Local hand experts treat the injured, deformed in Nepal

It wasn't long after Dr. James Higgins became chief of the Curtis National Hand Center at Union Memorial Hospital last January that he answered a call from Operation Smile, the Norfolk-based humanitarian group that provides free surgery for needy children with facial deformities.

He already knew Dr. Randy Sherman, the group's chief medical officer. Sherman was a visiting professor at a school where Higgins studied. But this conversation would prove more life changing for him – and dozens of people in Nepal.

"They wanted to expand their services to include hand surgery," Higgins said. "Any time you go around the globe you'll always find hand problems."

Operation Smile focuses on children with cleft lips and palates. But over time and geography the plastic and reconstructive surgeons who work with the group identified other, related needs that had to be addressed. They recruited burn experts. And the newest focus is on hands.

Many of those in Nepal with hand deformities and injuries had gone without any attention, Higgins learned. The afflicted often could not work or even hold their children.

Higgins assembled equipment and a team from MedStar, parent organization for Union Memorial: Dr. Ken Means, hand surgeon; Dr. Bob Andrews, anesthesiologist; Annlee Jackson, operating room nurse; and Rajani Sharma-Abbott, certified hand therapist.

They have just returned from their first trip to Nepal, where they screened more than 150 people, performed 33 surgeries and offered therapy to 25 more in a week, at Patan Hospital in Kathmandu.

"Hand sub-specialty doesn't exist in Nepal," Higgins said. "Mostly we saw fractures that went untreated. Some had elbows stuck in one position for years."

The hand is a complex mix of bones, soft tissue, nerves, arteries and tendons. Doctors that don't know enough are often hesitant to treat such anatomy or don't do so properly, Higgins said.

The hand team offered lessons to medical staff from around the South Asian country so eventually they should be able to offer technical care themselves. About 100 came to the hospital eager to absorb what they could, and some Patan doctors also scrubbed in for surgery.

Sharma-Abbott, the hand therapist, said many patients were grateful even if they couldn't do much to help because no one had ever tried before. She did send many home with braces and strengthening exercises, or techniques to reduce pain, improve function or, in the case of those with arthritis, to protect the joints. After surgery, she taught patients about wound care and hygiene.

She and the others plan to return for the next several years to treat patients and train workers.

"Nepal has such a need for orthopedic rehabilitation," said Sharma-Abbot, who was recruited for the team as a therapist but also served as a cultural and language liaison.

"I feel like all my training and hard work was for that one week," she said. "Each patient had a story, and every story was kind of like, for us Westerners, a devastatingly touching story."

Operation Smile's Sherman, also vice chairman of the department of surgery at Cedars-Sinai Medical Center in Los Angeles, said recruiting top medical staffers to Operation Smile is a top priority. And that now includes face, burn and hand specialists – and in the future, possibly other experts.

"It's a sensational group of individuals, and they add profoundly to what we do," Sherman said of the hand team. "The demand is immeasurably large. The problem you have is deciding what measured response you're going to give because there's always going to be more need."

Higgins is now looking for more hand specialists. The team's next stop: Malawi.



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