Surgical times

Hello
This week I have been placed in Surgery 1, which is one of the general surgery units at the hospital, but also specialises in Head and Neck surgery. In the rest of the world H&N cancers make up 10% of the total number of cancers, but in the Indian subcontinent it is up to 40% of the total. This is mainly due to the prominence of chewing tobacco and Betel Nut, often mixed with slake lime, a fairly potent carcinogenic mixture. This leads to some pretty horrific tongue and buccal carcinomas, all at a fairly advanced stage. This means that many of the operations carried out are fairly radical, involving large scale dissections of the neck as well as removing the primary tumour, with fairly large skin flaps from various parts of the body used. Also many of the people had travelled from West Bengal (up near Bangladesh in the north) to come to CMC, but I am not entirely sure why they have travelled so far, obviously it has a good reputation. Aside from head and neck stuff, there was a very nasty case of necrotising fasciitis on the ward, a benign parotid swelling, which we saw carefully removed to avoid damaging the facial nerve and lots of other hemi-colectomies and general surgery type things, which was quite interesting. Also attended some teaching with the Indian medical students, they get a whole week for head and neck conditions whereas we maybe had it mentioned once or twice in the ENT block but more related to pharyngeal cancers. I have enjoyed the week, although I haven't felt hugely well the whole time, quite a lot of standing in the heat and it has been a good opportunity to augment my knowledge illustrated with striking clinical examples.


The other main highlight of the week was our trip to see the Tamil Move Anniyan. Tamil is the main language of this region, Tamil Nadu and most of these films are made in Chennai (Madras), known locally as Kollywood films (cf Bollywood from Mumbai/Bombay). It was quite different from my expectations.
A few observations:

• It was quite violent, having quite a number of fighting scenes and fairly brutal murders, although mostly off screen. I was expecting some kind of lovey-dovey romance with lots of songs and dancing.
  
• There weren't as many songs I was expecting, I counted just 4, but the dancing was quite interesting and there were lots of scene and costume changes (This kind of thing would appall me in an English-language film but was somehow quite interesting in the Tamil film)
  
• It was actually fairly modern, employed now oft-used Matrix-esque time-slicing techniques for the fighting scenes.
  
• I was surprisd with how easy it was to follow the film, except in the long passages of dialogue.
  
• Good representation of Indian transport systems, showing the autorickshaws and the train; a good sense of the 'I've done that' tourist feeling.
  

I'm sure there was more to say but my brain is getting to that seizeing up point in the day.
I'm off on a 3 day taxi excursion round the temple cities of southern Tamil Nadu this weekend, which should be very interesting and provide some good photos.

Hope you have a good one.
All the best.