Playing House (MD)

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Amelia has told you about the huge range of procedures that they do at the TLM Naini Community Hospital, so I, as your de facto medical correspondent will give a little introduction about the hand and foot de-clawing operations they do here and at Nand Nagri. Basically there are 3 nerves running up the forearm connecting the fingers to the brain. The radial, median and ulnar, and the quantity of bacteria infecting each one is directly proportional to the amount of clawing in each of the corresponding fingers that nerve controls. The nerve damage caused by the bacteria, like all nerve damage, is virtually impossible to repair.

So in order to correct the clawing, a tendon is brought around from the other side of the hand to add some more tension in order to straighten the fingers, whilst shortening the A2 flexor tendon in the fingers to align the fingertips to then new hand position. A similar procedure is performed on the thumb around 2 months later. All this is whilst the patients are in the first stages of the MDT treatment as it is very important to allow the patients to regain the functional use of their hands and rid themselves of the physical stigma as early as possible. Also it take time to adjust to the change in hand control. So to clench a fist, the muscles previously used to arch the hand backwards are required and vice versa.

The eyelids are another important area to work on, as the bacteria like to live in the cooler conditions there and the local nerve damage will stop the infected person from blinking. This results in cataracts, eye infections, and in one elderly chap we met, some of the worst corneal scarring that I've ever seen causing blindness. To correct this, a truly ingenious method was devised. A length of tendon is taken from the thigh, and connected from the jawbone tensor to the corner of the eye. So to blink, the patient has to clench his/her jaw and the eye closes. It's not perfect, but it's pretty close.

I must add that, all day going around the hospital, for a good 7 hours I was constantly moments from bursting out crying, but only a few hot tears were shed an quickly wiped away. Either from the unbelievably sad stories of the patients, the sheer hopelessness we found, or for sheer joy at some success story that we found. I am still an emotional wreck as a result of the overwhelmingly good work that TLM are doing out here.

I'm welling up again.

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