by M. Rachadian R, M.D.
Fellow of Hand, Microsurgery , and Trauma Reconstructive Surgery, Ganga Hospital
From the Division of Plastic, Reconstructive, and Aesthetic Surgery, Ciptomangunkusumo National Hospital
There must be something special about this place when renowned hand surgery societies from the US, UK, and many more organizations choose to come far-east, to Ganga Hospital in Coimbatore, India, as their traveling fellowship award destination. So, let’s assume that you are interested in hand, microsurgery, and trauma reconstructive surgery, and you wonder what makes this place so special for most of the visitors who come here. I will give you the inside scoop.
In 1991 the hospital was paved with huge dreams to provide accessible care for hand injuries and microsurgery services in the region. It was these two legendary brothers who made the dream possible: Dr. S. Raja Sabapathy (Dr. SRS) a hand, plastic, and microsurgeon and Dr. S. Rajasekaran (Dr. SR) an orthopedic surgeon. As for now, the 480-bed hospital keeps expanding its capacity to cater to more than 24,000 surgeries yearly for the specialties of Plastic and Reconstructive surgery and Orthopedics (Figure 1). This unique combination of Plastic and Orthopedic specialties under one roof, by my knowledge, is second to none, making Ganga Hospital a truly orthoplastic surgery hospital.
There are many paths for those who want to stay and learn at Ganga fellowship program in hand, microsurgery and trauma reconstructive surgery. Whether you are from a plastic surgery or orthopedic surgery background, all are welcome here. Throughout the year, fellows from all over the world arrive and stay for 2 months, 6 months, or 1 year (Figure 2). Many foreign visitors also stay for the week-long microsurgery course, but many choose to add several weeks longer to become an observer. As for now, the hospital has recorded more than 1600 visitors to the department, a fantastic number for a place quite far from most of visitors’ hometown. The good news is that the hospital does provide a scholarship award that can be applied for at the end of the year.
Just like other academic surgery programs, the hospital offers a range of academic, clinical, and surgical activities for visitors.
Morning educational events such as journal reading and case conferences start from Monday to Saturday at 7:30-8:30 AM. Afterward, visitors can go straight to the operating theatre (O.T.), see inpatients, or go for the outpatient department (O.P.D.).
One of the most exciting parts of Ganga hospital is the Plastic, Hand, and Microsurgery O.T. Complex. The O.T. Complex is one of the busiest orthoplastic surgery suites in the world, with an elective caseload of around 30 cases and 20 emergency cases daily, spanning across 9 O.T.’s which comprise almost all upper and lower limb reconstruction surgery (Figure 3).
The O.T. just never stops. It is trauma-heavy; waves of patients come from local, even international region come to this hospital. One can expect to see tons of upper and lower limb emergency trauma cases like: replantation, major replantation, all kind of extremity salvage, and emergency free flap surgery. The extraordinary collaboration between surgeons and anesthetists is the heart of the effectiveness and efficiency in this hospital, and any severely amputated limb can reach O.T. from the emergency department in less than 10 minutes with all surgery preparation done. It was Dr. Ravindra Bhat, a legendary anesthetist from Ganga Hospital, who pioneered the game-changing trauma care in the region. All fellows can scrub-in and assist, and some choose to hop from one O.T. to another to catch all the various cases happening during a day.
The Plastic, Hand, Microsurgery, Faciomaxillary, and Burn O.P.D. is another highlight of the hospital. Here you can see directly how the hospital flourishes with hundreds of brachial plexus, upper and lower limb, hand, shoulder and elbow, pediatric, and burn-contracture patients. The work here is fast-paced; in 4 hours they can finish about 200 patient consultations spanning across ten rooms. Language barriers are easily overcome, as all the consultants eagerly discuss all cases in English. The patient medical records are also written in excellent English, with excellent photo documentation too, so you can learn the whole idea and knowledge by reading through them. There is also an intimate relationship with the physiotherapy department, which you can visit to see how patients are treated holistically after surgery.
The week-long microsurgery course is quite popular internationally, with more than 1100 participant across the world to date. Some orthopedic and plastic surgery programs in USA and UK will send their residents on a continued basis for this microsurgery course, again far in the east (Figure 4). The course was mainly based on the classical text by Robert Acland Practice Manual for Microvascular Surgery, which was edited by SRS, along with the associated videos.
When you feel like sitting and reading, there is an “orthoplastic” library with a vast collection of book and journals, mainly for upper and lower limb topics. Here you can also see how good friends of Dr. SRS like Dr. L. Scott Levin and Dr. Bruce Bailey have donated hundreds of collections of scientific journals related to orthoplastics to this library.
You will spend most of your life catching interesting cases at the hospital, getting up early in the morning, and arriving home late in the evening almost every day. However, don’t worry — the hospital has everything covered for you. The hospital canteen will serve you breakfast, lunch, and dinner throughout the week. Here you can take your taste buds on new adventures with delicious local Indian foods. They created this “Doctor dining hall” for all fellows, so you will not need to be in a long line; satisfy your hunger and get back work quickly, or you can order food directly to the O.T. and pay the food bill later at the end of each month.
Life outside the hospital can be fun, too, if you know how. According to a 2015 report, Coimbatore is on the top of the list of the safest cities for women in India. Apartment and housing are quite cheap here, but if you need more convenience, the hospital has a spacious and comfy “visitors flat” that is affordable. Transportation is widely available and safe through popular online cab applications. There are malls if you feel like going shopping, watching movies, or having great food. When you feel like just staying at home, you can also order food via an online app.
It’s an extraordinary cross-cultural experience in learning hand and microsurgery. The number of upper and lower limb cases I have seen here within two months of my fellowship is equal to that of my six years in residency training, or even more. The hospital is trauma-heavy and sees brachial plexus surgery, free-flap surgery, and microsurgery on a daily basis. For any resident, fellow, or even well-established surgeon who wants to broaden their horizons in hand, microsurgery, and trauma reconstructive surgery, with a unique setting in the far-east, then this place is right for you.