WITH BRINOS [2010, 2011 and 2013]
कान ऑपरेशन शिविर


Humanitarian medical missions give surgeon, doctors, ODP, nurses, and other allied healthcare workers the opportunity to help people in need and bring hope to the three billion people throughout the world who live without basic healthcare services. I was extremely fortunate to join the 2013 Britain-Nepal Otology Service (BRINOS) Ear Surgery Camp held during 15 to 29 Nov 2013 in Nepal along with Group Captain John Skipper. For the purpose of this article, written consent to publication of all clinical and non-clinical pictures of each individual patient was obtained prior to their surgery.

BRINOS is an organisation established in 1988 by Neil Weir, Consultant ENT Surgeon with the aim of “Prevention of Deafness and Promotion and Conservation of Hearing in Nepal”. A 1991 survey had marked out that 16.6% of the Nepalese population suffers from hearing disability; this proportion is among the highest in the South East Asia region. Sadly, 55.2% of the population diagnosed with deafness belongs to the school going age group. 61% of those aware that they had ear disease had never even attended a health post, let alone a doctor. In a quarter of a century, BRINOS has treated over a staggering 80,000 patients and examined close to 100,000 school children with the aim of alleviating deafness and ear disease, and has recently held its 52nd camp in the southwestern region of Nepalgunj. Despite operating in a low resource setting, the charity achieves patient outcomes that meet international standards.

Our expedition took place in November 2013 and lasted 9 days with four days for travel and rest. Our team from the UK consisted of 3 ENT surgeons, an anaesthetist, myself as an ODP and 1 scrub nurse. Each participant’s role was vital to the mission and the team soon became efficient.

My own role as an ODP put me into the challenging position of working in the multi-disciplinary operating theatre as an anaesthetic, scrub and recovery practitioner, and more importantly managing the theatre lists.

Providing medical service for people who are in dire need of medical attention, across the world is very important. The aims of the medical expedition are to provide an advanced primary ear care service, reaching out to the greatest possible number of ear disease sufferers living in rural areas of Nepal who have minimal access to primary or secondary health care.

On 15th November 2013, months of preparation and email contact had come to an end when the BRINOS team for the mission to Nepal assembled in London’s Heathrow airport in anticipation of an exciting adventure. We all travelled light as each volunteer carried one box of medical supplies and equipment in addition to their own personal luggage. After a long flight with one stop in New Delhi, we arrived on Saturday morning at the Tribhuvan International Airport, located in the centre of the Kathmandu Valley.

After spending a day exploring Kathmandu, the team then took a domestic flight to Nepalgunj.

The trip from the airport to the small town of Nepalgunj was an eye opening. We saw tiny villages scattered amongst lush green countryside. Small children running around in near-nothing, women dressed beautifully in traditional clothing of the most captivating colours, people riding on horse carts, buffalo carts and bicycles.

Prior to our arrival in Nepal, the cases had been screened by the Community Ear Assistants trained and supported by BRINOS. Each evening the ENT surgeons would examine and confirm the diagnosis and treatment plan for the following day’s surgery.

The surgical experiences during this humanitarian mission were different in many ways from typical NHS standards. There were 3 operating tables running simultaneously, out of which two were used for local anaesthetic procedures and one for general anaesthetic for major surgery and paediatric cases. The biggest challenge was the intermittent nature of the power supply. The only air regulating system in the operating theatres were two large fans which kept the temperature at bearable levels.

The operating lists were tightly scheduled but thanks to a very good organisation of work in the operating theatres we had no problems with performing all procedures smoothly. A majority of the cases involves repair of ear drum perforations (myringoplasty), eradication of potentially serious middle ear disease (mastoidectomy) and restoration of the hearing for those suffering with a condition known as otosclerosis (stapedectomy). These operations undoubtedly made quite an impact on the lives of these patients and their families, contributing to an alleviation of symptoms such as deafness and discharging ears and repeated infections. Patients stay in hospital for two days and aftercare is undertaken by the primary ear care team.

As an ODP, I would often carry out perioperative check, assist the anaesthetist for induction of general anaesthesia, prep the patient, prepare the surgical instruments, assist the surgeon and then recover the patient in Post Anaesthetic Care Unit. I was also responsible for sterilisation of surgical equipment used during the camp.

Over the course of 2 weeks the surgical team performed 117 major surgical procedures with 100% discharge in 48 hours with no medical complications. In addition, on the last day, grommets operations were performed on children using ketamine anaesthesia, a common, safe, anaesthetic in developing countries, but very rarely used in the UK.

The surgical experiences and a patient’s own journey during this mission were different in many ways from typical NHS standards in the UK. Many of our patients had waited years to be able to have their surgeries, often experiencing pain or discomfort due to infection. Most suffered in silence. One of the most compelling stories I have encountered during this mission was of a 7 year old boy named Bibek with chronic otitis media who was suffering from severe hearing loss. This boy was so ashamed of his hearing that he very seldom left his home. The other children called him “deaf”, and when he did go outside, he goes with his parents. His family was devasted and had long given up hope for possible treatment due to lack of money and health post in their local community. With encouragement from Nepalese Community Ear Assistants trained by BRINOS, Bibek and his father travelled 3 days by foot to get to the ear camp in hopes of a new life. And thanks to BRINOS and a host of other sponsors, Bibek now smiles every day, holds his head high, and graciously shares his reality of the ‘gift of life’.

Like Bibek, the distance that patients travelled to receive treatment at Nepalgunj was testament to years of Mr. Neir’s hard work, the establishment of the BRINOS medical mission, and the previous teams’ legacy in running the camp successfully.

On our last day in Nepalgunj, each member of the team was rewarded with a traditional Nepalese scarf ‘khata’ and letter of appreciation. We were reminded that we had been absorbed into the hearts and minds of both the hospital staff and local community.

I can honestly say that the experience of operating solidly for 11 to 12 hours each day, in an environment subject to power cuts, poor lighting, a lack of running water and frequently defective equipment has been the most rewarding of my career to date! Overall the experience was a masterclass in how to run an efficient theatre in a resource-poor setting and proved just how much can be achieved with relatively few staff and resources.

On our last day in Kathmandu, a group of us went to a local community school to teach students about ear disease, health and hygiene. The students were extremely humble and enthusiastic, and were very happy to have conversations with us. A very ceremonial and emotional finish to our humanitarian mission was a visit to Buddhist monastery in Boudhanath where our team was blessed by the Abbott the Venerable Chusang Rinpoche (5th Reincarnated Buddhist Monk). And after this successful mission, the UK team travelled back to London.

Humanitarian work is the seed that helps germinate a communal attitude of sharing and serving others. Through this concept, each individual's contributions will make a difference, one person at a time. The gratification and rewards I’ve experienced from participating in these endeavours have had an overwhelming effect on my life. It is an eye-opening, life-changing experience. Completely changing the course of a patient’s life, including Bibek’s, in 2-3 hours surgery should be an inspiration enough for anyone.

Our recent humanitarian medical mission in Nepal was nominated for various categories in the British Medical Journal Award Ceremony 2013. Described as “exceptional” by the judges, the BRINOS team were praised for “going beyond the normal expectations of clinical practice” and went on to win the BMJ Surgical Team of the Year 2013, and also the most prestigious BMJ Medical Team of the Year 2013. Both myself, and Group Captain Skipper had the privilege of receiving the most prestigious award in medical field on behalf of BRINOS with our colleague Mr. Angus Waddell, ENT Consultant.

I had the privilege of taking part in three medical mission representing Britain-Nepal Otology Service and Army Medical Services in the year 2010, 2011 and 2013. On that note, I would like to thank BRINOS for inviting me on this trip. The great success of this mission was mainly possible because of the distinguished capacity for team work of every volunteer who worked tirelessly to provide the best possible care to the people of my beloved country Nepal.