Bangladesh Update - Dr. Mohammad Rabiul Karim Khan (Papon)
I am Dr. Mohammad Rabiul Karim Khan (Papon), born in Bangladesh, the country which is one of the 20 poorest countries in the world. When I was a student of second year of my MBBS course, I had a dream to be a plastic surgeon one day! My dream came true with my completion of FCPS in Plastic Surgery. During my training period I became familiar with congenital deformities among which was cleft lip and palate, second most common congenital anomalies. Each year at least 5000-6000 child born with cleft lip and palate in Bangladesh.
Parents become frustrated finding their children with this kind of deformities. First they try to dig out the reason behind it. As majority of our population are illiterate, they depend on some false beliefs as the reason behind this kind of anomalies like cutting fish during pregnancy period, effect of full moon or, darkness and sometimes blame the mother for going out without covering her head at night during her pregnancy period etc.
Majority of the parents are not aware of the treatment protocol require for cleft lip and palate. As we know, in case of cleft lip it is very important for the patient to have surgery between 3-6 months of age. And for cleft palate the age limit for surgery is between 9-12 months. Sometimes series of surgeries are needed like alveolar bone graft at around 8-10 years of age. Other problems associated with cleft lip and palate like hearing defect, speech abnormality, feeding defect and some sort of psychological problems also need attention and regular follow up. But in our country it is pretty difficult to achieve satisfactory outcome because of the lack of awareness of the parents of the children suffering. In developed countries intranatal diagnosis of cleft lip and palate is possible and it make easy to prepare the parents psychologically to accept the issue.
Surgical correction of cleft lip and palate is not the only solution to the problem, rather it need holistic approach involving Plastic Surgeons, Paediatricians, SLT, Dentists, Audiologists, Psychologist, Geneticists, Orthodontists, ENT Specialists, Maxillofacial Surgeons, Cardiologists, Anaesthetists, clinical nurse specialists etc.
Cleft care in Bangladesh is not comprehensive care at all. As I already discussed before, lack of awareness make it much difficult to approach the patient on time. Even if the surgery is done on time other associated problems remain unattended.
Cleft care in Bangladesh need good attention and the man who realized it and came forward is Brian C Sommerlad, the former president of BAPRAS and consultant Plastic Surgeon. He has been serving our country for last 15 years by doing surgeries of the poor cleft lip and palate patients in free of cost. He is also conducting hands on workshops and giving lectures to the young surgeons to upgrade cleft care in Bangladesh. Despite of his heartiest effort Cleft care couldn’t reach its satisfactory level here in Bangladesh. He realized that the comprehensive approach and long term follow up of the patients and having a loop with the patient’s family is very much needed for gaining the targeted outcome. Therefore, it was his thoughtful idea to establish a Cleft center at Department of Burn and Plastic Surgery, Dhaka Medical College Hospital in collaboration with CLEFT UK. He along with others concerned in this project decided to ally few surgeons and to recruit an anaesthetist, a coordinator and a speech therapist to provide a complete approach to the patients as much as possible considering few limitations. I find myself fortunate enough for being a part of this project as one of the surgeons. It was decided that all of the members selected for this project will be trained from Great Ormond Street Hospital (GOSH), UK to have a better overview on cleft care so that they can imply their gained experience and knowledge in the Cleft Center at DMCH. I was the first person to get this opportunity to have a composite training program at GOSH with the help of CLEFT, UK and Emirates Airline Foundation.
My training program at GOSH gave me a clear view about multidisciplinary approach to Cleft care and what are the little things we can add here without much effort to change the life of a patient. I practically got the experience on how MDT team works there and met each member of the team providing comprehensive care. I got exposure to each and every specialties which are concerned with cleft care. I observed how everyone is adding something to the Care of a child with cleft lip and /or palate.
During my attachment to Speech and language therapy (SLT) department I learned the technique of speech assessment like nasometry, nasoendoscopy, video fluoroscopy etc. I also joined a workshop on nasoendoscopy to get hands on training.
In audiology department I learned how to assess audiological status of a cleft child.
To my surprise I also had to meet a photographer at GOSH to learn about the photography technique of a cleft patient.
Meeting geneticists was also interesting and learned about the research options on cleft patients here in Bangladesh.
I observed few surgeries, came to know about some innovative surgical techniques and their experiences. It was a directly supervised training.
Record keeping and paper works, instruments handling, handling the suture materials properly all these little but very important things can add a lot to cleft care which I learned at GOSH.
During my stay in UK I got the opportunity to know about their cultural heritage and history and experienced how sincere and devoted the people are to their work. They are very respectful to the laws of their country and well disciplined people indeed.
I planned to implement few things in the cleft center at DMCH from the experience I gathered from my training. They are as follows-
- Following a standard protocol of treatment for cleft patients
- Ensuring good surgical care
- Setting up MDT clinic
- Keeping records properly
- Following up on a regular basis
- Maintaining good hygiene
- Counseling for family members of cleft child
- Ensuring psychological support both for the patient and the family
- Improving awareness on cleft lip and palate by providing information on notice boards and arranging small sessions for the patients’ family members
- Keeping treatment cost as minimum as possible or at free of cost.
With the help of our government, CLEFT UK, GOSH, Emirate Airline Foundation we are determined to have a good quality cleft center here at DMCH under the guidance and direct supervision and cooperation of Brian C Sommerlad, Dr. S.L. Sen Sir, Prof. Abul Kalam , Prof. Sazzad Khondokar , Prof. Rayhana Awal and others.
I am very much grateful to all of them.