Plastic surgeons bring hope to poor

A team of leading specialist plastic surgeons offer free services at medical camp in Indian town.

CHALISGAON, INDIA // Splayed out on a hospital trolley, Tarannum Bano let out a scream. A man in a surgical gown and mask leaned over her, peered into her eyes and soothingly assured: "You won't feel a thing." He wheeled her into a makeshift operating room, where, amid the whine of a table fan and the cloying smell of antiseptics, the 13-year-old got a new lease of life.

A pigmented lesion on her upper left cheek had made her an outcast at school, but with corrective surgery, a happier childhood would be likely. Earlier this summer, a team of doctors travelled to Chalisgaon, a rundown town 350km north-east of Mumbai. All specialist plastic surgeons, the big-city doctors took time out of their well-established medical practices to offer their services in a free, two-day medical camp organised by India's Rotary Club.

In the blistering heat, hundreds of people from neighbouring villages spilled into the clinic, which for two days came to resemble a field hospital. Most of them were poor villagers, some with misshapen limbs and debilitating burn injuries, and many others with scars and cysts. Many had lived with these maladies and deformities all their lives, learning to embrace the pain. Like most rural areas, there were few hospitals and medical centres in their villages.

In this country of 1.17 billion, there is only one doctor for every 10,000 people, according to India's Planning Commission. India faces a shortfall of nearly 600,000 doctors and about a million nurses. Most rural Indians have no medical insurance and a visit to a city for treatment would mean forfeiting a year's salary. This rare medical camp promised to change their lives forever. Besieged by an overwhelming number of patients who needed surgery, the doctors conducted a preliminary examination to sort out their selection to a manageable number, taking on cases urgently in need of treatment.

Outside the examination room, people stood in a heaving queue, pushing and shoving, while some yelled obscenities at those who tried to jump the queue. "You're next," a camp volunteer said over a scratchy public address system. "Come on, hurry up. These doctors have come a long way and won't wait all day." "Surgery is the simple part," said Dr Shankar Srinivasan, one of the volunteering surgeons from Mumbai. He said choosing which patients to operate on was more difficult than the operations.

Dr Pankaj Jindal, a hand surgeon from Pune, had a specific criteria to pick those he would perform surgery on. "Female child, male child, female adult, male adult," he declared. "That's my order of preference." "Girls are unwanted, neglected in this country," he said. "If unfit or deformed, they become even more unwanted." For three hours, cases were examined, some were set aside for surgery, a few turned away because their deformities did not warrant surgery, while others were urged to seek treatment in a city hospital because their surgeries would be too complex to handle in a field hospital.

But some complicated cases just could not be turned away. A woman with mentosternal contracture - a condition in which the skin of the jaw gets pinned to the chest - was put high up on the list. The woman, a burn patient, had been like that for years. A man with complex syndactyly - a congenital anomaly of the hand in which finger bones are fused together - also warranted special consideration. And so did a man with a sebaceous cyst - a large protruding lump on the head due to swollen hair follicles.

Two makeshift operating rooms were set up. "In a city hospital, you have a full entourage of assistants, scrub nurses and anaesthetics," Dr Srinivasan said. "Here you're pretty much pushed into the wilderness and told to operate." Power outages were frequent, as the surgeons toiled in the heat. When Tarunnum's turn came, her father, Sheikh Raies, waited outside the operating room, wringing his hands nervously.

"If she were a boy, the [lesion] could wait," said Mr Raies, 33, a taxi driver. "But there's no hope she'll ever get married if she doesn't get rid of it. Our marriage market is funny. "Who'll want to marry a girl with an ugly lesion on her face, no matter how talented she is?" A couple of hours later, an assistant emerged and supplanted Mr Raies's pessimism with hope. "Your daughter will never be teased again," he told him.

Later that evening, after a gruelling day in the operating room, the surgeons reconvened for dinner in a local dhaba. Dining on kebabs, they appreciated the nobility of their endeavour, but launched into a scalding critique of the poor medical infrastructure at the camp, a world apart from what they are accustomed to in cities. "There were shortcomings," acknowledged a local volunteer who helped organise the camp.

"But please," he implored the surgeons, "don't let the good work stop. These people really need you." [e-mail]