minutes early. It’s all too easy. The doors swoosh open and India’s humidity descends upon upon us. I remove my clothes both physically and metaphorically. The girls do the same. For exploring a new country necessarily means leaving an old one behind.

Vijay meets us at the airport. We pack our gear into Vijay’s car just as Dilip arrives by motorbike. A short while later his brother in law, Jamil, also arrives by motorbike. There is enough room in the car but the girls decide to ride into town on the back with Dilip and Jamil. They weave through the whirl of noise and colour and disappear into a landscape far away from home. They touch India and feel her breathe. She wraps her arms around them.

Dilip takes us out to dinner at a nice restaurant in Nagpur. We then head off to the apartment he bought for his mother, Usha. I ride pillion passenger with Dilip as India heaves and grinds around us, hand to horn. Eventually we arrive safely at Usha’s place excited but exhausted. Usha has prepared our rooms. We have hot water for bathing and sleep well.

Thursday 31 December.

Dilip arranges a visit to a home for the aged and handicapped in Nagpur. It is run by Christian charity. The lady in charge tells me that funding restrictions means they can only accept 80 aged people for care rather than the 100 they are equipped to manage. I ask how long the average resident stays at the home but I do not get an answer. The home also takes in orphans and rehabilitates those with significant disabilities. Justine makes splints to manage some of those with correctable or partially correctable contractures. Jess lends a hand. There is on-site schooling for children.




India was declared polio-free (no new cases for three years) in March 2014.

Solar power provides 40% of the energy requirements for the home.

The solar inverter. 

Later in the day we look for a sari for Jessica. There is an incredible range of choices but Jess is quick to pick one out with the help of Justine. She also buys bangles to match her new clothes. 


It’s a two hour drive from Nagpur to Amravati. We greet the New Year in enchanting, frenetic, incredible India in the house of Avinash. 

Friday 1 January. We drive to the camp.

Ashish and Kavita greet us warmly and show us to our rooms. We are taken through the recent addition at the centre of the campus that houses a new theatre, an intensive care unit, and an eye clinic amongst other things. For the moment it will house the postoperative patients from our camp. 

If anything, India is flexible.

The clinic starts at about 2pm and extends well into the evening.

There are many post-burn contractures (PBC) at this camp. Woodrow Wilson, a friend of Dilip’s and a professional photographer, arrives soon after the clinic starts and assumes the formal role of camp photographer. The pictures on this journal are from Jess’, Justine’s, and my camera (before I dropped it), snapped by a variety of different people. There are many gaps but you get the gist of it.

PBC with a similar deformity to the preceding case but much, much harder to treat.

PBC dorsum foot.

PBC axilla and elbow.

PBC belly and groin in a young girl presenting with an inability to walk.

The young girl seen at the clinic two years ago (PBC digits-in-palm released four years ago) 
finally gets her second release this time round.

Post-infective PIPJ of middle finger with deformity.

Amniotic band syndrome.

Scoliosis (not treated at this camp).


And a miscellany of lumps and bumps.

Saturday 2 - Tuesday 5 January. And so surgery begins. Each day starts with chai tea and sweet biscuits followed by a hearty breakfast. The theatres run efficiently with the combined effort and superlative endurance of all involved. The difference this year is the organisation of the anaesthetic team. For the first time we have the usual suspects Vijay, Nitin, and Bhupat (amongst several others) present at the same camp weaving their magic in sequence and in unison. Also in attendance are plastic surgeons Parikshit and Pawan. Gopal attends for one day to do a mastectomy for a nasty breast tumour with Parikshit closing the wound using a lat dorsi flap. The operation is quick and almost bloodless. Digambar, Parikshit’s trusty assistant, movements are precise and synchronous: his boss works not with two hands but four. 

But first we take a walk to the river.

Theatre complex: calm before the storm.

The new theatres should be up and running next year.

The theatre runs so efficiently with all hands on deck that we have remarkably few photos to show for it. 

Release of the groin PBC.
(and a good example of why we come to India - although I am familiar with Peter Singer’s work I am no convert of effective altruism)

Laying SSG. 
(perfectly fenestrated by Parikshit using nothing more than a scalpel)

Three and half days later we complete 103 cases.

Two months ago I attended a meeting where two of the foremost authorities on the dynamics of wrist movement (which is actually a bit more complex than it sounds) presented their findings based on ten years of illuminating research. They closed the meeting with one stating that, despite the progress being made, they were still two blind men feeling different parts of the same elephant. That’s funny. Because it’s true. We know more about the pathological states yet struggle to manage them in an appropriate and consistent manner. Meanwhile in various labs around the world physicists labour to reconcile the two mighty theories that underscore our observations the universe: that of quantum mechanics and general relativity. Two elements of a much bigger elephant. 

Rocket science.

..or a part of it condensed into 1200 pages.

Not rocket science.
The spiral “anti-pronation ligaments” which underscore Garcia-Elias’ rationale for a spiral tenodesis: a possible partial solution to a very specific problem. It has no relevance to our work in India. Indeed, it has limited application in the day to day activities of those where this sort of conundrum falls within a scope of practice. But it marks where we are now in our understanding of some fairly complex wrist mechanics. Not a complete solution but at least a fairly good one based on a partial understanding of the underlying issues.

Experts often despair when the tools of their trade are taken out of context and generalised by the layperson; and it’s true of fundamental physics as it is for any other discipline. The forefront of physics deals with details not puffy conjecture of a grand unified theory - although that cherry never lies far from the surface. But allow a layperson a glimpse of such insights and you provide him an opportunity to see things a little differently. Certainly when we look at the very big (cosmic scale) and the very small (subatomic scale) things get kinda weird. Maybe, one day, we will discover an ultimate truth and touch the face of God. Maybe the structure of human consciousness means that we can’t know everything.
During the five days at the camp the girls get a couple of hours to visit a local village.

Village health care worker.

And Jess gets to meet Ravi and Smita.

My head is foggy as I board the plane. This is my sixth trip to India ( and the third time in a row that I leave with a head cold that goes to my chest. I can blame Dilip on this occasion as he fell sick on the first day of operating and infected the rest of the Australian team. We go our separate ways: Jess returns to Australia to spend a weekend with her friends before returning to work; Justine goes on a trekking trip in Borneo; and Dilip flies off to Kolkata to join his family. 

I refocus my thoughts to the days and weeks that lie ahead. There is much to do. I thank India for allowing me to realise something I recognise to be rather quixotic whilst I live a life that is otherwise decidedly and preferentially quotidian. For what I have done, and what I think I can do, and my interpretation of such isn’t an addendum to the decision-making process (logical or not) but integral to it.
In an age of reason we have far more questions than answers. And, when you think about it, the things that matter most to us - the joy of a smile, or a caress, or hope, or love, or beauty - are not easily, nor necessarily, subject to reason. 

If I had my rathers I would choose faith over reason. 

When I look at you I believe the sun shines out of your eyes. 

I want to believe that forever.

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