So No Child Must Wait

Speech Camp Provides Training for Patients and Caregivers

  Speech Therapy 
  Originally uploaded by interplast

Birgunj, Nepal -- Shankar Man Rai, plastic surgeon:  It is the rice-planting season in Nepal so it is a difficult time or year for  farmers to bring their children to the speech camp.  It is  also the rainy season and all the rivers are swollen.  One farmer had to cross a river that is normally only knee level--but it had swollen to the chest level after the rains.

In spite of these difficulties a total of 27 children attended the speech camp in Birgunj.  As you can see in the photo, the hotel rooms used by the children and their  parents doubled as the space for our speech therapy sessions!

Twelve of the children were attending the speech camp for the first time while 10 had attended it once in the past, and only a few had attended it for more than three times.

Most of the children were found to have relatively good speech and our speech therapists think that most of them may be discharged after a couple of speech therapy camps.  The relatively better speech results might be the result of our newer technique,  Sommerlad muscle dissection, which gives good apposition of levators and also does retro positioning of velum. We are trying to analyze it.

In addition to the speech therapy conducted by the therapists and trainees, all the children were given a general dental assessment. We have called three patients to Kathmandu for closure of anterior fistula. Pawan has been very helpful in incorporating the dental works in our program. It is so good that Interplast was able to support him during his training in Pakistan.

We're looking forward to building upon the training these camps have provided our newest trainees at a four-day seminar in Kathmandu next  month.

Speech Therapy Team Travels to Nepalese Plains

  Speech evaluation 
  Originally uploaded by interplast

Dhangadhi, Nepal -- Kiran Nakarmi, plastic surgeon:  Dhangadhi lies in the plains in the far western part of Nepal. It is one of the hottest places in Nepal--so it was not easy for either the kids and their families or the faculty to conduct a week-long speech camp when the temperature was approaching over 42ºC!   But we were surprised to see the enthusiasm of the kids and their parents. They were very keen to learn.

There were many of us in the team, so there was a lot of teaching and learning going on throughout the week. At the same time, the kids were kept busy learning speech therapy as well as playing interacting games.

Thirty-two of our patients were former Interplast patients.  Three of our patients had very good speech and we discharged them. They will be seen annually. Two of the kids with submucous cleft palate will be sent to a different location for palatoplasty because we are not able to do this surgery in Dhangadhi yet.

Twenty-three attended speech camp for the first time and seven for the second time.

Since the last speech camps, we have identified eight new trainees from different parts of the country for basic speech therapy training. We invited all of them to Dhangadhi. Additionally, our speech therapy assistants, Kabita and Shivkala, were there for the camp. Our speech pathologist, Bhawani, was also there. This gave us plenty of opportunity for interactive teaching and learning while also being able to keep the children and their parents busy all the time. Two plastic surgeons, myself and Dr. Bohara, also saw all of the patients with rest of the team.  And Badri and Madan were there to counsel the patients and their families.

Pawan was on hand to do the dental evaluation of all of our kids. As in previous camps, patients and families were taught about dental hygiene.

All in all, another successful speech camp.

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...

Speech Camps Provide Continuity of Care

  Showing Off New Toothbrushes 
  Originally uploaded by interplast

In Nepal's rugged countryside live nearly 1,000 of Interplast's former cleft patients. Shankar Man Rai, Interplast surgical outreach director in Nepal, has made it his mission to provide much-needed folllow-up speech therapy and dental hygiene training to these young people by traveling with a team of specialists into the difficult-to-reach villages. 

Recently, seventy-eight  patients were helped at two speech camps held in Biratnagar and Butwal.  Teams that included speech therapists, dental surgeons and hygienists, and counselors and coordinators traveled to the villages and staffed the week-long camps.  They were helped in their efforts by several speech assistants and trainees, who were being trained as part of an ongoing effort by Dr. Rai and his lead speech therapist, Bhawani Pradham, to fortify the ranks of specialists available to run speech camps in even more remote areas of the country.

Interplast provided grants that covered the travel and housing expenses for the patients and their families at the week-long camps.  Putting in long days, the therapists worked with the children in groups and individually and provided family members with detailed training so that the therapy could be continued at home.

For some, who were attending their first speech camp, there is additional surgery and therapy in their future.  But 10 lucky children “graduated” from speech camp entirely.  They will be followed and evaluated by Interplast’s team to check for any changes in speech patterns until they reach adulthood.  For now, however, they have mastered the techniques they have been taught—and provide evidence of the vital role Interplast is playing in the complete recovery for children with a cleft palate.

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...

A Very Special Note of Thanks

Translated from a letter written on a large sheet of red paper from a child in Chongqing, China:

Dear Interplast [Aunt and Uncle],

I am a cleft lip patient.  My family is poor and doesn't have money to treat.   I've had this for more than 10 years.  My parents love me very much and are very concerned.  At home, all the kids make fun of me and don't want to play with me. Therefore I am very shy and don't have self-esteem.  In school my classmates make fun of me.  I don't play with them. I put distance between us.

My grades are good and I pass my exams, but my inside is different.  My classmates envy me for having good grades but I envy them for having a complete face.  How I wish I had the same smile!  Every time I think of my cleft I feel sorry for myself.  Every new school year I am laughed at by the new students.  They harshly criticize me. I don't know how to deal with it. I ask myself why God gave me this deformity.

Now, thanks to you, I have completely recovered. I am not laughed at by others. I can smile. I'm so overwhelmed with emotion — I want to hug the dear uncles and aunties who fixed me. You doctors are not afraid of hardship; you came such a long way to Chongqing to help us with cleft. 

We are so lucky to get this gift of smile. I am deeply moved. I thank everyone in this group who helped.  You work so hard.  Although you are very quiet and do not brag, you do such extraordinary things.  You've made such a great contribution. We will never forget your giving spirit — it moves us to tears.

Thousands of words cannot express how I feel inside. I'm so grateful. I will study hard to repay my countrymen.  Please accept my sincere gratitude.

Bless you all.