The trip, funded largely by the Royal College of Anaesthetists and Association of Anaesthetists, was to Nepal’s main plastic surgery hospital at Kirtipur, which became a trauma centre in the wake of the first earthquake.
Joe Silsby, a consultant in anaesthesia and intensive care at Musgrove Park Hospital in Taunton, has already made several trips with the charity. He explained: “We weren’t sure what we would face when we arrived in Kirtipur, but I was fairly sure that ultrasound equipment would be helpful. We arrived a week after the first earthquake; many of the patients we saw came from remote areas where they had no immediate access to medical care following their initial injury.
"By the time they got to Kirtipur, their wounds were often badly infected, largely due to the humid and hot environment and poor sanitation, and they typically required soft tissue debridement or skin grafts. There were also ‘routine’ patients whose procedures had been put off since the disaster, simply because the whole system was under such stress. We were there to ease this backlog and give the Nepalese doctors a much-needed break, and were still there during the second earthquake.”
“We used the SonoSite system primarily to guide regional anaesthesia and pain relief in limbs – supraclavicular, distal tibial nerve and popliteal blocks. While many still needed a general anaesthetic, ultrasound-guided regional anaesthesia was ideal for high risk individuals, and became the anaesthetic of choice for the older, frailer patients – particularly those with isolated injuries – allowing procedures to take place under light sedation.
"The Kirtipur hospital does not have any ultrasound equipment but hopes to get a point-of-care system in the future, perhaps through charitable funding, for guiding intravenous access as well as anaesthesia. Medical equipment gets treated rather brutally in developing countries; servicing is frequently inadequate and machines need to be extremely hard-wearing and easy to maintain.Something like SonoSite’sNanoMaxx system is ideal for this kind of setting; it’s small, portable and very robust.”