Episode 26: Sunday December 13

Drs. Sam Jejurikar, Salvatore Pacella, and Sam Rhee welcome special guest Dr. Shahid Aziz DMD MD FACS FAACMFS, co-founder and President of Smile Bangladesh. A 1st generation Bengali-American, Shahid has been leading a small team of surgeons, anesthesiologists, and nurses to Bangladesh since 2006. To date, his teams have treated about 1100 children and adults with cleft lip and palate deformities.

Dr. Aziz is a Professor of Oral and Maxillofacial Surgery and Plastic and Reconstructive Surgery at Rutgers University, is a Diplomat of the American Board of Oral and Maxillofacial Surgery, and a Fellow of the American College of Surgeons.

Dr. Aziz is also an Attending Surgeon at University Hospital (Newark, NJ), St. Joseph’s Regional Medical Center, Paterson, NJ, Robert Wood Johnson University Medical Center, New Brunswick, NJ, and Hackensack University Medical Center, Hackensack, NJ. He is a graduate of the Lawrenceville School and Rutgers College. Dr. Aziz received his dental degree from Harvard University School of Dental Medicine and his medical degree from Columbia University College of Physicians and Surgeons. He completed his general surgery and oral/maxillofacial surgery training at New York-Presbyterian Hospital-Columbia University Medical Center. He has authored or co-authored over 50 peer reviewed journal articles and 10 book chapters.

Dr. Aziz's clinical area of expertise includes facial trauma and reconstruction and orthognathic surgery. He currently serves as President-elect of the New Jersey Society of Oral and Maxillofacial Surgeons, Chairman of the Section of Dentistry and Oral Health of the New York Academy of Medicine, and is a Fellow of the American College of Surgeons.

Full Transcript (download PDF here)

2020.12.13 S01E26 DR SHAHID AZIZ TRANSCRIPT
Dr. Salvatore Pacella: [00:00:00] All right. Welcome everyone. Welcome to our next podcast. I have a very special guest here, Shahid, Aziz. he is going to talk about smile Bangladesh, but prior to doing so let's go over our disclaimer here. This show is not a substitute for professional medical advice, diagnosis or treatment. The show is for informational purposes only.
Treatment and results may be, may vary based on the circumstances situation, a medical judgment after appropriate discussion, always seek the advice of your surgeon or other qualified health provider with any questions that you may have regarding your medical care, never disregard professional medical advice, or delay seeking advice because of something in the show that would, that being said, I'm going to hand it over to our other two gents.
Here we go. 
Dr. Sam Jejurikar: [00:00:44] thanks. Thanks for that. frenetic introduction, Dr. Pacella. so today's theme, we're falling up and a theme that we have had before, which is about service and giving back. And previously we have featured a project that was near and dear to Dr. Pacella's heart. and today we're going to talk about a project that Dr. Rhee and I have had some involvement with. And yeah. With that I'm really excited to introduce our guest, who is Dr. Shahid Aziz, a little background about Shahid. He is a professor of oral and maxillofacial surgery and plastic and reconstructive surgery at Rutgers university in New Jersey. He receives his, his dental degree from Harvard university and his medical degree from Columbia university.
And interesting fact Shahid is only one of six American trained oral and maxillofacial surgeons. To act to be inducted as a fellow of the Royal college of surgeons in Edinburgh, his clinical expertise is an actually complex maxillofacial trauma as well as orthognathic surgery. But today we're going to talk about his passion project.
Dr. Aziz much like Dr. Rhee and myself is a first-generation Asian-American. 
He is Bangladeshi, and in 2006, he founded the non-profits smile Bangladesh. he, took his first team of surgeons, nurses, anesthesiologists to Bangladesh in 2006, where they engaged in cleft lip and palate surgery.
And since then, I believe he's a lot about 23 missions. Is that right? Dr. Aziz, 
Dr. Shahid Aziz: [00:02:08] 23, 24 total. Total 24 missions. 
Dr. Sam Jejurikar: [00:02:11] I'm sorry. got that from the website. so that's 23, 
Dr. Shahid Aziz: [00:02:15] but it's an 
Dr. Sam Jejurikar: [00:02:16] over 1500 cleft lip, MP surgeries on both adults and children and I, and Dr. Ray have had the privilege of going a few of these trips.
And Dr. Aziz, thank you very much for joining us today. and I'm just curious about your inspiration. How does, a man that grows up in the United States never been to Bangladesh, decide that he wants to treat his ancestral homelands, of this, just to give back there. what made you decide to start this organization?
Dr. Shahid Aziz: [00:02:43] I think, first of all, thank you for having me, and it's a real pleasure to be on the show and, to talk about something that as, Dr.  noted is something very close and close to my heart. and the answer to that question, basically it comes down to, this is where I'm from.
This is where my father is from. And it's something that he, asked me to do. before he passed is to never forget, where he came from. And that's a numbness of why we started this organization.
Dr. Sam Jejurikar: [00:03:10] Okay. And, over the years, you've actually. Grown the organization considerably. what challenges have you found first five years relative to the last five years, a small Bangladesh? what are the challenges that you're dealing with in the current time brand that you didn't have when you first started?
Dr. Shahid Aziz: [00:03:26] I think there are challenges here in the States and their challenges, in Bangladesh, think, eh, when you look at, from the state side challenges, it's recruiting the right people. and the reason I say that is, as the two Sams know, because both of them have traveled with me on multiple missions in San Marie actually traveled with me, on the very first one.
you're, you have to bring the right group of people because you're in a very remote part of the world and you want to get along and you want to have everyone on the same page. And, it gets very uncomfortable when you have people who may not fit into the group. And, that's part of the challenge on the American side.
The other challenge is funding, doing a lot of fundraising and it's something that I do around year round is constant fundraising. And, the missions costs now about 40,000 a piece to cover, most of our expenses, not including airfare. we do try to cover, the non surgeon, non-doctor airfares for the nursing staff and things like that.
So we're constantly fundraising because it's important that we cover all of our expenses and the patients that we treat, are not incurring any expenses. So those are the two big issues, in the States. I guess the third issue is transportation and as far as getting, equipment, to Bangladesh, but we've overcome that because now we are actually storing most of our equipment.
In Bangladesh itself, but prior we were bringing it. And, that was a little bit of a pain. In country in Bangladesh, the biggest, hurdles are overcoming some of the politics. you have to deal with. the government is constantly changing and I've met with multiple health ministers over the years, to try to, further our.
A mission. there's a lot of, politics and you have to deal with that. there's a lot of egos and you have to be very careful about not stepping on toes with the local surgeons. And finally, just planning accordingly. And we're lucky now that we've been doing this now for, over 16 years, 24 missions under the belt, that we have a core group of sites that we now go to that are used to us, used to our needs.
And we have a really terrific, executive director in Christina Rosario. Christina is. Bangladeshi. and she ran a large NGO in Bangladesh prior to immigrating to the States about, 12 years ago. And, she basically handles all of our logistics on the ground and goes ahead of us. And, it was constantly making sure that, we are.
well-planned so planning, I think is the biggest issue. the key to success, prior to arriving, 
Dr. Sam Jejurikar: [00:06:07] I thought, many of our viewers really can't even picture a Bangladesh looks like. And so you were kind enough to put together some slides, which I'm going to load up on my screen here, and was hoping that you could run through and talk about smile, Bangladesh, and 
Dr. Shahid Aziz: [00:06:21] sure.
Dr. Sam Jejurikar: [00:06:22] No. Why Bangladesh? Why not? what is it about the country? So can you guys see any shot head slides here? Okay. 
Dr. Sam Rhee: [00:06:28] not 
Dr. Shahid Aziz: [00:06:29] yet. 
Dr. Sam Rhee: [00:06:32] Hold on. Okay. 
Dr. Sam Jejurikar: [00:06:33] It says that it's perfect. 
Dr. Shahid Aziz: [00:06:34] Yep. Yep. good. 
Dr. Sam Jejurikar: [00:06:36] even before you start that, I did want to ask you, let me ask you one question shot ahead and that's, Rutgers is on a five game losing streak to Michigan after 
Dr. Shahid Aziz: [00:06:45] last night, 
Dr. Sam Jejurikar: [00:06:46] which when they're triple overtime, as, 

as a professor at Rutgers, I just kind wanted you to know what you think about the state of the annual Beatdown of Rutgers university 
Dr. Shahid Aziz: [00:06:55] of Michigan.
Yeah, it's
it would look even worse if Michigan lost erupted. So it's a given, although Michigan, did lose to Rutgers, I think the very first time they ever played in the big tent, cause I was actually at that game, but, last night was close. you have to really, really bad two really bad first teams duking it out.
And it was actually, they actually did stay up till almost one o'clock in the morning and finish it. it was disappointing, but it is what it is what it is. Michigan should be doing a lot better. 
Dr. Sam Jejurikar: [00:07:28] Yeah, I think we can agree to bad teams, but Rutgers is still worse, 
Dr. Shahid Aziz: [00:07:31] All right.
 I. I like this slide. it's a great telling slide because this is a mother and daughter, and they are in a site that the two Sams know well, which is in Khulna, which is on the Western border of Bangladesh about, an hour from Calcutta and in India. And, this is a 20 year old mother and a three-year-old daughter.
And, It tells you one that there's a need for services in rural bearing with dash, because you have a 20 year old woman who with an unrepaired, lip, and you have the daughter with an unrepaired lip, but it also tells you there's a large genetic component, associated, in Bangladesh, in general, emo in clefting around the world, there's a large genetic component, but this slide tells you why there's a need in the rural parts of Bangladesh.
And that's why I like this slide so much. Yeah,
correct? Correct. Yeah. rural Bangladeshis, they don't necessarily have access to care. So that's what so important about what we do, and again, we're basically, based out of my basement. we're a small organization, with big goals, but we are a five Oh one C3. So any donation is tax deductible.
And our goal is basically to provide, surgical and medical care to individuals with facial, cleft deformities and facial deformities, in Bangladesh and around the world. But our, obviously our focus is Bangladesh and that's our website. So please take a minute to check it out. if you have a chance.
 for those of you who don't know where Bangladesh is, basically it's, a small nation it's about the size of Idaho. but it does have 162 million people in it, which is half the population of the U S so it's a very densely populated country. and, we've been fortunate, we've done 24 missions.
we obviously we're on a. Pandemic hold, for 2020, normally we go every March and every November. and we. Where literally a day or two away from leaving in March for our 25th mission when, the pandemic, entered the States. And, we made a decision as a board to, abort simply because we were simply worried about traveling and coming back into the U S at the time.
But, our next mission hopefully is in 2021, maybe. Or definitely November of 2021. and, we've treated 1600 patients over the last, 14 years. So I think it's not, I never thought we would get to this point. and it's really, thanks to a lot of people that, including the two Sams, including a lot of other people that we were able to achieve, what we've achieved.
And I think we have a bright future.
No worries. so again, why Bangladesh it's country of 62 million people? It's estimated there are about 300,000 individuals with unrepaired, cleft formalities, and there's only about 30 surgeons or so in the country with formal training, which is 10,000 patients per surgeon, in the U S there's about.
One in a thousand births, individuals with clefts and in Bangladesh, it's a little higher, significantly higher, really it's up to one in 500, so twice. And it's used, usually caused by either genetics. As I mentioned before, nutritional deficiencies we've found that, fully deficiency is the one thing we know, that.
If you have prenatal, folate deficiency is associated with clefting consanguinity. So one of the issues in rural Bangladesh is first cousins do marry. That's a tradition and a lot of rural communities throughout the world, to keep money in the family. And as a result, you're sharing a common gene pool, which is, increasing the risk of birth defects.
And finally, I, in rural Bangladesh, girls get married extremely young, and they, their bodies are probably not ready for delivering children. And so there is an increased risk of birth defects in the, in that population as well.
So this is our typical team. and this varies from site to site that we go, when Sam Rhee and I first started, it was just the two of us. And we went, to, a hospital ship, Bangladesh is full of rivers. And so we actually took, landed in doctor, took a sea plane, To a rural part of the country landed next to the boat.
And it was just the two of us running two ORS, but over the course of, and again, that was 2006 over the course of, the last 14 years we've evolved to a running four to up to four, or tables, depending on the site, meaning we'd bring four attending surgeons, as well as appropriate number of anesthesiologists.
We always bring more anesthesiologists than we need, because, w it's really, where is the risk? it's with the anesthesia. And, we'd like to have more anesthesiologists, pediatric anesthesiologists available, and knock on wood. We've never had any anesthetic issues. sometimes their pediatrician comes, but more often the local host, provides us with a pediatrician or a primary care physician to prescreen the patients.
we do bring nursing staff, specifically a circulating nurse, as well as a one or two. recovery room nurses, depending on the site and the size of, of the, mission that we're undertaking. Christina is our, administrator and she's, I always call her the MVP of smile Bangladesh because, she plans everything and it's literally planned minute to minute.
for the week to 10 days that each mission lasts and, planning a well-planned trip is a successful trip. And I think what's really, important to me is that we bring residents and we've brought oral maxillofacial and plastic surgical residents on these trips. and it's a really great experience for them because they're working one-on-one with, an attending surgeon and it's an intense experience over the course of four to five days, they're doing 20 to 30.
cleft surgeries, it's something that they probably wouldn't do in a full year of their training. Maybe even their whole training experience. And they have the opportunity to work one-on-one with an attending, maxillofacial or plastic surgeon doing a lip, doing a pallet and a, and they learn a heck of a lot, but more importantly, you want to.
Try to inspire them to realize that, they're becoming surgeons and they have the opportunity to make the world a better place. And so it doesn't really matter what they do as long as they give back. And, and I'm hopeful that, during their careers, they'll see what, the four of us have done, as far as, for example, as far as giving back and inspire them to do and I know that there are several residents who have gone on to do their own thing over the years when that's all was a great thing. I wanted to tell you a little bit about our patients. I like this picture in particular because it's a bunch of kids waiting on the hospital ship that Sam Rhee and I were on.
and the one kid inadvertently is. Giving me the bird
yeah, I think he was like, who's this Mexican guy, taking a picture, but anyway, it tells you, they all lined up and, wait for our, wait for their surgery. and again, you can keep going, Sam, the, just some pictures again, of, some of our patients. this picture is courtesy of Bruce Byers is a photographer in New York city.
and this, this picture, I particularly by going to multiple sites, Rotating the sites. We tend to see the same patients for their lip surgery initially, and then their palate surgery. So this is a year apart. This is a young girl who on the left, just moments before entering the, or for her lip repair.
And then on the right, the morning after her palate repair, which is why she has a little bit of a bloody nose, but you can see how. doing that lip repair the year prior, you have to look closely and, the four of us would obviously know that something was done, but the average person probably wouldn't pick up on the fact that she had something done and, a 60 to 90 minute procedure changes this person's life forever.
And that's why doing surgery is so profound. Interestingly with Bangladesh, you have a lot of older patients. And as was mentioned earlier, a lot of people don't have access to care. And this is just a bunch of literally a bunch of teenagers, with, lip, disorders, just waiting to be treated.
and so we often are treating adult sized patients of teenagers, moving on to, adult patients. you can. Yeah. And this is a, 20, I think 22 year old that treated a while ago. And you can appreciate as the, patient gets older, the primary deformity gets wider, becomes much more anesthetic.
And again, an hour surgery. This is him literally right after surgery, an hour surgery. you can see the big difference that, that's achieved and you can see the. You can appreciate, you're not just affecting the lip, but you're also bringing the nose back together. this is a 60 year old, woman from the Hill Tracts of Bangladesh, right on the myin Mar Porter, which is why she has that little more, Asian look to her.
and, again, she never had an opportunity to have her lip repaired. She's six years old and then she wandered in and, had our. A team take care of her lips. again, it just tells you in parts of the world, such as Bangladesh, there are a lot of people who just don't have access or even realize that they can get this repaired.
this is, our oldest patient, a 68 year old farmer, who literally just wandered into one of our camps. He has a bilateral cleft lip and, you can go to the next slide, Sam. it's 
Dr. Sam Jejurikar: [00:16:59] It's amazing how you ought to counsel him for tobacco cessation and get a pre-operative EKG, which is not typical in the U S for our cleft patients.
Dr. Shahid Aziz: [00:17:09] and again, this is just him going to sleep, which is literally why on the or table, going to sleep. And this is him in, recovery. and again, you can appreciate. the, the difference that we've made for them, why organizations like Smile Bangladesh is so important and, the nice kind of caveat to this story is he really was looking to get married and he did apparently get married, later on, at the age of 68 or 69, but, good for him.
so one of the things about, clefs is it's more than just lips and palates. it affects actually the facial skeleton and it affects how your jaws are positioned. And so one of the things over the last five years that we've evolved into in addition to doing lip and palate, repairs is. In the main in the larger cities, Dhaka, Chittagong we've, teamed up with, the Bangladeshi society of oral and maxillofacial surgeons to develop what's called an orthognathic program, meaning that we're treating individuals, with class, and even non-class who have what's known as skeletal malocclusions, or.
Or under bites, overbites things like that. cleft patients tend to have, because of the star scar formation from the powder, lip repair, they tend to have a restriction of the growth of the maxilla and it results in, Excellent hypoplasia and underbite, et cetera. So they need to have in the States, for example, they'll have orthognathic surgery or repositioning of their jaws, by the time they're teenagers and this often doesn't happen in a more, underserved parts of the world.
So one of our initiatives now, in addition to doing, cleft surgery, lip and palate surgery is working with local surgeons to develop the orthognathic component. And it's something that, isn't really done in general in Bangladesh. So this is an exciting new chapter for our organization.
I just want to make a note that when we do travel to all these different sites, We do take local surgeons with us and work with the local surgeons because it's education is an important component of what we do. And this is a sort of an evolution of, smelling Bangladesh. In fact, there's one site, in a town called Cox, Bazaar where, they really basically told us a few years ago, they don't really need us anymore.
Because they're comfortable, after five missions, they're there, they're comfortable, their local surgeons are comfortable taking care of whatever they need to take care of. and while it's not, a little disappointing in the sense that it was a great site, but it's, it's rewarding because we've gotten, achieved our goal in that site.
So a couple of years ago we started doing orthognathic surgery and we, This was a much more complicated than your lip and palate repair. it requires a lot of instrumentation, a lot of equipment, and it has to be done in a formal hospital. A lot of, the clef camps that we did in the more rural areas were done in more rural, facilities, that were safe.
But, they're not great for very involved, intricate surgeries, and. We've done two orthognathic, workshops so far, the first one was in 2018. It was educational workshop. with lectures followed by, cadaver surgery, which basically I had a, like a GoPro on my head or they were filming me, doing osteotomies on cadavers, in Bangladesh, which was an interesting experience.
so that was in 2018.
Yeah, please.
Yup. Or just a couple of pictures of, that first symposium this was done at East West medical college, which is right outside of, Dhaka. it's actually where in the part of Dr where all the garment factories are, which is interesting, and this is, they set up, again, it's in a, it's in a, medical and dental school facility.
so they had the large lecture hall and, next slide, I had about 200 people in attendance, from the local dental community, listening to our team, talk about different, aspects to orthognathic surgery. Next one too. And this again is, the cadaver part where they're filming the actual osteotomies.
I'm talking into a microphone and explaining things. And in another room, people are watching and asking questions. So that was the first, The first time that we did this a couple of years ago. And then last a year ago, last November, we segwayed into more formal, actual live surgical demonstration, in, and this was arranged in conjunction with the Bangladeshi association of oral and maxillofacial surgeons.
we did three, orthognathic surgeries, during this trip, including this young man who was a. Young man with a cleft lip and palate deformity, as well as a severe, underbite, which you can see from this photo. Okay. keep going to, and this is just, yep, no worries. And this is his, you can see him from his, repos, smiling and side view and the side view, you can obviously really see the jaw deformity, that he has keep going.
Okay.
Again, this is a x-ray, it's called lateral ceph. you can really appreciate the underbite, and you can imagine how difficult it must be to function to eat, but with something like this, and this is a, again, a different x-ray of, his, deformity. And the trip prior to, the actual surgery.
So when I was there in March of 2019, I had a chance to work this, young man up, evaluate him, had a set of dental casts, made, got some x-rays on him and, took it, got an actual CT scan done. So I brought all that information back with me, to the States, so that I could plan his surgery out.
next
now orthognathic surgery is done. Orthognathic surgery is done in the States now through, surgical planning. So it's done virtually now. you don't have to really stay in the lab and do, pour up models and make splints. You actually can do it by a 3d printing and planning it, digitally.
And that's what we did, here. And this is when we got back to the States, we took a CT scan, figured out. What kind of osteology, we're going to do a reposition, his upper and lower jaws. And from that made splints, that would guide us in intraoperatively. we had, donations from some of the companies that I work with, to allow this to happen specifically 3d systems, medical modeling, who made the splints for us.
Free of charge and, Stryker, craniomaxillofacial who donated the power system that we brought to Bangladesh, as well as the plates and screws. Next slide, Sam.
Yeah. So this is again in 20, in 20, November, 2019. we were at Dhaka dental college and we did three orthognathic surgeries, over two days. And, For this young man surgery, the cleft or thing, they have the surgery. obviously we had, cameras filming us and we were miked up. And so in the adjacent room, there were people watching and asking us, questions, unique experience.
I'm not used to having people right on top of me while I operate. but it was a well worthwhile and again, I was actually very impressed. How they, arranged everything. but they were able to, from an AAV standpoint, really make it work. So they had us on film, had a smile and then in adjacent conference room, they set it up so that, people can ask us questions and watch as we did the surgery.
Next slide.
 and again, this is a. I think it'll take a minute to line up, but you can see, pre and post, slides, for some reason it's not lined up much quite sure why, but, yeah. Yeah.
And so part of what we also did was, we had a day-long symposium, with, a couple, individuals from the States that I brought with me, from left to, is Dr. Jose Marchena, who the Sam's know who vice-president of smile Bangladesh. She was a maxillofacial surgeon at university of Texas Houston.
Jessica Lee, who, at the time was a craniofacial fellow in West Virginia. and the two people in the mid middle, Padma Mukherjee is a, orthodontist from Rutgers and Greg, Jacob is a colleague of mine, from New Jersey. He was a maxillofacial surgeon and then myself. And so we basically had a symposium, discussing surgery with the Bangladeshi oral surgery society talking about ortho, orthodontic care, and preparation.
So it was a really day long comprehensive, Thing that we did in addition to, the surgery. these are just a few, slides from, over the years. this slide on the left is, Sam Ray, and I during I think that first mission, to Bangladesh in 2006 when we were both young, without gray hair.
And, this is Sam again, with, in recovery, looking at one of his patients. and again, Sandra Jura car, looking perplexed on the left. and, and then what, one of the things that, I really, liked is, and, smile Bangladesh is a family where we are a family. It's very important to me.
we have a core group of people, including the two Sams that are involved in the organization and we are a family and I always extend to everyone. If they have children, teenagers who can. Who are interested in coming and also are, they have to be, able to travel the distances that we travel in and you don't sleep a lot on these missions.
you get there as a huge time change, you hit the ground running. and so they have to obviously mature enough, but, Sam brought his son Kai multiple times with us. And Kyle was a huge asset to, To, our missions, he was, would play with the kids, help out in the recovery room and it was really, a source of, real, positive energy for everyone.
so I was really happy that Kai, came, born and hopefully we'll see him again. And I know that, I'm going to, when my kids are a little older, I'm going to bring them as well. but it just tells you that we are a big family. And, I'm really pleased, not just to be talking about this today, but to, to just amaze how well we've evolved.
And this is just a picture of the three of us in Cox's bazar probably about 10 years ago would be my guess. And, yeah, and that's really it. So again, that's a broad overview of what we do. And then again, I'm just amazed, how we've evolved. I would never have imagined, in 2006, we'd get to where we are now.
It's a, 
Dr. Salvatore Pacella: [00:27:50] what a, what an amazing, amazing organization. Shahid, thank you for sharing. do you, so tell me, obviously the types of surgeries you're doing require some additional, follow up after the case. And I know you mentioned that, you guys are really taking a priority to teach local surgeons, and Yeah.
Has that changed over the years? what's your comfort level and the type of cases that you're choosing and doing. 
Dr. Shahid Aziz: [00:28:15] Yeah. that's a great question. I will tell you that, we do bring local surgeons, to train and also we ask them to follow up. and it wouldn't technology.
It's very easy to Skype or FaceTime when there are issues. they always will follow up with us. So we are able to keep it pretty close eye on how things, transpire. and, so far knock on wood. We haven't really had any major issues, will in the last 14 years. That's great. 
Dr. Sam Rhee: [00:28:42] I have to say, Shahid that the organization I've been involved with from the beginning and it's, having. and it, the thing I would say is it does everything the right way. I, one of the things that these charitable organizations need to do is come from the heart, which certainly, smile Bangladesh has always come from the heart. It serves a population that really needs care. And, as we know, Bangladesh has gone through many trials and tribulations over the years and it's grown.
Tremendously, but it's a place where care is desperately needed more than more so than I would say most places in the world. And so if you were looking to a place to help, that would be one place and the group, that you've put together over the years have been. completely dedicated they've, really worked with the local, surgeons and a super positive way.
Every time I go, I really enjoy, interacting with, the surgeons that we meet and that we talk to and all the other people. And it's a really an educational experience. It's not a. drop in, operate and leave a situation by any means. And, the longevity of smile Bangladesh has meant that you have some very fantastic, relationships.
you've educated them, you have symposiums and if you're going to go someplace and do work, that's the right way to do it. And lastly, just, the people that you bring, I remember, and I know, at Michigan when we went, Our need for our desire for service was kindled by Dr. Bob Gilman and a lot of the trips that he initially did when we were residents. And the fact that you bring residents that you, bring young people, you are fostering a sense of. service and the realization that your skills and what you can do can help everyone. And it doesn't have, it can be, in your neighborhood.
It can be people that you bring to your, area, just like a fresh start surgical gifts does for Sal. or you can travel halfway around the world. And, I would say every trip I've gone on has changed me, in some significant positive way. I've become a much better and bigger person because of it.
And at the same time, I've learned a tremendous amount and that's the sort of, endeavor that, has been amazing to watch from the beginning all the way to. To now. 
Dr. Shahid Aziz: [00:31:04] Yeah. Thank you, Sam. that means a lot. And again, both of the Sams have been on our board and, I've been really involved.
we actually, San Rhee and I, or at Columbia together and with a third person who's now passed away. Di the three of us came up with this idea to go. and starts small Bangladesh. and it's been really, it's really great, and for me on top of that, I actually believe it or not.
my father died when I was 16, so I never had, an opportunity to go to Bangladesh until we started Smile Bangladesh. Sam Rhee remember the first time that I was meeting my family, he came to my family's house. And the funniest thing I remember about that story is. they're Bangladeshi families are massive.
I have literally 51st cousins in Bangladesh. and every time I go and meet a new one, and they're probably about, we go to my uncle's house in Dhaka and we pull up Sam and I, and, there are probably 30 or 40 people outside and Sam made the unfortunate decision to get out of the car first. And so they think Sam is me.
So I just see him surrounded. And his little hand in the air pointing. So that was funny. it, for me also, I get to see family and everyone, the two Sams I've had all of my family out there. And so it's, it's a lot of fun on many levels of Sal, you have an open invitation, you're always welcome to come as well.
Dr. Salvatore Pacella: [00:32:27] I would love to join you. Yeah. 
Dr. Sam Jejurikar: [00:32:29] Yeah. I will say, one of the things that you mentioned, two things that really stuck out, and I want viewers to think about, which is Bangladesh is the size of Idaho, but the population is 160 million people, which is about half the population of the U S so just the density of people is overwhelming.
And most of our viewers will never see Bangladesh, but the kindness of the people as well. So many of these people have so little and they are. So grateful that people are willing to travel halfway across the world to care for them, that these are some of the most life affirming, positive experiences that I will have throughout my life.
And every time that I get to go, it's quite a privilege. And it's all due to Shahid's efforts and Christina's efforts. So I'm half with Sam and me and the people of Bangladesh. Thank you very much. We appreciate the trips and we appreciate your time today. 
Dr. Shahid Aziz: [00:33:18] Yeah. thank you for giving me the forum to talk about it early.
Appreciate it.