2/10/11 Tika Se

We’ve done so many awesome things this week. Saturday we observed a few surgeries (both cleft lip and cleft palate) and I actually scrubbed in for one of them! I mostly just suctioned for Carlos, the surgeon from Lima. It was sooo awesome! The operation was mostly in Spanish too, so that was interesting. I ended up translating for some of the medical staff, like the anesthesiologist from Egypt. It was such a memorable experience. I couldn’t believe the way surgeons just cut right through the mouth so aggressively and then carefully stitch it back up. I’m so interested in trauma medicine and surgery. Maybe I can become a physician assistant in surgery because I can’t see myself for the next 8+ years committing to medical school.

Sunday was the last day of the first mission, so it was a half-day. Minh and I have taken on a side project doing post-op evaluations or satisfaction surveys before patients are discharged. This was appointed to us by Cindy who is in charge of quality assurance. Most of them are happy with their surgical results, but some said the wait time was too long. I’m not surprised; some of them had to wait 24+ hours. This project is more for internal use to improve the mission experience for patients.

Tuesday the second team arrived for the second mission. So yesterday (Wednesday) was screening. Minh and I were going to pull information from the first mission’s charts, but EMR was having logistical issues, so we ended up playing with the kids and making a flow chart for Justin who had a meeting with Prof. Samet to update him on the different research projects going on. Alex (plastic surgeon living in Guwahati) and Carolina (another plastic surgeon from Colombia) have many ideas for research. Last night we had a meeting at his apartment and there are literally 10-11 different project ideas they have! The most relevant one to public health was nutrition burden amongst cleft lip/palate patient, the associated risk with surgery and also whether or not speech improved after palate repair if they’re older than 7. So today we are doing a literature review of the different articles published on nutrition related to cleft lip/palate in India and also how the WHO measures their growth curve. Defining malnourishment is a whole other task, because it can’t be universal. Some phenotypes are smaller than others. For example, Europeans on average are taller than other population groups. Of course, this is a huge generalization, but a growth curve could be developed per region. Alex and Carolina want to develop one for Assam for insight on whether or not surgery would be appropriate of if the patient is too malnourished in which case Operation Smile can help the patient get healthy in order to get their surgery. Stephanie said that Op Smile actually just hired a MPH graduate who’s in charge of Maternal and Child Health at headquarters. Also, Stephanie is working on a grant to study the use of herbicides in the tea plantations and the prevalence of cleft lip/palate amongst the farmers. It’s so apparent that the worst cleft lips (bilateral with exposed gums) are in the farmers. There was this one man who every time I looked over he had the hugest smile, but really bad cleft lip. I saw him before and after surgery and took pictures telling him I was so happy for him and he just put his hands together bowed implying Namaste.

I hope I can continue to be involved in all the research and project ideas here in Guwahati. I don’t know how and to what extent, but I really enjoy this field work and especially how Operation Smile isn’t just concerned about cleft lip/palate, but also other factors effecting these patient’s lives like nutrition and herbicide exposure. This are the kind of upstream factors us public health students have been trained in evaluating and is what really inspires me to be in this field. Human health is not just disease, but also quality of life. That is something I’ve learned by being here. Public health is also concerned with how people live. Everyone deserves a life with full opportunities not hindered by bad health or environment. Cleft lip/palate severely effects prospects in marriage and education therefore effecting mental health. A couple patients’ parents actually told us that their children never left the house out of shame for their appearance and/or speech impediment. This has been difficult for me to process as I’ve always concerned myself with emergency medicine. However, some of these people have lived 40+ years with limited opportunities and social stigma because of the way they look and sound.