Drama in Theatre:

Camp 3, Mid-Western Nepal:

Day #3. 6:30pm, Operating Theatre:

It will be dark soon. The power is sure to go out at any minute and we’ll have no light. To have any chance of completing this operation we’ll need the hand-held torches.

This is our fifth and final operation for the  day. Our  team of volunteers must be as weary as I am. For the past two hours we’ve been operating on a woman named Dilli. Dilli is 28 years old, and a mother of four young children. Like almost all of our patients, she suffers from severe genital prolapse. We’ve only known Dilli for the 48 hours leading up to her surgery today, but during this time she’s won enormous respect from our surgical team with her resilience and grace in the face of her dreadful affliction.

Four years earlier, Dilli’s bladder, bowel and uterus burst through her vaginal entrance and sat painfully between her upper thighs. She has been incontinent of urine every day now for three years. Sexual intercourse has been impossible. A year ago, ulcers appeared over the mass of prolapsed tissue, and in recent months the ulcers have often become infected.

We can fix this woman. We can get rid of this fetid mass and put her bladder and bowel back where they belong. We can take away her chronic pain and stop her incontinence. We can restore her sexual function. We can restore her dignity.

We just need more light …

6:52pm
The lights go out.

Ah, the Nepalese electrical grid-sharing system – on days like these it seems to deliberately challenge our surgical camps.

Our team members find every conceivable source of light to shine into our deep, dark operating field. They struggle to find the best angle to hold the battery-powered lights. These lights are getting dim. Despite months of planning we usually neglect one thing or another on our camps. This time it’s the torch batteries. How could we miss that?

As the light gradually fades, it’s a race against time to finish this operation. This is becoming dangerous. There is bleeding – there is always some bleeding – but this is heavier than usual,and in the dimming light I struggle to see the source of the blood loss. In a desperate effort to improve my view of the convoluted web of blood vessels and nerves and ligaments, I ask for immediate suction to quickly clear the blood from the area. But I’m reminded that the suction machine also relies on electrical power; we will have no suction until the power returns, and this will be at least another hour. Swabs will have to do.

We continue to apply pressure and mop up the blood in an effort to find the source of this bleeding. An hour ago we ran out of standard surgical swabs. We’ve  improvised with  pieces of drapes that  our resourceful nurses have cut into small squares.

Despite every effort, things go from bad to worse as the volume of blood loss escalates. It becomes clear that the situation is now critical. Dilli’s blood pressure begins to fall in response. At home we would transfuse this woman immediately, but here we work with limited facilities. The nearest blood bank is in Pokhara – nine hours away. The theatre team are silent as they grasp the gravity of the situation. We are now at crisis point.

We use our hands to apply pressure to the general area of bleeding. This settles the blood loss temporarily, long enough to allow us to catch our breath, to think.

‘What is this woman’s blood type?’ I ask.

Mack, our anaesthetist replies. ‘B Positive. But, Ray, you know we have no blood bank.’

Drama  in Theatre: Part  I

B Positive is an uncommon blood group. I realise that our chances of finding a match are even smaller.

‘Alright,’ I say, my heart in my mouth, ‘who else in this room has the blood type B Positive?’

Fazi, a junior Nepalese doctor with a soft, gentle voice says, ‘I am blood type B Positive.’

‘Have you been screened recently for HIV and hepatitis B and C?’

‘I have, and I am negative for these viruses.’

‘Then I need to ask for a very big gift from you. We need you to donate a litre of your blood to transfuse directly into this woman. It will possibly save her life.’

Fazi does not hesitate; she appears proud that she can play a crucial part in helping this woman. Our team quickly arrange another table in theatre next to our bleeding patient, and Fazi lays down next to her. Within 10 minutes, precious, whole blood is flowing from Fazi to Dilli. We have a reprieve.

Paul – our ever-reliable theatre aid – remembers that his mobile phone still has some charge. He  moves to an area above my right shoulder, points his phone towards the operating field, and turns on the torch function. Light – gorgeous, dazzling, radiant light!

We quickly see the haemorrhaging pelvic vessels and suture these tightly to arrest the bleeding. After another 30 minutes we complete this demanding operation.

Despite the struggles and the near disaster during the surgery, Dilli will recover completely.

The  team  have been  fantastic. The  conditions  here  are  really challenging. Our camp is on the edge of a mountain in the foothills of the spectacular Himalayas. And it’s cold – really cold – and it will get even colder when that sun disappears in a few minutes. But no one in the team complains. It’s something I notice on each of the camps we have run to date: the harsher the conditions, the greater the resilience, and the stronger the bond between the team members. A wonderful camaraderie develops with these volunteer adventures.

Is it the shared burden? Is it the simple joy we all get from making a difference to the abysmal lives of these underprivileged women? I guess it’s a combination of the two.

At dinner tonight we’ll all crowd together in the Dining Hall to suck in every bit of heat from the ridiculously small potbelly stove that will do its best to warm our cold, weary bodies. And like nearly every night here, we’ll be exhausted, but content.

And yet…

After dinner as we all sit there huddled together, I watch that tiny stove as it struggles with the  impossible task of heating the huge room to anything near a comfortable temperature. But this will never happen; the natural elements are far too overpowering for this pintsized potbelly.

As I  stare into  the  small flames, the  stove takes on  a bizarre, distorted human form. I know this stove. I know its twisted, writhing face. And I understand the reasons it squirms and spits and contorts. We are brothers, this stove and I. We both struggle in grossly one- sided battles. The number of women enduring appallingly poor health in Nepal is immense. Despite the valiant attempts of our organisation, I wonder if we can really make a major difference to the overwhelming numbers of women suffering in this beautiful, desperate country

Most of the team have gone off to bed. The only two team members who remain in the room are Louise and I, and we sit together in the dim, flickering light of the dying embers. Shadows dance off the walls of the Dining Hall, bringing the room alive as if all of the volunteers were still here, animated but silent.

Louise is a midwife, a registered nurse, a leader in our team, and a wonderfully wise and loyal friend. ‘Okay, Ray,’ she says. ‘Want to tell me what’s bothering you?’

I give an uneasy sigh. ‘We’re not making inroads, Lu Lu. There is so much prolapse here. I know it’s only our first camp in this part of Nepal, but we’re not even scratching the surface.’

‘But, Ray, you know there’s only so much we can do. We’re treating as many women as we possibly can each day, and we’re transforming their lives.’

The problem is that  when we leave this camp we’ll also leave behind hundreds of women we’ve been unable to treat. There’s simply nowhere near enough time or resources to treat the enormous numbers of women suffering from genital prolapse in this country.

We want to feel like we’ve made a big difference here – we all do. But on our final day here when we’re packing up to leave, I know it will be just like the end of our other camps: there’ll be so many untreated women with faces of forlorn hope. And just like the other camps, their wretched looks will weigh on us, long after we’ve returned home. We all get the joy and fulfilment from improving the lives of the women we treat, but too often this is eclipsed by the despair of the women we can’t help.

‘Lu Lu,’ I say, ‘it’s not only that. We nearly lost a patient today. This is elective surgery; this is not emergency surgery. What  went wrong today with Dilli was almost fatal, and it was entirely preventable. Obviously I take responsibility for the near miss, but we’ve got to do everything we can to make sure these mistakes never happen again. Batteries – can you believe it? Batteries, for God’s sake!’

Louise begins to speak, but I cut her off – I’m on a roll now.
‘I get the buzz, too, Lu Lu; I get that sense of exhilaration when we manage to fix these women who’ve suffered so much. But whenever I look at the bigger picture I feel we’re not really helping at all. How many women do we treat on each of these camps – 40 or 50? By the time we return to this part of Nepal next year there’ll be at least another hundred women here with prolapse. We’re going backwards. There has to be another way.’

Louise responds in her reassuring style. ‘Ray, you’re way too hard on yourself. It’s wrong to overlook the colossal effects we’re having on so many women. Most of these women were destitute before we came along. Just think how many women would still be suffering if we weren’t running these camps.’

But Louise’s words of encouragement sound distant, and I sense in her that she, too, has some doubts. Even though our days are full and our resources are stretched, we can surely do more, and do it better.