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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.

Today was the last day of operations. We operated on 105 patients during this very successful medical mission. The mission's success is due to many factors, but four stand out.

We were hosted by the Chittagong, Agrabad Rotary Club. Starting months before our team arrived, these Rotarians worked round the clock identifying potential patients, assisting with translation and other patient needs at the Nurture Centre, and making us feel at home in Chittagong. They were incredibly generous with their time and hospitality.

The Nurture Centre's founder Nasreen and her extended family and friends are angels. Words can't describe the kindness and empathy they provided to our team and to the children and their families.

Our team of surgeons, anesthesiologists, pediatricians, recovery room nurses, operating room nurses, and non-medical volunteers was simply incredible.

The people of Bangladesh are warm, friendly, and resilient. Working with these children and their families was a real pleasure. 

As I was leaving today, Nasreen's sister Selma asked me "Why do you do this? What makes you travel far away from your family to treat poor children?" I answered that my reason was the same as her sister's. Nasreen founded the hospital because her own children had access to medical care and she identified that many others did not.  She wanted to address this gap, and she had the capability to do so. I know I speak for all of my amazing Rotaplast colleagues in saying that we volunteer because we also see a gap and we have the capability to help close it.

Parents in Bangladesh are no different than parents in my home town--we are all the same as we strive to provide the best opportunities for our children. I am very glad I had the opportunity to serve. I am grateful to GlaxoSmithKline for allowing me to take time to volunteer and I can't thank enough my family for their support.

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 mentioned in an earlier blog that the founder of the Nurture Centre where we are working is a woman named Nasreen. Nasreen has created a very special center where people in need can receive medical care and her generosity and selfishness also extends to her family and friends. Nasreen's sister Selma, who lives in Texas, travelled to Chittagong to help us with the mission along with her 22-year-old son Shehzwan (Shez). Shez, a neuroscience student at the University of Texas at Dallas has been helping the Rotaplast team as an interpreter.

On the first day of the mission, identical twins walked into our intake clinic. These brothers, who speak Bangla and English, have been at our side round the clock. They have been interpreting, assisting the operating room nurses, transporting patients, finding supplies, changing dressings, fixing the air conditioners, (it has been over 100F every day), and doing whatever is asked--always with a smile. They are Nasreen's 23-year-old boys (there is also a 10 year old sister). Yamin and Yasir enjoy being together.

They attended The National University in Singapore and spent a post-graduate year at Harvard and MIT studying fluid mechanics. This Fall they will be enrolling in Cambridge's aerospace engineering PhD program. As if being astronauts isn't enough, Nasreen would like them also to be medical doctors.

The wards have been filled with wonderful patients and each day we are creating many new smiles. The children and their families welcome me to take pictures and they enjoy viewing the pictures in the playback mode on my camera. Everyone here has a cell phone and I have been in hundreds of cell phone photos the parents are taking as well.

One patient from yesterday stands out. Twelve year old Rohamat pictured below was born with a cleft lip and a nose deformity. His parents had no idea that the deformity could be fixed by surgery until just a few weeks ago when they saw a newspaper advertisement about the Rotaplast mission. They travelled eight hours by bus to get to Chittagong. Their father told us that Rohamat has been given a new life.

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.

On a recent Saturday at the Nurture Centre, we made 17 new smiles. One of the children is 10-year-old Riyaz. Soon after birth he developed a growth on his upper lip that was operated on when he was six years old. After that surgery, the growth increased in size and two years ago he also developed a growth on his left upper eyelid. He attends school but has trouble concentrating because his eyes hurt when he reads for long periods. I enjoy speaking with the children to learn about their lives and what they like to do. Riyaz plans to be a wholesale business person like his father.

Our surgical team removed tissue from his eyelid and lip and pictures below show the dramatic difference. It is not clear what has caused the tissue growth. Tissue samples were sent out to a local hospital laboratory for examination and I hope we have the pathology results before our mission concludes.      

Mohammed, 15, was born with a cleft lip and had surgery when he was younger. The first surgery did not completely repair the defect so he came to see us. Our team of surgeons did their magic and created a fantastic new smile. Mohammed plays soccer and cricket, sometimes wears his hair spiked with gel so it looks like he has a Mohawk and wants to be a doctor. His father told us when seeing his son for the first time after the surgery, "he was always beautiful, and now is even more beautiful."

Our last patient on Saturday was a 28-year-old man also named Mohammed. As he was recovering from the surgery, I noted that a young woman with a little child in tow was sitting next to his bed in the recovery room. She was beaming and so happy. She was Mohammed's wife and it was an honor to see her joy upon seeing her husband's appearance transformed.

We stayed late in the hospital last evening taking care of a 5-month-old who had her cleft lip repaired. She developed respiratory distress, required extra oxygen and developed a fever in the recovery room. We started treatment for pneumonia and transferred her to a nearby hospital with the help of local doctors so she could have closer monitoring overnight. While we were waiting for the ambulance the wind picked up and a storm blew through. It rained like cats and dogs for 60 minutes and the ambulance was delayed getting to us because the roads were flooded.

When we finally left at 10:15 PM, it had stopped pouring but it was quite a scene. Many of the roads in Chittagong are dirt and those that are paved have poor drainage. The roads were filled with water four to five inches deep. This did not seem to bother the Bengalese who continued going about their business as if nothing had happened. Men were driving passengers in bicycle rickshaws despite water covering a good portion of the tires, people walked through the streets with no mind at all to the water obstacles, water flowed from the roads into shops and did not disrupt business, and people sat in restaurants with water way above their ankles. The only difference I could tell from the rain was that it made the traffic and congestion even worse. At one point when we were moving inches at a time a car in front of us decided to turn around in the middle of the road and somehow managed to drive against traffic. We could not believe our eyes.

Flooding is a serious problem in Bangladesh. The country is the size of Utah and has a population of 164 million (half the US population). It is already wall-to-wall people and the population is expected to rise to 220 million by 2050. In the future, large portions of this country will likely be under water as the sea levels rise due to destructive river flooding and cyclones which have been increasing in intensity. As the sea levels rise, salt water mixes with coastal fresh water streams interfering with the growth of crops and fish farming. Loss of land for people to live on and to farm is a big issue as the cities are already overcrowded. Their neighbor India is concerned about immigration and is building a 2,500 mile border security fence.

My experience working with the Bengalese people is that they are resilient and adaptable. I am glad we are here to help some children and their families as now they have one less thing to worry about.      

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.

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.

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.