International Mission Trips
A Mission of Service, a Milestone in Training
Lavanya Nagappan, MD
As residency comes to an end and I reflect on the past five years of training, I find myself returning often to a single week in February that became a defining experience of my surgical education. I had the profound privilege of participating in the second iteration of a surgical mission trip to the Indus Hospital and Health Network in Karachi, Pakistan, as part of a team assembled by my division head and mentor, Nadir Ahmad, MD, FACS.
Our team brought together surgeons from multiple otolaryngology subspecialties and institutions: Luke Stanisce, MD, former Cooper resident and now attending head and neck surgeon at Cooper; Natasha Mirza, MD, laryngologist and director of the Penn Center for Voice and Swallowing, and her resident, Austin Cao, MD (PGY-3); Scharukh Jalisi, MD, Chief of Otolaryngology-Head and Neck Surgery at Beth Israel Deaconess Medical Center; Nauman Manzoor, MD, neurotologist and skull base surgeon at Virginia Commonwealth University; and Arshad Kaleem, MD, DMD, oral and maxillofacial surgeon from El Paso, Texas.
Indus Hospital is an extraordinary institution funded entirely by private donations, and it serves one of the most underserved populations in Karachi, the largest city in Pakistan. My co-resident, Swar Vimawala, MD participated in the inaugural trip to Indus in 2025, helping establish the groundwork for a deeper collaborative relationship with the Department of Otolaryngology at Indus, led by Asif Ali Arain, MBBS, and Shakil Akhtar, MBBS, and their residents, who welcomed us with tremendous warmth and enthusiasm.
The Indus team had carefully selected patients from their vast patient population based on their surgical complexity and the expertise offered by the senior attendings on our team. Over the course of the trip, our team performed over 50 surgeries ranging from advanced oral cavity cancers associated with betel nut consumption, which remains the leading cause of cancer in Pakistan, to large thyroid goiters and complex cases spanning laryngology, skull base surgery, and head and neck reconstruction. The trust and gratitude of our patients, combined with the dedication of the Indus Hospital team, made every long day in the operating room deeply meaningful.
One of the most memorable moments of the trip was a laryngology masterclass led by Dr. Mirza. Early in the week, I assisted her in performing a type III thyroplasty for puberphonia, a procedure not commonly performed in Pakistan. Later in the week, she translated this experience into a hands-on workshop using goat larynges, where Austin and I assisted in facilitating the course for visiting faculty participants from across Pakistan and neighboring countries.
Beyond the operating room and the lecture hall, what was most impactful is harder to quantify: the camaraderie of our team, the generosity of our hosts, and the quiet resolve of the patients we served. Operating alongside my mentors and the faculty at Indus was an invaluable experience that taught me the importance of creativity and adaptability in a resource-limited environment. Equally rewarding was the opportunity to work with the residents at Indus, as our shared learning and teaching experiences pushed me to grow in ways I had not fully appreciated before.
As I prepare for the end of residency and the start of fellowship, this experience will continue to shape the physician and surgeon I hope to become. I am deeply grateful to Dr. Ahmad for his vision in building this partnership and for including me on this journey; to the other surgeons on our team for their mentorship and generosity with both their time and expertise; and to the faculty and patients at Indus Hospital for their hospitality and trust. This trip felt like a culmination of my training and is an experience I hope to return to in future years.
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