Bangladesh: Same Time Next Year
By Eve Jacobs

angladesh is a country of 140 million, with many rivers large and small, most eventually pouring into the Bay of Bengal to the country’s south. They number 700, including the tributaries — and make up a 15,000-mile water network, one of the largest in the world. The rivers are so numerous in some areas that they appear on a map to link into a blue-green maze. Their importance to the area is unequivocal: They provide water for crop irrigation and fish as a primary source of protein and serve as an important means of travel in a country with minimal transportation outside of its major cities.

On this water network a river barge called the Jibon Tari journeys to the most remote regions of the country, bringing doctors, nurses and medicines where none had previously been available. Bengalis travel long distances over rugged terrain — often with children and sick family members in tow — for the chance to be seen by a surgeon or other specialist when the barge docks locally for a two-to three-month stay.

It is an 8,000 mile journey from New York to Dhaka, the capital of Bangladesh, but that was not the end-stop for two American surgeons weary after 15 hours of air travel. Their final destination was Kishorganj province in the northeast part of the country, a five-hour trip over land or just 20 minutes by seaplane. The two doctors and their team chose the short flight since time was so much of the essence. They had one week — including four days of travel roundtrip — to do 31 cleft lip surgeries, a challenge in the most optimal circumstances.

The team of nine — including team leader and UMDNJ-New Jersey Dental School (NJDS) maxillofacial surgeon Shahid Aziz, MD, DMD, and UMDNJ-New Jersey Medical School (NJMS) plastic surgeon Samuel Rhee, MD, — left JFK Airport at midnight on Saturday, January 14. They arrived in Dhaka on Monday at 4 a.m. New York time, which is 4 p.m. in Bangladesh.

What they found when they got to their final destination was a floating hospital on a three-story barge with a staff of 38, including four physicians and 10 nurses, an eye clinic, operating room, recovery room, 12 beds for post-surgical patients, and bedrooms and dining facilities for visiting medical teams. “This is a well-equipped hospital ship literally in the middle of nowhere,” says Aziz, who planned this medical mission over a period of two years.

Group pictured above (from left to right): Sam Rhee, MD, Jibon Tari staff member, Roshini Gopinathan, MD, Jibon Tari staff member, Shahid Aziz, MD, DMD, Robert Memory, MD, DMD Pictured at right: Jibon Tari Floating Hospital, Impact Foundation Bangladesh, moored off Kishorganj Village.

Poverty plays a key role in this story. Because many Bangladesh residents are just too poor to afford even basic medical care, surgery to correct physiological abnormalities is way beyond their means. In the U.S., facial anomalies such as cleft lip and cleft palate are fixed before a child’s first birthday. In countries such as Ecuador, where poverty also seriously limits access to medical care, teams from the U.S. and Europe frequently fly in to help fill the gap in services. [A surgical team from UMDNJ went to Ecuador this past February and in March of 2005 to operate on children with cleft lips and palates.] It is simply a question of proximity.

Jibon Tari Floating Hospital, Impact Foundation Bangladesh, moored off Kishorganj Village.

Bangladesh is just too far — and the outlying regions too remote — to make a week-long or 10-day journey worth the investment of time and money. In addition, there are reported to be less than 10 Bengali surgeons in the country trained to repair cleft lips and palates. Consequently, in Bangladesh clefts often remain untreated until the teen years or early adulthood. This major facial flaw — so routinely fixed in our country — often becomes the source of a child’s heartache and an entire family’s isolation. As a child grows and develops from infancy to early adulthood, the cleft grows as well, and the faces of otherwise beautiful children become seriously misshapen. Teeth grow willy-nilly, and speech and eating are often affected, too.

Aziz has a deep connection to Bangladesh. His father — who was a physician-researcher at Merck and who is no longer alive — was born there and has many relatives still in the country. Knowing about the poverty and the grave medical situation, Aziz was determined to do something.

The two surgeons and their team — including plastic surgery resident Roshini Gopinathan from UMDNJ-University Hospital, oral surgery nurse Fran Devonshire from NJDS, and five members from Columbia University’s College of Physicans and Surgeons — worked on the barge’s two operating tables set up side-by-side, doing simultaneous surgeries. In this way, they were able to do 10 procedures each day.
This is a story where the pictures really say it all. When a two-to three-hour surgery accomplishes such radical transformations, words are ineffective to describe the difference. Suffice it to say that there are 31 children and their families, whose lives will be radically different from here on in, and 81 children, teens and young adults waiting in Kishorganj province for this team to return next January.

“We’ll go for two weeks next year and operate on as many clefts as we can,” say Aziz. A year seems like a cruel wait for those of us who have major hospitals and skilled surgeons practically on our doorsteps. But being able to look forward to the return of the UMDNJ surgeons next January is an important milestone in itself for many families.

Although this trip was all work and no play (four days of travel, four days of operating), the team was treated to a fine dinner in Dhaka on the Friday night before leaving the country. But even better than the array of specially prepared Bengali foods that the group enjoyed was the rather emotional meeting of Aziz with members of his family who had gathered from far and wide. The maxillofacial surgeon’s visit was truly a bridge linking the past and the future, and two very different cultures.

“This was certainly the most memorable of the six medical missions that I’ve participated in,” says Aziz.

“These trips always benefit the medical team as well as the patients. We are reminded of why we became doctors and that we are connected to a larger global community,” he says, in summing up their venture.

The team has returned to the trials and tribulations of their daily routines in the U.S. but with the collective memory of 31 faces — one by one — turned to the camera’s eye with a little less hesitancy and a dream of a future that didn’t exist for them before.

This trip was sponsored by Healing the Children (www.htcne.org) and Impact Foundation Bangladesh (www.impactfoundationbd.org).