COURTESY TRIPLER ARMY MEDICAL CENTER
Above, Capt. Marc Herr performs microscopic ear surgery with the assistance of Spec. Andrea Miller and a Bangladeshi surgical technician.
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Mission rejuvenates lives
A Tripler team goes to Bangladesh to operate on patients suffering from various ailments
A Tripler Army Medical Center team performed "life-changing" operations on 50 adults and children in Borga, Bangladesh, for cataracts, chronic ear disease and cleft lip and palate deformities.
U.S. Army surgeons can make a difference with specialized skills and equipment lacking in Bangladesh, said Lt. Col. Christopher Klem, an ear, nose and throat surgeon and chief of head and neck surgical oncology at Tripler: "It is a small investment on our part with a big payoff."
The "Sight, Sound and Smile" humanitarian mission was the second there for Klem; Lt. Col. Benjamin Cable, chief of pediatric otolaryngology (a specialty involving diseases of the head and neck); Maj. Brett Nelson, ophthalmologist; and Sgt. Melissa Aschenbrenner and Spec. Andrea Miller, surgical technicians. Capt. Marc Herr, resident otolarygologist, was a new team member. The mission from Aug. 12 to 24 involved six days of travel. Surgery was performed Aug. 17-20 on 20 patients with cataracts, 22 with congenital cleft lip and palate deformities and eight with chronic ear disease.
Klem said many impoverished people throughout Asia have these diseases. Bangladesh has nearly 150 million people living in an area about the size of Iowa, Klem said. The country has a national health-care system, but most people live in poverty and access to medical care is difficult, he said.
COURTESY TRIPLER ARMY MEDICAL CENTER
A cleft lip patient poses before surgery.
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Bogra, with 285,000 residents in the Rajshahi region of northwest Bangladesh, was chosen for the mission because it is largely agricultural and "one of the poorest areas in the world," Klem said.
The regional health minister made arrangements with the military hospital to treat medically underserved civilians during the mission, he said: "It is pretty unusual. It would be like if we went to Honolulu and offered services to civilians at Tripler."
Hundreds of patients were prescreened as candidates for surgery by the civilian hospital in Bogra and about 100 were sent to the military hospital, he said. The Tripler team selected the most serious cases, starting with children, he said.
Only eight cases were taken for chronic middle ear infections because they involve complicated microscopic surgery to remove diseased tissue and reconstruct ear drums, Klem said.
Ear infections are the most common cause of deafness in Asia, where people aren't treated adequately with antibiotics and the World Health Organization deems them a priority in Asia, he said.
Cable, who did cleft palate and lip reconstruction, said he's the "smile" part of the mission: "It's a phenomenal thing to do for kids."
The number of those needing this surgery was whittled to 60 in prescreening and the mission's goal is to do 20 to 25, he said. His team repaired 19 cleft lips and three cleft palates.
In the United States, these congenital deformities "get fixed so early it's not that big a deal," Cable said. But most patients in Bogra were 5 or 6 and some up to 17 years old because few Bangladeshi surgeons can do the surgery, he said.
COURTESY TRIPLER ARMY MEDICAL CENTER
The same patient is shown at center on the day after Lt. Col. Benjamin Cable, chief of pediatric otolaryngology, performed surgery. His team repaired 19 cleft lips and three cleft palates.
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It is a big social problem affecting families as well as children, who generally are ostracized, Cable said. They can't go to school or hold a job and aren't likely to marry, he said. "So these kids are shut in. With repair, we can get them back in the mainstream.
"Part of our mission is to train local surgeons who are very good" but don't have the training needed for these cases, Cable said.
The Tripler worked with surgeons at the Combined Military Hospital Bogra, a Bangladeshi army hospital. At the end of the mission, they were doing cleft lip surgery on their own, he said. "They were at the point of being independent. We're hopeful they will continue to do this."
Cable said it's "just a privilege" to go on such missions. It creates "genuine friends" among people of different countries, he said: "When we take care of somebody's family, any cultural difference there is set aside."
Nelson, director of Tripler's laser refractive surgery center and assistant chief of the ophthalmology clinic, removed advanced cataracts from 19 "basically blind" patients. He also had a ptergium case, involving a growth of tissue over the cornea.
Cataract removal, he said, "is a very rewarding experience for patients as well as the surgeon. It is a huge lifestyle benefit, going from having to feel yourself around the room to being able to see."
Nelson said he acquired an instrument last year from a Bangladeshi company to perform the surgery. This time, he took with him a more modern ultrasonic machine that emulsifies the lens of the eye, he said.
American Medical Optics makes the only federally approved portable version and loaned it to him before receiving a purchase order, he said.
The mission was "kind of a lot of work but a lot of fun for us too," Nelson said. "You recharge your batteries as far as doing medicine. It's all the good things about medicine and pretty much none of the bad."
"People were unbelievably supportive and very happy," Klem said. "There was incredibly positive response from the military and civilian patients. Everybody came and thanked us in English, Bangla or Bengali."