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Catherine Graham

Trinity College Medical student fellowship


Catherine Graham in Guwahati, India – 28 January – 11 February, 2010

If you ask a seven-year-old why she wants to be a doctor she may well give you a far better answer than a final year medical student. Through endless lectures, early-morning tutorials, and stressful exams, it can be easy to forget what originally inspired us all to follow this career path.

Operation Smile Ireland offers a chance to rediscover that underlying aim, and to view medicine again - stripped down to its essentials – to help people and to change their lives for the better.

In a ten minute presentation on an average Monday morning in Tallaght Hospital, Mr Orr immediately grabbed my attention and imagination with his talk about Operation Smile Ireland and the incredible opportunity of a medical student fellowship that was on offer to us. I have always been interested in medicine abroad, and have taken every chance to do electives overseas. The more I read about it, however, the more I felt that Operation Smile Ireland may manage to achieve that elusive goal of transforming good intentions and enthusiasm into genuine and long-term benefits for the individuals and communities involved.

Before setting off to India, I met with Susan from the Operation Smile Ireland office, and David Orr, a plastic surgeon and cleft specialist in St James’ Hospital, who shared photos and stories from previous missions to give me a picture of how these unique projects are run. It was great to talk to them, and I was certainly excited, but I could sense that they knew I had no idea of just how much there was to look forward to; and they were right!

Leaving a hectic, snowy Dublin behind, I flew to India with the other Irish volunteers, and the incredible two weeks began. The Irish group was diverse in itself, from nurses and dentists to medical records coordinators and a photographer. It was the first experience I had of how many different people with contrasting talents come together with one common goal to make these missions work so well. But if I was impressed by this, it was nothing compared to the collection of people I would meet in Guwahati. There were people from as far apart as Colombia and Sweden, Hawaii and China, Honduras and the Philippines. Returning volunteers, reunited from previous missions across the globe, greeted each other like old friends, and as one of the surgeons remarked on the first day, it really was like our own mini-version of a United Nations. Numbering 133, this was the biggest group a mission had ever seen, and yet, very soon there was an incredible sense of unity, and the feeling that we really were one team.

We screened patients over five days in Guwahati, and also in 3 other nearby cities due to the huge number of people waiting to be seen. In the Indian state of Assam alone, there are an estimated 35,000 people with cleft lip and palate - a humbling figure in which to make a dent. A small, but significant dent.

Every patient who presented on screening days was seen by the full team of surgeons, doctors, dentists and speech therapists, and although some of them were unsuitable for surgery (some presenting with bizarre conditions wholly unrelated to cleft lip and palate), at least they left having been fully assessed, and, if possible, referred to where they might receive further treatment. Patients were of all ages, and it was heart-warming to see an 80-year old lady hobble in with a stick and declare she would like to have her cleft lip repaired, as well as the ten-day-old baby brought by a mother, also with a cleft lip, who wanted a better future for her child.

As a medical student, the screening process provided a great opportunity to learn from the vast array of experts that surrounded me. I had no specific role, but endeavoured to lend a hand in whatever way I could, which led me to experience almost all aspects of the process at some stage or another. One morning I would be a dental assistant, and another busy afternoon a speech therapist, in between getting a personal tutorial on the in and outs of diagnosing cleft palates by a Peruvian surgeon. In every field, there were enthusiastic professionals only too happy to teach me, and answer any questions I might have.

Over 1200 patients were screened in total, and selecting and scheduling the suitable patients onto 15 operating tables for 6 days' surgery was an unenviable task for the clinical coordinators. It would be wonderful to be able to offer surgery to everyone in need, but the enormity of the problem in this part of India is not something that can be addressed on one two week mission. It was great to know that another Operation Smile team would arrive immediately after us, and that there were further missions planned for later in the year.

A morning was then spent setting up the hospital wards and operating rooms for surgery, and there was a buzzing sense of excitement in the air. I felt that already the experience had been so wonderful, and that I had learnt so much, and yet others seemed to feel like it was just about to kick off. I don’t think I’ve ever met a group of people who so looked forward to a week of 5.30am wake-up calls. It was an amazing, almost enchanting atmosphere.

Surgery week was another great opportunity for me to work alongside and learn from some top class surgeons, and I was encouraged to scrub in at every opportunity. I was fascinated at how the surgeons learned from each other, incorporating some tips they picked up from their international colleagues into their own procedures. There was a huge amount of respect shown by everyone to each other member of the team, and the working environment this created was fantastic.

Each surgeon was dedicated to perfection, often taking time to deliberate what, exactly, was the best treatment for a child, conferring with colleagues to ensure no option for the patient was unexplored. Although I was undoubtedly impressed from the outset, I came to realise just how lucky I was to be working with so many exceptionally talented people a few days later. On a morning ward round with the team leader, an American surgeon, he remarked to me how impressed he was with several childrens' cleft lip repairs in a row, and looking at their charts as we went, we saw the name of a different surgeon on each and every one. The fact that he himself was so delightedly astounded by this made it more real to me that I truly was experiencing some of the best from all over the world at work in this small Indian hospital.

Seeing the transformation in the patients and their subsequent reactions was something I will never forget. One story of a father and son is especially memorable to me. The father had brought his son to screening, in the hope that the child would get his cleft lip repaired. After examining the son, the surgeon asked the father, who also had a cleft lip, why he didn't have a chart as well. On realising that he too would have the chance of receiving surgery, the father was overwhelmed to the point of tears. In the operating theatre I met the father again, whose son was happily recovering downstairs from his operation earlier that morning. Immediately after the procedure, under local anaesthetic, we were able to show him his face in a mirror. That first expression of shock breaking into a prolonged smile will stick with me forever.

To try and sum up what I will take from this experience is difficult - difficult to express in words, and difficult because I think the amount I have gained is beyond what I myself yet realise. The team of people that I was fortunate enough to meet and work alongside is definitely one of the things that made the biggest impression on me. Their eagerness, commitment and dedication was impressively unrelenting. Although there was a very serious aspect to the team, and we had goals we were determined to achieve, there was still time to get to know each other, share experiences, and for the Latin Americans to laugh at the inability of the Irish to salsa!

I would like to offer my sincerest thanks to Operation Smile Ireland, to the fellowship sponsors Tekno Surgical, and to Trinity College Dublin for granting me this wonderful and unique opportunity.

My classmates have asked me how I felt about taking two weeks out to participate in Operation Smile in the run-up to my finals, and whether I felt I learnt things in India that would help me in my exams. But I think this misses the point. What I learnt in India cannot be taught in the corridors of the biggest acute hospitals in Dublin, or on the newest e-learning website. The reality of experiencing firsthand how medicine can be practised in resource-poor settings is an invaluable aspect of medical education. Operation Smile's work to provide care under these difficult circumstances is a wonderful example of what is going to be a great challenge for the next generation of doctors.

On landing in rainy Dublin, I received three voicemails from a secretary in Trinity College about my exam on Monday morning. It was back to reality - with a bang, but with a difference too. And certainly, with a smile!