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Final Thoughts

  Green "Baby Taxi" 
  Originally uploaded by interplast

Dhaka, Bangladesh -- Tim Sproule, plastic surgeon: 21 June:   I am driven back to the hotel.  On the way we pass by some low huts stuck up against a wall--this is home to many Bangladeshis.  I pass by one of the green "baby taxis:" the faces inside mutely speak of their hardship.  I want to come back and help more...

The Last Day

  A Crowded Patient Ward 
  Originally uploaded by interplast

Dhaka, Bangladesh -- Tim Sproule, plastic surgeon: 21 June:  I have had an interesting last day here at Dhaka Medical College.  Shafquat had asked me to help him with a difficult case of obstetrical palsy: a young woman had suffered a traction injury to her arm at birth, and was left with a pratically paralyzed arm.  After considering the case for a couple of days, and reading up on the options for her, I decided to advise Shafquat that the woman should wait for the hand team coming in November.  While I have a lot of experience as a hand surgeon, her problem is simply beyond my expertise.  I would be no better than Shafquat at helping her. This is humbling, but I feel it is in the patients best interest...

The case we did instead was one of a severe burn to the hand that required a complex release and placement of a groin flap.  The team of trainees did virtually the entire case under my supervision, and demonstrated good surgical technique and a wonderful atmosphere of camaraderie.

I gave a final lecture right in the operating theater as the case was being completed, and then was overwhelmed to receive some gifts from the group for my small efforts this week.  The Bangladeshis are so generous, despite having so little...

After the case was completed, I went on rounds and reviewed the small boy we had operated on the day before.  He was doing fine, and hopefully will be ready for some further work in November when the full hand team comes. 

I also toured through a couple of other wards.  In one room, there were 77 patients in a space designated for 22.  The halls were filled with patients and their families lying on the floors.  Doctors and nurses do their best, but there are so few resources.  I take a few pictures.  The images hammer home why it is so important to help people like Shafquat who dedicate their lives to these suffering people.  My contribution is so small in comparison...

A Difficult Day

  Electricity Accident Patient 
  Originally uploaded by interplast

Dhaka, Bangladesh -- Tim Sproule, plastic surgeon: 
19 June  (at the end of a long day):  We did a very difficult case today.  A young boy suffered an electrical injury and has lost his left arm just below the elbow, and also has suffered a severe injury to his right arm.  We did an thorough exploration of the arm, and found that he had extensive injury to his nerves and muscles, as well as the loss of a large amount of skin. The skin coverage we provided with a flap of tissue from his abdomen--the groin flap.  But the rest: the muscles, the nerves, the joints, will need to be reconstructed later.  I have suggested to Shafquat that the next Interplast hand team, scheduled to come in November, make this brave little child a priority.

I was fairly tired today. The jet lag was a problem as it always is on a short trip, but I also was tired because I had gone to observe Shafquat at his after-hours clinic, where he does cleft surgery for Interplast thanks to a grant from The Smile Train.  Between the hours of about 4 pm and 2 am he and his team did eight cleft repairs.  Dr Khundhkar estimates that he is now doing around 600 clefts a year; I suspect that may be more than any other practitioner in the world!  We discussed trying to organize some kind of exchange program for American and Canadian trainees to come and learn from him.  This would be a full-circle advancement: Interplast first comes to help by doing surgery, then trains Shafquat and empowers him to start doing the work himself, and then he achieves the status of a true international expert and has our "boys and girls" come to learn from him!  It is gratifying to see what an accomplished surgeon he has become...

The Training Begins

  Hand VE Workshop 
  Originally uploaded by interplast

Dhaka, Bangladesh -- Tim Sproule, plastic surgeon:  18 June: Today, we did our first day of surgery.  There was great anticipation in the large enthusiastic group that Dr. Khundkar has assembled.  They are so hungry for knowledge and experience.  The operating room looked like a surgeons' convention.  We got down to work and got a couple of good cases done.  I will speak more of some of the cases on subsequent entries.  I am really pumped to do some good teaching!

Settling In

  Bob McCahill & Tim Sproule
  Originally uploaded by interplast

Dhaka, Bangladesh -- Tim Sproule, plastic surgeon:  17 June:  I am settled in back in the Sheraton, which is like a strange luxury liner in the middle of the reality of Dhaka, a sprawling city of some 30 million struggling souls.  I spent yesterday and today at Dhaka Medical College, meeting Dr. Khundkar and his "boys" (which include several girls now...) and going over what we would try to accomplish in the week.  I did a clinic where I tried to put the plastic surgery trainees on the spot to help them with their hand examination skills, and we made some plans to do some surgery.

I had the pleasure of meeting up with an old friend as well, Brother Bob McCahill, who is a missionary who has lived in among the poorest Bangladeshis in isolated towns for more than 25 years, showing them by example how to live a selfless life of service.  He brings patients with congenital deformities down to Dhaka for Dr. Khundkar to assess and possibly help as part of his service to the isolated communities that he lives in.  He looks the same as when I first met him in 1994: despite his hard life, the spirit of giving obviously agrees with his health!

Return to Bangladesh

  6:30 AM Descent 
  Originally uploaded by interplast

Dhaka, Bangladesh - Tim Sproule, plastic surgeon:
It is 6:30 am, and I am making my final approach down to Dhaka, Bangladesh.  This is my 5th trip to this country. The flight has been a long one: I am traveling 10 time zones ahead of my home town of Toronto.  A couple of hours ago we flew over the Middle East:  Iraq, Iran, Israel, Palestine.  From up in the clouds, you would never know that there was so much strife and unhappiness down there.  Everything looks pretty much the same from 30,000 feet. But now that we are getting close to ground again, I see that Bangladesh is basically like a huge marsh--water everywhere.  It's Monsoon season, and it has been raining a lot.  Last week Chittagong, one of the major cities, apparently went 2/3 under water during a big thunderstorm.  And in a country that has so little resources--to combat such disasters!

I am here to help Shafquat Khundkar, an Interplast Outreach Director, by teaching some hand surgery skills.  I was supposed to come in November last year with a full highly skilled team, but we had to cancel the trip at the last minute because of political unrest.  I feel lucky to be able to make some smaller contribution to make up for our November failure.  Things have improved on the political front, but Bangladesh is never without big problems.  Like the weather...

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