Collaborative workshop on Lymphoedema

A Report

Lymphoedema is a common disease in our country affecting over 20 million persons. Recent advances have made this disease eminently treatable but knowledge of the therapeutic protocol is not well known even amongst the healthcare community.

After running a counseling centre at AIIMS (see http://sathi.org/Partners.html ) and doing a camp at a charitable hospital in Vasai (see http://sathi.org/CampVasaireport.htm ), SATHI has attempted reaching out to other locations where this knowledge can be shared.

Following an invitation by Goa Medical College, a preliminary visit was made in October by President SATHI, Dr. S B Gogia and Rtn (Ms) Arun Rekha Gogia – Lymphedema Counselor to the hospital and a presentation of the problem and the work of SATHI to the Dean, Dr. V. N. Jindal and the Department of Surgery. A couple of patients were also assessed then. A decision was then taken by the Professor Director and Head of the Department of Surgery Dr. D. Amonkar to invite Dr. Gogia and team to conduct an educational program and operative workshop under the Visiting Faculty Scheme of the Government of Goa. Dr. Yuri Dias-Amborcar Professor in Plastic Surgery would interact with Dr. Gogia and work out the modalities and dates of the same.

Accordingly a team from SATHI consisting of Dr. S B Gogia and Ms Arun Rekha Gogia –traveled to Goa and spent three fruitful days – between 7^th to 9^th December 2011 mutually sharing their experience and understanding the disease spectrum with the doctors and staff of the Department of Surgery in Goa Medical College. The Directorate of Health Services, (DHS) Goa was also present there to oversee the project and utilize the learning experience on a wider scale for other affected persons in the state of Goa.

All expenses were borne by the Medical Education cell of Goa Medical College under Professor S M Bandekar , but additionally some bandage kits were donated for the workshop through Rotary Branch of Delhi Safdarjang (RCDS).

Planning for the workshop

After discussions on the phone and email, Dr. Yuri conducted camps to identify patients who could come for the consultation. Resident doctors had taken their history and measurements based on a proforma which were shared previously. The patients planned for surgery were to get a lymphoscintiscan done through Manipal Hospital as the facility was lacking in Goa Medical College.

Day I - 7^th December 2011

8:30 AM Visit to the Plastic Surgery Unit to see the patients planned for surgery

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IFrom Extreme Left, Dr Geley, Dr S B Gogia, Dr Sasmit with a patient

 9. 30 AM Patient consult started in Surgery Seminar room
patients were seen in the morning OPD– the history and proforma for these patients had already been taken but some of the details were additionally transferred to the Medic Aid Software which had been specially created for Lymphology patients. (A copy of the software was later provided free of cost to the Surgery department). A demonstration of history taking and primary examination which needs to be done along with perimetry and measurement techniques was done for the first 3 patients. The patients were then given a demonstration of edema care as well as bandaging by Mrs Gogia.

Dr. Gogia then took a 20 minutes lecture for all patients and residents where the basics of the disease and its treatment methods was done in Hindi. This was followed by a demonstration of the technique of the use of the machine, bandage application and self massage by Mrs. Gogia.

A relative of one patient then re explained the entire talk by Dr. Gogia in Konkani (the local Goa Language) to the patients.

Following this the rest of the patients were quickly seen by Dr. Gogia along with Dr. Sushmit, Dr. Charan and Dr. Laxmi who noted the salient findings of the patients in the proforma chart as well as Medic Aid software. A pre printed treatment protocol was given to all with additional hand written notes as required. Almost all patients required Penicillin and around 26 required Anti fungal powder. Two patients with Post mastectomy Lymphedema were asked to re attend the afternoon clinic which was reserved for post mastectomy patients.

Each patient was subsequently sent to Ms Arun Rekha Gogia who did the counseling and provided the basics of self care and bandaging. Senior doctors from Goa Medical College also attended the bandaging sessions for a few patients. Free bandages were provided to these patients (courtsey RCDS)

The post lunch afternoon session had been coordinated with Dr. Sharmila Correia, Trustee, Muskaan an NGO which is providing support to patients of Cancer. Mostly post mastectomy patients had been given an appointment. The morning talk with repeated by Dr. Gogia with specific nuances of upper limb edema Patients were then examined and demonstrative measurement techniques (for the upper limb) were explained.

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Mrs. Gogia is applying the bandage as others watch

Also present were Dr. Rajnanda Desai, Director Health Services and Dr Dipak Kabadi, Deputy Director Public Health and BVBDCP.

The above named representatives of DHS and Dr. Amonkar from GMC then held a meeting with Dr. Gogia and expressed their interest in starting at least 3 lymphoedema centers in Goa. SATHI was asked to submit the estimated costing for such centres.

The day ended with a visit to the Ward patient who had come back after the scan. This patient was put on the compression pump to prepare the patient for surgery the next day

Day II - 8^th December 2011

8:30 AM Started with a visit by Dr. S B Gogia to review the Lymphoscintiscan reports and see the progress of the patient put on the machine. The patient for surgery was having Grade II edema. However there was paucity of nodes in the affected side so an alternative plan to do only fibrosectomy was explained. However the nodes were palpable.

While awaiting for the OT and anesthesia, a demonstration of Medic Aid Software was done for Dr. Yuri and residents as well as methods to take photographs and measurements.

Nodo venous Shunt Surgery was done in the Left Groin by Dr. S B Gogia assisted by Dr. Geley Sr Resident

Lunch was served in the OT complex preceded by a demonstration of bandaging techniques and use of pumps by Mrs. Gogia. Dr. Gogia then took a small presentation on the surgical aspects of Lymphedema therapy

At 3 PM a talk was taken for the Nurses and Therapists of the hospital along with Field workers and Extension Educators from the Directorate of Health Sciences.

This was followed by a demonstration on leg washing, as well as other aspects of community based care for Lymphedema. This meeting was attended and arranged along the DHS. The entire proceedings were recorded by a local news channel, ‘Prudent’.

The pumps were then shifted to the ward to start therapy for the ward patients

Day III - 9^th December 2011

9:30 AM Nodo Venous Shunt surgery demonstration on a patient with gr III edema was done jointly by Dr. Yuri and Dr. Gogia. This was preceded by leg washing and measurements by Dr. Yuri. Later, further demonstration of the machine, bandaging and software were done in the OT where lunch was served.

In the afternoon a lecture in the main auditorium of Goa Medical College on the topic “Recent Advances in the Management of Lymphedema” was taken by Dr. S B Gogia under the aegis of the Medical Education Cell.

Workshop ended with notes on planning the future steps especially the establishment of three clinics in Goa.

Nodo Venous shunt surgery in progress