Voices From the Frontline: Q&A with Surgeon Ankur Pandya

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Operation Smile has over 6,000 medical volunteers from over 80 countries around the world, including the UK. Over 70 volunteers from the UK have recently served on our medical missions in countries in Latin America, the Middle East, Africa, and Asia.

One of them is Ankur Pandya, a plastic surgeon who works both within the NHS in the UK and is also a Wing Commander in the Royal Air Force who has been to 43 medical missions.

Can you tell us more about what’s the situation in your hospital and how you have been involved in the COVID-19 response?

I am a plastic and reconstructive surgeon, so I operate on patients on a daily basis. Once Covid-19 started, we had to rethink our roles. We started offering trauma services where patients could just walk in. Normally patients are very scared of having to go to the hospital because of COVID-19, so we informed  local clinics, health centres and GPs, saying that we were open and doing whatever was required to keep our patients safe.

Our biggest challenge has been in treating patients with cancer, because they are not only a very susceptible part of the patient group, but many of them are also undergoing chemotherapy. It becomes very difficult to motivate them to come in and have surgery. So, we had to spend a lot of time with them.

For every single patient that we operate on, all the normal practices have been thrown out of the window. We consider every patient as suspected to have COVID-19, so the anaesthetists, the surgeons and all the nursing staff in the operating room are wearing full PPE, to be protected from aerosol generated during the surgical procedures.

In London hospitals and even at Southampton, there have been young medical students who have been working in ICU. So, my goal in terms of teaching has changed as well. I am now teaching two or three times a week on Microsoft Teams to large groups of  medical students, because they cannot go to medical school, but their education has to continue. I’m also a visiting professor at the University in Romania, so I am doing the same with my students over there. Finally, I’m the Associate Dean for the National Defence Deanery. So, it’s, again, a large number of trainees who are very apprehensive, and who don’t know what’s going to happen about the future. I give them as much care and support.

Surgeons elsewhere have been working on the ITU helping with proning patients. There has been talk of us being involved in this. If and when this happens this will be a significant change in the way we work. Proning takes a number of people to perform and the risks in these environment are much higher.

I have been to war before and whenever someone sees   something bad or unjust, their  general temperament changes.  I usually go to an Operation Smile mission both before and after a military deployment, because that gives me the calmness that I need, as I know that I’m helping other people. Now that is no longer possible, so it is more of a challenge, but I try and do the same through teaching and webinars. I have been to 43 medical missions and I learnt so much from these experiences. I have a lot of understanding of how to react in emergencies, mobilise people, motivate people, try and encourage people to work as teams, get hold of logistics and if something is missing, try and come up with different ideas. So, going on missions and working with new teams with people from all over the world, has definitely had a major bearing on working during a pandemic.

What kind of medical assistance do people need at the moment?

The weather has been very good and a lot of people because they are bored at home are now buying equipment for the garden. These include circular saws, hedge trimmers and as they don’t know how to use them, they come with devastating hand injuries that involve missing fingers. Unfortunately, we’ve had lots of those types of accidents. We also get a lot of injured children that get hurt playing outside. So please, be careful while at home!

What motivates you to continue this fight on the frontline, and how do you motivate your students?

Students look upon people like me to get signals that everything is safe and that it could be normal. All of us know that there is going to be a new normal. Life is never going to be the same as before, but that doesn’t mean they are not going to lead fruitful lives as medical personnel. So, keeping them motivated for that is a very, very important part of my life. We know that a lot of medical students have problems with going and working on the wards because they are very, very scared. So, it’s important sitting down with them, telling them the advantages of PPE, telling them how good these things are. There were regular tests done that showed that personnel did not have antibodies despite working in the ITUs. So, we were just telling them that the fact that we don’t have antibodies means that despite working in high risk areas, we still have such fantastic protective equipment that keeps us safe.

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I think the hardest thing is hearing stories of frontline medical staff dying. Most medical students, most trainees are volunteering to go into high risk areas. For two reasons. Number one, they know they will be trained. Number two, they say that for all their lives they wanted to be doctors because they wanted to do something for people. This is a chance that they are getting. Finally, they realise that because they are young, they will hopefully not get any adverse effects from it. So, it’s a combination of all of these. Of course, we hold regular virtual meetings with trainees. I think social media has come up in a very, very big way to facilitate things and even allowing doctors to be in touch with vulnerable patients by telephone or video consultations, and they are genuinely very grateful that the NHS has not forgotten about them.

You were involved in training with Operation Smile as well, can you tell us more about that?

I have been involved in the training of cleft surgeons in Mozambique last year as well as teaching burns in Dagestan this January. A couple of months ago I had some conversations with the regional director to continue the training in that country. Once things are safer, I have absolutely no issues to go back working on medical missions. I don’t think you can keep your life on hold fearing the worst, because when you do that innocent people who do not have a voice, who do not have anyone to advocate for them, are going to suffer. So, we have to step up and we have to continue with the medical missions, we have to continue doing the work for the people whose only hope are organisations like Operation Smile.