Episode 61: Thursday December 01

On a special episode of 3 Plastic Surgery Podcast, Dr. Sam Jejurikar @samjejurikar, and Dr. Sam Rhee @bergencosmetic record their thoughts returning from Bangladesh on a surgical mission trip with a medical team from @smilebangladesh.

All three plastic surgeons, including Dr. Salvatore Pacella @sandiegoplasticsurgeon, have worked with charitable groups for many years to utilize their surgical skills to help children in need. We discuss the challenges of working with underserved populations and what makes charitable care so special.

#podcast #plasticsurgery #cosmeticsurgery #plasticsurgeon #beauty #boardcertified #aesthetic #3plasticsurgeonsandamicrophone ⁠#bergencosmetic ⁠#bestplasticsurgeon #beforeafter #aesthetics #realpatientrealresult #boardcertifiedplasticsurgeon #njplasticsurgeon #njplasticsurgery #nyplasticsurgeon #nyplasticsurgery

#gratefuleveryday #blessed #givingback #cleftlip #cleftpalate #makingsmiles

S03E61 REFLECTIONS ON SURGERY IN BANGLADESH

[00:00:00] Dr. Sam Jejurikar: Welcome everyone to another episode of Three Plastic Surgeons, uh, and a microphone. As always, I am Sam Jejurikar, joined by my co-host Sam Ree.

But unlike always, we are not joined by our third co-host, uh, Dr. Salvato Pacella. And that's because, um, unlike most times, Dr. Re and I are actually in the same location. Um, Dr. Re and I, uh, actually just spent the past week in Bangla. With the charitable organization, smile Bangladesh, which is an organization that is near and dear to our hearts.

Uh, Dr. Ree went on the very first smile Bangladesh mission with the cohost, with the, uh, co with the founder, uh, Shazi about 16 years ago, and was on the board of directors about two years into the, uh, the, uh, organization's inception. He invited me along on a trip and I've been involved ever since. And I'm now on the board of directors.

So, uh, it's near and dear to our heart. For those of you watching our um, podcast on video, you may notice that we are definitely not in Bangladesh. Um, we are enjoying a little extended layover in, uh, a, a place very unlike Bangladesh, Dubai, um, which, um, is a beautiful city with a lot to offer. In fact, earlier today, Dr.

Re and I were enjoying afternoon. Uh, Sam, you ever had afternoon tea

[00:01:22] Dr. Sam Rhee: before? Yeah, we just had it a couple days ago. We were sitting in a hospital in daca, in Bangladesh, in a tiny room in a hospital eating food that Bangladesh's think American people like, which was basically fried chicken, coke and chips sitting with Azi.

Dr. Azi, who, uh, is my dear friend, our dear friend, and, uh, to me that. Afternoon tea is when we travel. .

[00:01:52] Dr. Sam Jejurikar: Yes. For our viewers who don't know what afternoon tea is, it's a very sophisticated British thing with little sandwiches without the crust on on it. But in Bangladesh it's Kentucky Fried Chicken, and uh, and tea.

Um, but they have a very unique, uh, local chicken they use. Um, Sam, how would you describe the local chicken in Bangladesh?

[00:02:12] Dr. Sam Rhee: You. I would say lean would be charitable .

[00:02:18] Dr. Sam Jejurikar: It's all breading, very little meats, which as a child I would've liked a lot. Um, but yeah. So, uh, we're, we're here today to talk about, uh, going to Bangladesh and what it's like to operate there.

I, I've done numerous missions to Bangladesh, so, so it's Sam and over the years, one of the questions that always comes up from people is why do you travel all the way across the. To help people with plastic sugary services when there are people in your own country that need help?

[00:02:47] Dr. Sam Rhee: That's a really good question, and, and I do get asked that.

I think the biggest thing to realize is that Bangladesh and the rest of the world is very much unlike the United States. Um, it's, it's a place of unique need and I know, you know, the size and scope of the issues faced with a place like Bangladesh.

[00:03:10] Dr. Sam Jejurikar: So, so I think from the beginning, let's just talk about demographics.

If you talk about demographics, the incidents of cleft lip andal deformity in Bangladesh, um, is um, somewhere between two to four times higher than it is in the United States. Now, couple that with the fact that Bangladesh is the land mass size that's equivalent of about the state of Arkansas. It's about the size of Arkansas, but the population is about half of that, of the united.

If you do the math, the density of Bangladesh is about 35 times greater than that of the United States. It's like half the population of the United States crammed into something the size of Arkansas. So for every neighbor you might have, Sam, um, in Bangladesh, someone would have 35 neighbors. Uh, and so it's incredibly dense.

Um, the other thing is, you know, as, as Shaha disease has told us numerous times, there's very few plastic surgeons and oral surgeons that can actually offer these service. Um, and so it's, it's, it's an abject poverty and an abject need that's on a different magnitude than what we see in the United States.

Yeah. The

[00:04:18] Dr. Sam Rhee: need for pla uh, for care, for cleft um patients is it's enormous. And when you go to a place like Bangladesh and you see the density, just how crowded it is, how many people there are just the vast numbers of patient. There. I mean, you are a drop in the bucket for sure, but the impact that you feel like you can make there in a week with these children is, is unlike what you could, what you could do in a, in a place that has way more resources and abilities.

Such a, such as a place like the United States.

[00:04:54] Dr. Sam Jejurikar: So the way our trips are typically structured is we tend to have a team that comes from across the United States. Uh, smile Bangladesh is headquartered in New Jersey, but there's a component from Dallas, which is where, where I'm. Um, there's a component from the Northeast, which is where Dr.

R is from. And on this last trip, we had a team that had 22 people. And this consisted of oral surgeons, plastic surgeons, which were me and Sam, um, excellent nurses and amazing anesthesia crew. Um, with four, five anesthesiologists actually. Um, and um, and an anesthesia tech. So we had a full compliment of people from across the united.

Our first and um, and there's a few sites now because we've been going for a while to Bangladesh, a few different sites that we actually will go to probably five or six hospitals altogether. But every time you go, you basically go to an OR that's just an empty room you got, or table some anesthesia machines you can use.

But we have to bring all of our own equipment, we've gotta bring the anesthesia, gas, we've gotta bring the surgical instruments, the suture material, the gauze, everything we have to bring. And so on the one hand, part of the team is working on getting everything set up. The other part is screening patients.

Screening patients is a really, um, sort of interesting phenomena. Sam, like how would you describe screening data to, to our

[00:06:14] Dr. Sam Rhee: listeners? Oh, you know, after all these trips, we've gotten incredibly efficient about it. I love our team. We made this year screening go by well, but as you know, it's, it's literally hundreds of families.

Showing up from Great Geo, you know, really far distances because, you know, they have advertise in advance that there is a team coming from the United States to help, um, these specific types of patients and these families are literally crowding around this hospital that, um, to be evaluated.

[00:06:50] Dr. Sam Jejurikar: Yeah, I mean, to, to even talk about it more, imagine sitting at a.

Um, with you maybe a local physician, an anesthesiologist and tens and tens up to a hundred people crammed into a room, and you've got, um, you're basically surrounded on all sides that people that want to be seen. There's a language barrier. Um, you're reliant upon other people to translate for you. You might have some labs.

You know, in my impression, and tell me if you agree with us, Anne, the level of deformity of what we see there is unlike what we see in the United States, and a lot of these kids have just so many other congenital

[00:07:30] Dr. Sam Rhee: problems. Yeah, I mean, I've worked as a cran facial surgeon in a, in a previous life, and I've never seen the range and rarity of some of these craniofacial and cleft deformities.

These are things that typically you might only see in a textbook, um, and you might see, um, these routine. Uh, in, on a screening day, and you, you literally have no information about these patients other than what these families can give you, and they can pretty much give you no information. So you're, you're trying to d diagnose these pretty complex conditions in the space of five minutes, maybe because you have so many patients to see, you know, anesthesia's trying to determine if they're healthy enough or if it's safe enough to have them, uh, withstand surgery.

And it's a little stressful to try to figure out what it is that you can do for these. Uh, when, you know, these are the kind of issues that if you were in the United States, you would literally spend months teeing them up in order to take care of them properly.

[00:08:33] Dr. Sam Jejurikar: And so I think you got different types of patients that you see.

Rarely you see a young child with a relatively straightforward cleft lip or cleft palate, no other problems. Those are the ones that we get ex, you know, can. Really amazing about being able to help because we know we can take care of them in a safe manner. You know, the first rule of the Hippocratic Oath that all doctors take is to first do no harm.

And we know we can, we can do these cases safely. Another category go though, can be somewhat heartbreaking. These are either the patients that clearly have medical problems that are, uh, that would require significant workup that we're just unable to deliver in these situ. or medical problems that are just beyond our scope.

Um, Sam, tell 'em about the, the young woman that we saw together at our

[00:09:18] Dr. Sam Rhee: table. This was a heartbreaker. She was such a, a beautiful young woman. She had a large vascular malformation, which is basically a large collection of blood vessels that she was born with. Looked like a big, um, spongy grape, like collection on her lower lip.

Um, it was basically filled. With blood vessels and, uh, you might see them in the United States, these type of, uh, human's or vascular malformations, sometimes they call them stort bites. Um, they're little small ones often you might see in a, in a child and they usually, um, they might regress and get smaller on their own.

But this poor, um, girl, she might, maybe she was about six. Um, it just, it, it covered her entire lip and it extended all the way along her jawline, almost back to her ears and, It was really difficult to, uh, tell her and her family.

[00:10:09] Dr. Sam Jejurikar: No. Yeah. Be And the, and how would you manage that in the United States if you saw that?

Well,

[00:10:13] Dr. Sam Rhee: we would get vascular imaging. We would see the extent to which, uh, the blood vessels that were feeding this, this, uh, benign tumor, this, this massive blood vessels were they led. We would work with interventional radiology, um, specialists who would then lock those blood vessels, uh, and, and, To embolize them basically.

Uh, and then once we reduced the blood supply or cut off the blood supply to these, to these masses, then we could safely surgically remove them without risk of severe blood

[00:10:46] Dr. Sam Jejurikar: loss. Right? We would have blood products available to, because the risk of bleeding is quite high. Meanwhile, in Bangladesh, we don't really even have working basic cautery devices like we would have in any or true, like a breast augmentation or an upper eye.

Um, we don't, we don't even have that in our operating rooms there. And then you have the family really wanting us to do this operation. They dressed this young woman up in her finest clothing for the, for screening day. She was wearing like a tiara and, and pearls and, and, um, and even the local surgeons are trying to get us to, to do something cuz they don't really quite understand, or, or, you know, want someone else to try to help this young woman.

Saying no on screening day can be heartbreaking. It was

[00:11:31] Dr. Sam Rhee: the worst, especially this particular girl. Like I said, you said she was dressed up. She was so cute. She had these little pearls on her tiara. She was wearing this gorgeous little pink dress because you know, these families often really dress up these kids because they want them to look good.

They want us to do these surgeries, and the families don't really understand that the reasons why we can't do surgery on a particular child. All they know is is they. such a long distance. This, they know their daughter needs help and they look around and they see this co child being helped and this, you know, me saying yes to this other child, but for some reason that they can't understand, we're saying no.

And, you know, screening days over, they're still standing out there, they're begging probably one of the tougher times, uh, when you're dealing in this type of situation.

[00:12:24] Dr. Sam Jejurikar: Yeah, it's, it's situations like that, luckily. The norm, but they are heartbreaking for sure. So that day is over. We set up the or and then Shazi, who we've had on a previous podcast, if you're interested in learning more about him and the organization, check out that one.

Um, um, but he then compiles this master schedule and we take, and this particular case, we had four operating tables going simultaneously. We had an oral maxillofacial surgeon from Houston, Jose March. Who's, uh, works at Ben Top Trauma Center. We had Sha AZ on another table. We had me on a table. We had Sam on a table.

And then, um, we had John Wallace, an oral surgeon from Dallas at another table. You may have noticed that's five. And we have four tables, so we have some rotation going on and some relief, but that means we have four anesthesiologists and all this is happening in just sometimes one or two operating rooms.

When we're doing this, there's a lot of. Um, lots of, you know, cases going on at the same time. Lots of residents in all maxillofacial surgery from across the country. So it's an amazing experience for these residents cuz they get to see just the full breadth of cleft lip and palate surgery literally in the span of just a few days.

I mean, you

[00:13:36] Dr. Sam Rhee: gotta realize these are exceptionally skilled people who come on these mission trips. Um, shout out to the anesthesia, um, providers, Dr. Mike Rieves from Colorado. Dr. Chris Chin from Dartmouth, uh, Dr. Patel, uh, and, uh, you know Hussain? Yeah, yeah, yeah. And Ena Hussain. These guys, listen, doing pediatric anesthesia is challenging under any circumstance.

You, you know, it's easier, easier to take care of 150 or, you know, a hundred pound person, but when you're going with literally four, like a two month old, four pound kid or six pound kid who's mal. Has a lot of chronic issues. Bangladesh is a really difficult place to grow up and live. These are very unhealthy children, and for them to be able to manage what we do surgically on them, get them through the surgeries, get them to recover, get them to be pain free and comfortable during this, it's, it's a feat that it blows my mind every time I see them do it.

We have sort of a simple part of it where we're just doing what we normally. Um, but for them, these are exceptionally different difficult patients to, to, to manage. I always have a hard

[00:14:56] Dr. Sam Jejurikar: time putting this next thing into words, but I'm never fully comfortable when I'm in Bangladesh. And I'm not just talking about personal comfort, though, that's certainly factoring into it, but even in the operating room setting, um, just all aspects of life, I don't feel that comfortable when I'm there.

Do you feel that way?

[00:15:19] Dr. Sam Rhee: It's a challenge. Listen, you're taking us, we live in the United States. It is comfort. Everything we do is comfortable. And yet, and then you come here. Well, I'm here. This is very comfortable. Okay. This is very comfortable Dubai. But you, you go to Bangladesh and, and you go to some, we actually were in DACA this time, which was marginally better, but we've been in.

From the minute you step foot into the country where you, where you where we stay, our living conditions are, let's just say multiple orders of magnitudes. Different. Yeah. You're dealing with potential health issues. Dengue fever was an issue that we were concerned about this time. Generally speaking, when we go out, um, into the hinterlands and out into the rural areas, malaria prophylaxis, the must.

Just the, the hospital conditions under which, you know, you have to sort of navigate and, and be creative about it in terms of, I mean, these are not, or tables, some of these things, I mean, to this time it was pretty good. But weed on wood tables, like

[00:16:17] Dr. Sam Jejurikar: literal wood tables. Yeah. We've had, we've had operating room lights go out.

Yeah. And I remember doing a cleft palette with just my headlights and an, uh, and a ambient light of a laptop to, to try to be the light. So, yeah, the operating Now, I will say that it seems like things are getting better in Bangladesh. Like there's more, it was still not the United States, but this most recent trip we actually had real, or lights for the first time on any trip.

Um, so it is, it is getting better. But yeah, I mean, Sam and I shared a hotel room, a tiny, tiny little hotel room with, we were on these narrow little beds where our beds were basically touching each. We, um, had a view of, uh, uh, where, where the, the apartment next to ours was about three feet away from our window.

It

[00:17:08] Dr. Sam Rhee: became crumbling

[00:17:10] Dr. Sam Jejurikar: structure we could see right into there. And it was a very nice lady who would look right back at us and she would be doing laundry, uh, and cooking her dinner, all sort of in this tiny little space right across from us. We basically ate curry or rice and doll, which is like a vegetable sort of curry.

For every meal, breakfast, lunch, and dinner are, are the same, are the same meal. I, I think the

[00:17:33] Dr. Sam Rhee: more I travel and the more we are experienced with this, you focus on the very basics. And the basics are what can you eat safely? How do you make sure your GI tract is working properly and how can you not get sick on any of these trips?

And I think that we pretty, I mean, as opposed to other trips, we pretty much escaped unscathed this time around, hopefully.

[00:17:55] Dr. Sam Jejurikar: Yeah, I mean, I definitely have my. Which are go completely against what I do at home. I only eat highly processed food and I don't drink water unless I'm sure it's come from a bottle.

And I've seen the bottle cuz Sam and I have both been burned by that in the past for sure.

[00:18:14] Dr. Sam Rhee: I think the odors and the smells are. Always interesting when you're traveling around in and out of the country particularly. So when you're in, in, in Bangladesh and, and, uh, there's, it does every time I travel here it or to Bangladesh, it does remind me, yes, the minute I step foot in the country, this is Bangladesh, I can smell it.

It's, it's, and, and most of the time it's, uh, it's, uh, quite a variety That is not what you would normally encounter in the United States.

[00:18:41] Dr. Sam Jejurikar: So, Complaining aside, ,

[00:18:46] Dr. Sam Rhee: was that complaining? I was trying to be good

[00:18:47] Dr. Sam Jejurikar: about it. Yeah. . Oh, I brought it up so I'm not singling you up by any stretch. Um, I think this trip is one of the best things that we both do.

Um, the profound gratitude that I have that comes out of this trip, whether it's for everything I have in my life, whether it's for the bonds that I form with people from another culture, another country who don't speak the same. Yet show such unmistakable gratitude and um, and just are so overjoyed that people will come from all across the world to help them.

The bonds that you form with these people so quickly are probably the, one of the, you know, probably the most fulfilling thing that I do in my life. Um, I don't, I mean, you feel that way too

[00:19:38] Dr. Sam Rhee: as doctors. And listen, let's face it, we do aesthetic surgery. As our job at this point, we impact patients' lives for the better.

We want patients to be happy, happier after we've helped them, but this kind of helping on this level is profoundly different. Um, when you think about a child that grows up in Bangladesh, children that would be shunned, ostracized, never made part of a normal. and when you can actually change their life, their entire course of their life with a two hour surgery at an age or even, or even a one hour surgery or, or some of them one hour.

Yeah. You're a faster sur a better surgeon than I am. It might take me two , but you're right. It's just when you, um, when you think about what, when I think about those people that I feel like I can make such a dramatic. It, it, it brings meaning, and it brings contrast to everything else I do. I, I enjoy what I do every day at work.

I appreciate it even more when I come to a place like Bangladesh and I can help these patients. It's, it's overwhelming. It's, it's profoundly overwhelming and I am always left with such a sense of gratitude and, and joy that we have the skills to be able to do this. And, and in a week, in literally a week of, of our lives, every year, uh, this is the first year in a while that I've been able to do it, but, but over the years, it, it, it's kept me grounded and it's, it's made me a better person, pretty much in every way

[00:21:27] Dr. Sam Jejurikar: you're here.

That I couldn't agree more. I can't wait to go back next year and I can't wait to go. I can't wait to see my family, can't wait to work at Dallas Plastic Surgery Institute where everything is efficient and um, and I don't have to worry about where the equipment is coming from. No more surgical, little

[00:21:45] Dr. Sam Rhee: surgical temper tantrums when you're, uh, in the operating room and they don't have the right music playing for you.

[00:21:50] Dr. Sam Jejurikar: Yeah, I mean, it just makes me feel so grateful for everything, both the trip and for what I have in my.

[00:21:56] Dr. Sam Rhee: I want to thank all the people in Bangladesh. I would like to thank SMILE Bangladesh and the, the founder, Dr. Azi. I would like to thank our team. This was, as Sam said, the biggest team, 22 people.

Fantastic. These were all amazing surgeons. Anesthesia, pacu, um, Adrian and Caitlin were amazing. Mm-hmm. , uh, in recovery. Um, I will not complain about my life for at least a week

[00:22:24] Dr. Sam Jejurikar: after I get back. So hopefully you have a little bit of insight into what, um, Bangladesh is like for us. We thought we would talk about this.

Uh, while it's fresh in our head, if you would like to learn more or would like to help in any way, website is smile bangladesh.org. There's a donate section on there as well. Every little bit you can donate helps the organization and helps us take care of more children. So thank you for watching and, uh, until we see you again, take.