Thursday, April 12, 2012

Single incision laparoscopy in a mission hospital

Recently, I was talking to a friend who was concerned he may have to go to a mission hospital to work for a short time. He said, that it was a dead-end and he would lose out a lot professionally. I have often come across people who are worried about working in a mission hospital for a variety of reasons and a long time ago, (when I was blogging regularly!!), I had started a post on why I loved working in a mission hospital. However, it got rather too long and personal and so it never saw the light of day. So this time, I thought that instead of putting down all the benefits of life and work in a mission hospital in one long, wearisome post, I would address the fears people have one by one in different posts (if and when I get the time and mental space to write them!). I hope you will forgive me for using my own experiences most of the time. Please do add on your own experiences in the comments and other reasons which I can touch upon in later posts.

One of the biggest worries I discern from bright young doctors who are thinking of working in a mission hospital is what my friend shared with me - that professionally there is nothing stimulating about mission hospital work and everyone ends up doing primary health care and treating coughs and colds. Now of course, that is also important, especially if we are trying to see every patient as the image of God, but it is not completely true. In fact, mission hospitals provide a great opportunity for the committed and innovative doctor to improve greatly rather than decay professionally.

One example is the technique that we developed in Shillong of doing single incision laparoscopic surgery (SILS). This simply means doing laparoscopic surgery through a single incision rather than the 3 or 4 that are usually used. The main advantage of the procedure is the lack of a visible scar if well done. The procedure is not very commonly done in India even in the larger centres. However, with the large volumes of laparoscopic cholecystectomies that we had there in Shillong, it seemed a natural progression to try the technique. The problem was that the equipment required was rather expensive and we could not justify using disposable instruments and ports that costed many thousands of rupees. Over the course of the next two years, the surgical team at Shillong developed a technique that did not involve any additional cost over a conventional laparoscopic cholecystectomy or appendicectomy. With more or less similar results as you can see from this picture taken immediately after the operation.

Out here in Ludhiana, the procedure, which was not being done previously, is now being adopted by more and more surgeons. While the expensive ports are now available here, surprisingly, it is the 'Shillong technique' that seems to be catching on. So when I heard my friend say that he feared professional suicide by going to work in the mission hospital, I had to differ with him. The number of techniques that have been developed by physicians and surgeons in mission hospitals that I have witnessed myself, are too many to be listed here. Of course, very often they do not become well known, as they remain within the confines of the hospital. But for someone who is interested in academic and professional development, a mission hospital is sometimes better than an established set-up where anything new requires a lot of time, persuasion and approval of seniors. So if you are considering your future, do not be fooled into thinking that a mission hospital is a place for those who could not make it in the outside world. I can truly say that my time in Shillong (and earlier in Jharkhand as well) were times of extreme professional growth and satisfaction. The SILS techniques was just one of the exciting things that happened!

19 comments:

  1. This comment has been removed by the author.

    ReplyDelete
  2. Arpit, I do agree with you. Mission hospitals are the best place to learn a lot of new skills. I too, was very unhappy about having to do a bond in Kerala and did not want to leave the confines of CMC. But now looking back, the 2 years at Codacal (in Kerala) was probably the time I saw immense growth in my skills. Being a physiotherapist, I learned so much with regard to critical care and rehabilitation, that it put me ahead of my peers when i did my specialisation in cardiopulmonary physiotherapy.

    A lot of things we do in mission hospitals do not get the recognition we want at that point of time. But a lof of times, you do hear from your juniors who take over from you about the impact your presence has made for the community.

    Many people believe that in a mission hospital, there is no scope for any growth. Similar to the Shillong technique, I had the opportunity to develop rehabilitation programs for our patients with severe cardiopulmonary disorders. The good part was that we were able to publish our results and we currently have about 5 papers published in PubMed indexed journals from our mission hospital!

    For those of you preparing for you bond, believe me...it is scary at first, but the experience you have truly carries you a long way! I must say that your work in a mission hospital always gives you the ability to work with limited resources and still provide the best possible care for your patient.

    Stay true to your calling and you will see that you are able to care for people and show the love of God to all those around you (even when it is sometimes very hard!)

    ReplyDelete
    Replies
    1. Abraham, good to hear from you! And thanks for sharing - that is really impressive and gives me an idea for my next post, whenever that may be - research! Looking forward to hearing more great things from you. Thanks!

      Delete
  3. Amazing the visit was worth…
    chennaiflowerplaza.com

    ReplyDelete
  4. It is so amazing and good...
    Gurgaonflowerplaza.com

    ReplyDelete
  5. Really I appreciate the effort you made to share the knowledge on laparascopic surgery,How does a doctor preform a laparascopy? I read there can be more than one incision but are very small- like around 2 inches.

    ReplyDelete
  6. Good one...
    http://www.gujaratonnet.com

    ReplyDelete
  7. Arpit, nice to see that your blogging has revived. We need to document such innovations. You may know that Dr Denis Burkitt after whom Burkitt's Lymphoma is named was also serving at a mission hospital.

    ReplyDelete
  8. It was a good experience to read the articles and contents on this site.
    http://www.deccansojourn.com

    ReplyDelete
  9. Hey Arpit it is true we don't realise the blessing it is to work in smaller setups. the autonomy we have in trying out new things is precious. I believe in creating a shift among all doctors towards semi urban and rural India as the preferred place for practice. With communications improving (skype, Mobiles,internet etc.) and better availability for articles for daily living I believe health professionals will prefer semi urban to rural India to start hospitals.
    The Myth of it being a sacrifice needs to be culled. Land is cheaper, labour free, full autonomy,among the few educated elite of the society and as for family they can come move in too ;-)

    ReplyDelete
  10. Hey Arpit, I'm glad that you wrote this . I hope people read this and actually get also an opportunity to see for themselves. Personally I'm a mission guy...dunno if you remember me but I'm that guy who works with Dr. Sunil Jiwanmall at Christian Hospital, Bissamcuttack....I leanrnt all my surgery here and I can vouch for what you have said......I'm glad there are still people who support this theory.....it made a surgeon out of me.....how can I disagree.....

    ReplyDelete
  11. The said post here is very informative. I am impressed as to the ways in which the author delivered the message to us readers. I am curious as to the details and have read and got my answers to my query. It is nice to know that this one here really exist. I would love to track your future posts.
    laparoscopy operation

    ReplyDelete
  12. Laparoscopic surgeryJuly 31, 2012 at 12:31 PM

    S..... Hospital is one of best hospitals in India providing world class laparoscopy, minimally invasive, laparoscopic surgery treatment by best laparoscopic surgeon in Mumbai.
    (sorry, this sort of advertisement, doesn't seem to go with the tone of the blog so I modified it. My apologies, Arpit)

    ReplyDelete
  13. I really appreciate the efforts you have put in your blog. Its very effective and informative blog. Thanks for sharing your information.
    Pediatric Laparoscopic Surgeon

    ReplyDelete
  14. Send flowers to Pune, flowers to Pune delivery,flowers to Pune, Pune flowers delivery, flowers Pune, Online flowers to Pune.

    ReplyDelete
  15. Send cakes to chennai, cakes to chennai, cakes to chennai delivery, cakes home delivery to chennai, buy, online, same day, cake delivery to chennai

    ReplyDelete
  16. Flowers to Bangalore; send flowers online to Bangalore and buy Birthday flowers, wedding flowers, Anniversary flowers, condolence and sympathy flowers, send same day flowers to Bangalore online with us. Buy flowers online for same day delivery in Bangalore.

    ReplyDelete

  17. Thanks for sharing the blog it is very important and interesting topic in which peoples are receiving great information and very helpful in the health care.

    Best Gynaecologist
    Infertility specialists

    ReplyDelete