May 2011 Archives

GSK PULSE Volunteer, Len is working with a non-profit organization, Rotaplast, to provide pre-operative and post-operative pediatric care for cleft palate surgeries in India & Bangladesh.

I arrived in Chittagong, Bangladesh on Tuesday, May 15. The trip from Philadelphia took three flights and 32 hours. Meeting up with my 24 fun and interesting Rotaplast colleagues in the Dubai airport made the long journey seem shorter. Almost everyone is a Rotaplast veteran of many medical missions. This is my second medical mission, so I am no longer a rookie.

I spent a few hours walking around Chittagong on the afternoon we arrived. The city is very busy with people walking and shopping, men of all ages pedaling colorful bicycle rickshaws transporting people and goods, motorized green rickshaws, trucks painted with colorful pictures, and shops selling everything imaginable. The street food looks delicious and tempting; however, I won't dare try anything as I am here to work, not to get Delhi belly.

This morning we left at 6:30 to travel 30 minutes by car to the hospital.  Within 10 minutes of driving we were no longer on paved roads. We were heading out of the city limits into the lush and verdant countryside. What a scene--people, bicycle rickshaws, animals, and road side shops filled the streets. You don't need to look far to observe the ever present poverty. 

The hospital we will be working at for the next ten days is the "Nurture Centre for Disabled and Paralyzed." It is not a hospital as we think of hospitals. There is no laboratory, no blood bank, no pharmacy, no x-ray capability, and only rudimentary operating rooms. We knew this in advance and shipped our own anesthesia machines and virtually everything we will need. The hospital was founded by Nasreen, a woman from Chittagong who has two young adult children. When Nasreen's children were young she had the financial means to bring them to the doctor for their routine and urgent medical care. However, she felt uneasy that many parents in Chittagong could not afford to bring their children to the doctor and that these children often went without medical care. Ten years ago, Nasreen visited a rehabilitation hospital in Bangladesh 150 miles away from Chittagong and learned that 40% of the patients were from Chittagong. Nasreen decided to establish a rehab hospital in Chittagong using savings from her beauty parlor business. Many years ago, Nasreen bought plot of land in outskirts of Chittagong and started building and fundraising. In 2008 the six-floor building was dedicated. The mission of the Nurture Centre for Disabled and Paralyzed is "to accommodate the needs of the poor, the diseased, and the paralyzed who cannot afford treatment in clinics and hospitals." Nasreen is an amazing and generous woman. She, along with her sister and sons and other relatives, was with us at the hospital today.

Our Rotaplast interpreter is Shez, a college student in Dallas and Nasreen's nephew.The Rotaplast medical records person is Nabali, who lives and works in Bethesda, MD whose mother is a close friend of Nasreen. Shez and Nabali are so proud to be working in Nasreen's hospital.

Today was clinic day, the day we evaluate our potential patients and set the operating room schedule. It was a busy day. We evaluated 139 patients and scheduled 107 for surgery. The vast majority of the patients have cleft lips or cleft palates, though 15 or so have burns with scaring that is interfering with function. Unfortunately we were not able to schedule everyone for surgery. Either we could not correct the problem during our two weeks here (a congenital, very small and malformed, non-functional ear is one example), or the children suffered from severe malnutrition and anemia.

I enjoyed meeting the families and children, talking with them and trying to understand their culture and traditions. One tradition among some Bangladesh people is to paint with pigment on the side of the infant's forehead a black dot. The mark is called a Kazaler tipp and is meant to ward off evil spirits. Similarly, some infants wear necklaces with metal decorations referred to as Herr, also to keep evil spirits at bay.

The chronic shortage of trained healthcare workers in the least developed countries in the world is recognized as one of the greatest constraints to improving healthcare in the world's poorest countries.  While progress has been made in improving the availability of medicines in these countries through a variety of programs, including medication donations, it's clear that providing product it's enough. We need trained health care workers to administer it and to educate their community.   

Last year, GSK committed to reinvesting 20% of its profits made in the least developed countries back into projects that strengthen healthcare infrastructure in those countries. Today, we announced that re-investments will be administered by AMREF in East and Southern Africa, CARE International in Asia Pacific and Save the Children in West Africa. Our shared objective is to improve health outcomes by supporting front-line healthcare workers who operate in these countries.

Appropriately trained and adequately supported health workers can improve access to basic health services in their communities.  One fully trained and well-supported community health worker can effectively reach up to 5,000 children in a year.

We don't currently make a lot of money in these countries--the profits across 37 of the 48 least developed countries comes just about £3.5 million. However, this commitment represents a dedication to increasing access to our products and building a sustainable business.   

Read more about the projects GSK is supporting with its reinvestment initiative, watch a video of Andrew in Africa, or view an interactive map of our work with communities around the world.

GSK PULSE Volunteer, Len is working with a non-profit organization, Rotaplast, to provide pre-operative and post-operative pediatric care for cleft palate surgeries in India & Bangladesh.

After two weeks away from family it was very nice to come home for a brief visit. Continuing my PULSE assignment, this week I join another Rotaplast medical mission. This time I will be going to Chittagong, Bangladesh.  This will be Rotaplast's first mission to Bangladesh where 50% of the population lives on under $1.25 a day, and there are approximately 300,000 individuals with untreated cleft lips and palates. After witnessing the poverty and malnutrition in India I worry about what awaits us in Bangladesh.

No one from the India Rotaplast team will be with me in Bangladesh.  However, I am thrilled to meet and work with 25 new medical and non-medical volunteers. The medical director in for the Bangladesh mission is the plastic surgeon who co-founded Rotaplast in 1992.  Amazingly he has participated in 58 international medical missions, 38 with Rotaplast. The mission director is a RN and full-time Rotaplast volunteer, also with extensive international medical experience. I am really looking forward to working with and learning from these two professionals.

The Rotaplast mission to Bangladesh will take place at the recently-built and privately-funded Nurture Center for Disabled and Paralyzed in Chittagong, Bangladesh. Chittagong is a port city in Southwestern Bangladesh built on the banks of the Karnaphuli River.  It is the country's busiest seaport, the country's second largest city, and among the ten fastest growing cities in the world.

Friends and family have been asking about cleft lip and palate.  Here is information on some frequently asked questions.

Q: What is a cleft lip?
A:  A cleft lip can range in severity from a slight notch in the red part of the upper lip to a complete separation of the lip extending into the nose. Clefts can occur on one or both sides of the upper lip. Surgery for a cleft lip is generally done when the child is 10 -12 weeks old.

Q: What is a cleft palate?
A:  A Cleft palate (roof of the mouth) may occur as part of the cleft lip deformity (cleft lip/cleft palate) or as an isolated cleft palate. These two occurrences of cleft palate are distinctly different congenital anomalies even though the surgical correction and treatment are very similar. Cleft lip/cleft palate is far more common than an isolated cleft palate. Surgery for a cleft palate is generally done when the child is nine months to 1 year old.

Q: What causes cleft lip and palate?
A: There are a number of reasons for the cleft anomaly including a genetic predisposition, diet, life style, lack of adequate vitamins especially folic acid, smoking while pregnant, and pollution. Research has shown that a genetic predisposition can be triggered by any of these factors thus increasing the chance for the cleft anomaly to appear more frequently among those who are poor.

Q: Why do we see so few people with cleft anomalies in developed nations like the US?
A: Healthcare providers and the public healthcare system subsidize the cost of reconstructive surgery for most children born with cleft lips and palates. These programs are often not present in developing countries such as India and Bangladesh.

Q: How is Rotaplast working to address this disparity?
A: In addition to providing free reconstructive surgery, Rotaplast also teaches local surgeons about the most up-to-date surgical techniques for cleft cases. Local medical communities are encouraged to adopt a multi-disciplinary approach to treatment, including orthodontic and speech therapy follow-up programs.

Q. What is PULSE?
A. Launched in April 2009, PULSE is a GSK initiative that empowers employees to make a sustainable difference for communities and patients in need. Employees are given an opportunity to use their professional skills and knowledge during an immersion experience within a non-profit or non-governmental organization. Through this experience, volunteers address a clear need while developing their own leadership capabilities. 

Photo courtesy of Rotaplast.

Generations of scientists have worked with physicians and patients to deliver medicines that treat and prevent diseases better than ever before. We are learning more each day about how the body works, how to manage disease more safely and effectively and how to prevent or eliminate diseases that once were fatal. New medicines still offer the promise of helping us feel better, be more productive, and reduce our overall healthcare bill. One area of research that seems to be showing promise is the relationship between gender and symptoms.

Did you know that some diseases affect women more often than men? Or that women may suffer different symptoms from the same disease?

It's true that women are more often affected by diseases including osteoporosis, multiple sclerosis, depression, rheumatoid arthritis, and age-related macular degeneration.

Dr. Lorraine Fitzpatrick is a Medicine Development Leader for GlaxoSmithKline (GSK) working to better understand one of those diseases--postmenopausal osteoporosis--and to develop new medicines to treat this bone disease which affects about 8 million American women and 2 million American men.

She notes that long ago, most of the medical research was in men. But today scientists are making progress understanding some of the science behind the differences in health between men and women.

For example, Dr. Fitzpatrick said we know today that women's bodies react to stress by producing higher levels of cytokines. This could lead to increased frequency in women of autoimmune diseases such as rheumatoid arthritis and multiple sclerosis.

But there is much more to learn. Listen to an interview with Dr. Fitzpatrick or read more about the 851 medicines in development for diseases that disproportionately affect women. 

Stories about health are always in the news. Makes sense--we all want to find ways to maintain or improve our quality of life. My favorite health story of recent weeks was about the beneficial effects of fidgeting. If only this study had been done when I was a kid--I could have had a great comeback for when my mother would constantly telling me to sit still!

The study looked at the role of activities of daily living or incidental exercise--getting up from your desk, chopping vegetables for dinner, drumming your fingers, or tapping your feet--in the subjects' levels of fitness. As it turns out, these activities can help maintain or improve your fitness levels.

This is especially true at work, where so many of us stare at computer screens all day. I get up frequently to walk around, and I spend a lot of time sitting on a yoga ball instead of an office chair, to help fight the effects of non-manual labor.

For the last few years, many companies have taken an interest in getting employees to be more active to improve both health and productivity--and reduce healthcare costs. An article in the LA Times highlights a number of companies--including GSK--for their innovative approach to encouraging employee wellness. 

At companies large and small, employees are being encouraged to get active--with great results! How does your company promote wellness?

GSK's commitment to our core values was highlighted in the most recent issue of Pharmaceutical Executive in a column by Deirdre Connelly, President, North American Pharmaceuticals.

Deirdre's commentary points out that despite the many contributions the pharmaceutical industry makes to society, the lack of trust in the industry is both puzzling and frustrating. She writes that while the pharma industry has made many changes in how it operates over the past ten years, negative perceptions remain. To remedy this, Deirdre calls for those in healthcare to embrace a values-based approach to interactions with patients, healthcare providers, and other stakeholders. By conducting its business with a focus on the patient, with transparency, integrity, and respect, she believes the industry can regain the public's trust.

Read the entire article on PharmExec.com

GSK PULSE Volunteer, Len is working with a non-profit organization, Rotaplast, to provide pre-operative and post-operative pediatric care for cleft palate surgeries in India & Bangladesh.

The first leg of my PULSE assignment with Rotaplast in Udaipur, India has drawn to a close.  We left Udaipur at 4 PM for a four-hour bus drive to the Admedebad airport. Given the six-hour ordeal we had with airport customs upon our arrival 12 days ago we wanted to give ourselves plenty of time when departing. We arrived eight hours before our 4:25 AM flight to Dubai. The team is sitting around in a group in the departures area, chatting, reading books, downloading pictures, and filling the time.

My experience on the medical mission has been tremendously rewarding. We completed our last operations on Friday and this morning we rounded on the remaining patients who were all ready to go home except Karma. Karma is the six-year old boy with the severe burns who I wrote about in an earlier blog. Yesterday he was taken back to the operating room for dressing changes under anesthesia and some touch up plastic work on his chin and eyes. This morning he was doing great. Karma's family lives in a village without electricity or running water. It is three miles from the closest paved road. The team purchased a bicycle for Karma's dad with a seat for Karma. Now Karma's dad can take him more easily to school. One of the local plastic surgeons, a member of the Udaipur Rotary Club has agreed to provide medical care to Karma after we leave.

This morning, one of the Udaipur Rotary Club members, Vinod, came by our hotel and asked if we needed a ride to the hospital. Vinod is a kind and well educated man who spent many days with us in the hospital acting as an interpreter. He is trained as an engineer and MBA, and he and his brother operate a factory. Vinod asked if we would be interested in taking a tour of his factory. Of course we would; what a great way to see another slice of Indian society and commerce. Vinod's factory produces two medical contraceptive products, a copper IUD and a silicone fallopian tube closure ring. It was fascinating touring the factory. I felt right at "GSK" home talking GMP (good Manufacturing Practice, reviewing the procedures used for sterility and to create ultra clean working areas, and discussing their QA (quality assurance) and QC (quality control) processes. I was especially impressed with Vinod's focus and commitment to provide jobs, decent wages and opportunities to people in the local community where the factory is located. VInod also has a program where middle school age boys and girls intern at the factory and part of the intern program includes classes on nutrition. Vinod was especially proud that these boys and girls have breakfast at the factory where they get to drink milk and have a nutritious breakfast.            

Every moment of my PULSE assignment has been fulfilling and we have changed many lives.  People are the same everywhere. We all want the best for our children. I feel very fortunate to have been able to use my medical skills to help change lives.  

As GSK PULSE Volunteer, Len is working with a non-profit organization, Rotaplast, to provide pre-operative and post-operative pediatric care for cleft palate surgeries in India & Bangladesh.

The last few days have gone by in a flash. It is hard to believe that today is our next to last full day of surgeries for this medical mission. Later this month, as part of my PULSE assignment, I will be joining another Rotaplast medical mission to Chittagong, Bangladesh. 

We meet for breakfast at 6 AM. Breakfast each day is a variation of potatoes and grains. There is always some fresh fruit which I have been avoiding worrying that it was cleaned with dirty water. Today I could not resist the sliced mango. The mango was delicious! I hope I don't pay for breaking the rule "cook it, boil it, peel it yourself, or don't eat it."  

We leave by bus for the hospital at 6:30 AM. After the killing of Bin Laden, we have been following US State Dept advice to not follow a set routine and have been varying our bus route each day. Taking different routes is great as we get to see different villages. These villages are so interesting. We see people preparing food, selling goods, children walking to school, children playing, and roaming cows, wild boars and mules. The roads are full of motorcycles riders without helmets and trucks blaring their horns. I have been taking pictures when the bus slows down (which is infrequent) and hope I have been able to capture the essence. Nobody follows traffic rules, and I wonder if there are any! I thought that car drivers in Italy and the Middle East were reckless; the Indian drivers are in a league of their own. 

When we arrive at the hospital, the anesthesiologists, surgeons and nurses head to the operating rooms to prepare for the first cases. The other pediatrician and I head to the patient ward to check on the patients who were admitted overnight to recover from the prior day's surgeries, and we check on the patients scheduled for surgery that day. For those who were operated on the prior day we make sure the child is drinking, is not in pain, that the surgical wounds are healing, not bleeding and not infected, and we answer questions from the nurses and the parents. The ward is a happy place full of new smiles. 

One of our patients is a 19 year old named Tara who lives 60 miles away. She needed a palate repair, lip surgery and nose surgery, all secondary to a mid-face defect. Palate surgery can be associated with a significant amount of blood loss and our criteria preclude palate surgery for hemoglobin levels below 10 g/dL. Unfortunately, her hemoglobin was 8.6 which is too low to safely repair the palate. While Tara and her mother were disappointed that the hole in her palate (roof of her mouth) could not be fixed, they were happy we could repair the lip and nose.  We prioritize surgery for younger patients as they have the most to gain from speech improvement after repairing a cleft palate. As a result, Tara's surgery was not scheduled until 10 days after she arrived and was admitted to the hospital. She has a great disposition and took this all in stride.

Tara became the ward's unofficial den mother. There are 38 beds on the ward. She knew everyone in the ward and was helping the mothers and fathers care for their young children. When I came by to round on patients she was often at my side telling me things about the family through an interpreter. Tara had three different traditional Indian dresses and rotated outfits, and she liked when I took pictures of her with the other children. On Tuesday she took out her cell phone to show me pictures of her family's cows. The family has five cows and she proudly showed me pictures of each one, taking special effort to point out their horns.

Tara did great after her surgery. On the day she went home, her mother took out a shiny metal pot filled with bread and offered me a big piece. It was sweet and very tasty. I thanked her and she was beaming. The piece of bread was too large for me to finish so I handed out pieces to some of the local doctors and nurses. They were very happy when I offered it to them. I asked why and they told me that the bread comes from a temple 60 miles away where Tara lives and that it is special, holy bread.

The days are filled with patients coming out of surgery and I am occupied with their post-op medical care. One case yesterday was very interesting. We operated on a six-year old boy who had a small mouth, a previously repaired cleft lip that could use some cosmetic revision, syndactyly-fused fingers on both hands, web toes on both feet, and normal intelligence. The surgical team repaired the facial defects and they freed up the fingers on his left hand (the right hand was less affected). I have a book at home from residency called Smith's Recognizable Patterns of Human Malformations. I can't wait to open that text book when I get home to try to figure out if his abnormalities are from a characterized genetic syndrome.

We leave the hospital most days by 6:30-7 PM and gather together back at the hotel to socialize and unwind. We have such a great group of fun, dedicated and skilled professionals. 

GSK PULSE Volunteer, Len is working with a non-profit organization, Rotaplast, to provide pre-operative and post-operative pediatric care for cleft palate surgeries in India & Bangladesh.

We have settled in to our routine, running three operating rooms on a busy schedule. I continue to be amazed at the work being done to help these children and their families. Yesterday, in our screening clinic, a six-year-old boy and his father came in to ask what we could do to treat the child's burns.

The story I am about to tell captures why we are here. This boy was severely burned at age two when he was playing outside in the area where his mother was preparing food in an open pit fire. His mother's sari caught fire. To get the burning fabric out of her face she flipped the scarf part of the dress over her shoulder and it caught the clothes of her son. The boy suffered severe burns to his face, lip, chest, and right arm. They went to a local hospital and were told there was nothing the hospital could do to help. How this boy survived and did not die of dehydration or infection is a miracle.

As the burns scarred, he was left with the right side of his lip attached to his chest, limitation in opening his mouth and in moving his neck.  His right elbow had a contracture severely limiting movement of the elbow and his right thumb ended up bent backwards and attached to his forearm. Prior to seeing the Rotaplast team he had no surgery or any medical care for his burns and the related complications. 

Our surgical team members are all plastic surgeons and while we are here to repair cleft lips and palates, the entire medical team met and immediately determined that we needed to do whatever we could to help this child. Operating on the little boy, Karma, was also judged to be risky because the neck burns and restricted neck movement create the possibility of a difficult airway to control when placing the boy under anesthesia. The anesthesia team met and planned an algorithm for how to manage the airway, and the surgical team worked out their plans for the operation. 

The operation was went well. The airway control went smoothly with a tube placed in the trachea via a scope with a video camera. The team then did a series of regional nerve blocks for pain control and the contractures were released via skin/scar dissections. To cover the wounds the surgeons took non-burned skin form the lower abdomen and did skin grafts to the neck, elbow and thumb. At the end of the operation the anesthesiologists did a caudal nerve block which will provide continuous pain control to the abdomen, chest, neck and arm for hopefully 12 hours. 

In the recovery room the nurses and I managed his pain and kept him hydrated. I was concerned about Karma's safety being on the general ward overnight where there were 38 patients in one room, very few nurses, and no monitors. Thankfully I was able to arrange for Karma to spend the night in the hospital's ICU. I met with the ICU doctors and we worked out a plan for pain control overnight. The look in the father's eyes when he saw Karma after surgery was special. Karma will be back in the operating room in three days for wound dressing changes under anesthesia. When Karma leaves the hospital in about a week it will be the first time in four years that he can use his right elbow and thumb and also move his neck without his tongue being attached to his chest. His life has been changed for the better.    

GSK has major operations and thousands of employees in North Carolina, so we were especially moved by those whose lives were turned upside down by the recent tornadoes. But if there is any "calm after the storm," it's in the fact that we have some great neighbors to help in these times of need--including the American Red Cross Triangle Area Chapter and the United Way of North Carolina.

These two organizations are providing vital services and essential staples--such as food, shelter, emotional support and medicine--to the hundreds of our residents whose homes were lost or damaged in these violent storms, as well as to the thousands who were otherwise impacted. To directly support these life-saving relief efforts, GSK has donated $250,000--half of which will go to the Red Cross and half to the North Carolina Disaster Relief Fund that is administered by the United Way.

Disasters are indiscriminate and create both physical and psychological hardships. Not only do they devastate homes, but they also can be cruelly isolating. We are therefore thankful to the Red Cross and United Way for being there for us...true neighbors in good times but especially in bad.