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!