Report: Makunda, India. November 2018
Dominique Robert, Consultant Surgeon (Head of mission)
Team : Dominique Robert, Rob Bohmer and Jurij Gorjanc
Makunda is in Bazaricherra, Assam, IndiaMakunda hospital is a missionary hospital created 25 years ago by Ann Miriam and Vijay Anand Ismael, in the southern part of Assam, near the border with Bengladesh, from a derelict dispensary to a 150 bed hospital which has now paediatric and adult intensive care, adults wards, a large maternity coping with 5000 deliveries a year and 1500 caesarean sections, 2 theatres and all the necessary equipment to run the hospital as well as a nursing school, nurses and doctors accommodation and a secondary school. Both Ann working as an anaesthetist and outpatient doctor and Vijay as a paediatrician surgeon have put a continuous and tremendous effort to achieve this. Money is coming from donations and a fee for service is charged to each patient.
The 2 theatres have 4 operating tables, air conditioning and sufficient basic equipment. The nurses are extremely proactive and efficient and craving for learning, Rob did a laparoscopic small bowel obstruction and spontaneously had 3 nurses assisting. They are all competent, smiling, easy going and want the job to be done. The lack of a permanent general surgeon is obvious but will be addressed in the coming months. Only 3 tables can be used as the fourth one is dedicated to the gynaecologists who usually perform no less than 5 sections a day.
Usually, new patients are seen directly in theatre, children arrive with their IV line in and are mainly induced with Ketamine, most adults will have a spinal anaesthesia, follow up is organised by the doctors on the wards which is a good option as very few patients speak English and there are many dialects used in Assam. You may be asked to perform an extra non hernia operation but we are guests here and it is not compulsory, small bowel obstruction, fistulas in ano and gastroscopies were added to the lists.
For the next team : 3 surgeons is enough as there are 3 tables, 2 would not be adequate as if one falls ill, the list cannot go on, 4 pointless and the hospital has to deal with plenty of emergencies and hernia patient admissions may be delayed. Bring : gloves, your own theatre outfit, caps and masks, meshes ( make sure they have at least a sterilisation date and/or a use by date written down), sutures, patients are thin so 0 or 00 stiches are sufficient, sub cutaneous skin stitches, 40% of the patients are children and anything you can as it will be used quickly. Never used before diathermy cables with a 3 pins connection are in demand. An anaesthetist would be a bonus as there is only one permanent anaesthetist David who has to deal with the emergency sections.
This part of Ass
am is quite deficient in infra structures, electricity and water supplies, there are a few small shops only in Bazaricherra where you can find only basic products. Accomodation was in Ann’s house, showers are bucket type, a new house is being built for 8 visiting doctors at a time and should be completed next year. This is a very interesting hernia mission to achieve in a poor rural area far away, it takes 4 hours minimum to drive the road from Silchar airport. This is a malaria area and prevention is recommended. There is nothing else to do if you are not in theatre.