Bill Klaproth (Host): This is an AAOMS On The Go Podcast. I'm Bill Klaproth. Joining us today are Dr. Shahid Aziz, Dr. Jessica Lee and Dr. Vickas Agarwal. Dr. Aziz is Professor of Otolaryngology, Hackensack Meridian School of Medicine; Division Director, Oral and Maxillofacial Surgery at Hackensack Meridian Health. He is also the President and co-founder of Smile Bangladesh. Dr. Lee joined Smile Bangladesh in 2019 as a resident volunteer and has returned each year to serve as a volunteer surgeon. And Dr. Agarwal joined the Smile Bangladesh team in 2022 with help from a $2,500 GIVE stipend from the OMS Foundation.

Doctors Aziz Lee and Agarwal are here to discuss their volunteer experiences and the rewards associated with providing humanitarian healthcare to underserved areas of the world. Doctors, welcome to the podcast. We appreciate your time today. Dr. Aziz, let's start with you. When did you launch Smile Bangladesh and what inspired you to do it?

Dr. Shahid Aziz: Smile Bangladesh was officially started in 2010, but we started our first missions in 2006. Within that time between 2006, 2010, I decided that the best way to perpetuate what I'm hoping to develop in Bangladesh, was to start our own 501(c)(3); and hence, the Smile Bangladesh was born.

The origins really are I'm half Bangladeshi on my father's side. I have a lot of family in Bangladesh. And the person who trained me, Dr. Steven Roser, had allowed me to accompany him on multiple missions to South America. And as I became more involved and developed a passion for global surgery, I also at the same time found through family that there was a huge need for the services I could provide. And that's when in 2005 I worked with Christina Rozario, our Smile Bangladesh's Executive Director, to develop our first missions to Bangladesh in 2006. And again, we did several missions and then I realized, from a logistical standpoint, it was a lot easier to do our missions as our own 501(c)(3) nonprofit; and hence, that was how I started Smile Bangladesh.

Host: Got it. And are there local healthcare providers you work with in the communities you serve?

Dr. Shahid Aziz: So every mission we do, we partner with an NGO locally, typically in rural Bangladesh or if we are in a larger city such as the capital Dhaka, we partner with a dental school. So, each of those organizations have healthcare providers that we work with during our missions. And oftentimes, especially with the dental schools, we work with their own set of oral surgery residents, because training local surgeons has become a big part of what we do and an important part of what we do. So, again, we do work with the local healthcare team. It's a very important part of what we do.

Host: Right. So when you travel, how many team members travel with you?

Dr. Shahid Aziz: The team typically is up to 16, 18 people. The size depends on the number of OR tables we're able to run at a given site. Typically, it's three to four. So, I typically will say, for example, if we have a site with three tables, we're going to take three attending surgeons, we're going to take four anesthesiologists, we're going to take two or three nurses. We have an administrator. And then, I try to get oral and maxillofacial surgery residents to accompany us. And because the GIVE scholarship has now facilitated that, we typically take about four OMS chief residents on each trip. And the reason for that is to really just inspire them to have a great experience internationally and inspire them to give back.

Host: Right. And then, so why is it important to include OMS residents on the team?

Dr. Shahid Aziz: As I mentioned, the goal is not to make them cleft surgeons. The goal is to provide them with an unparalleled experience and a unique experience to add to their training. And the hope is to, again, inspire them to give back in their own career. It doesn't matter in what fashion. It could be international work, it could be domestically. But really, it is to make them aware that they have the ability, the skills to make a difference in this world. And that's what I hope to inspire them to realize.

Host: So then, how many patients then would you serve during a typical visit?

Dr. Shahid Aziz: Typically, we do 50 to 60 surgeries per mission.

Host: Okay. And then, what does a typical case look like?

Dr. Shahid Aziz: Well, it actually depends now. It's a little more complicated as we've evolved. Initially, it was almost a hundred percent cleft lip, cleft palate surgery. In the last three, four years, we have added orthognathic surgery to what we do in Bangladesh, specifically cleft orthognathic surgery. And we were able to do that because we're able to use the facilities and partner with those dental schools in Dhaka because we do need much more sophisticated facilities than the rural NGOs can provide. So if we are going to a rural site, it's a hundred percent cleft lip and cleft palate surgery. If we're going to Dhaka, often it's a combination of 30 cleft surgeries and 10 orthognatic surgeries.

Host: And then, who delivers followup care?

Dr. Shahid Aziz: Again, it's the NGOs that we're partnered with when it's out in the rural community combined with the dental schools that we work with when we go to those dental schools. They all provide really good followup. And, you know, technology today, it's very easy for communication after we leave through WhatsApp, through Zoom, through FaceTime, what have you. So, we are able to have a good followup with all of our patients.

Host: And then, how about your relationship to the communities you serve?

Dr. Shahid Aziz: Well, you know, for me, it's a unique relationship because I am a Bangladeshi American. So, it is a special relationship for me personally. We have been really well received by the Bangladeshi Oral and Maxillofacial Surgery community by that specific national society. And I think now that we've been going so often, we've made more than just professional relationships. We've created and developed into close friendships with many of the surgeons in Bangladesh.

Host: Right. Well, that is good to hear. And then, how do you finance an undertaking like this?

Dr. Shahid Aziz: Well, the organization, we spend the whole year, basically doing fundraisers or writing for grants. So, we have a fair amount of money that comes through from corporate sponsors. One of our board members, Dr. John Wallace, who's an AAOMS member and based in Dallas, has a really fantastic fundraiser in Dallas every September. And then, the balance frankly comes out of our pocket.

Host: Okay. That's very interesting. Well, Dr. Aziz, thank you so much for your time. And then, Dr. Lee, I want to bring you into the conversation. Thank you so much for being here. I understand you were one of the first recipients of a travel stipend from the OMS Foundation's Global Initiative for Volunteerism and Education or the GIVE Program. So, what inspired you to apply?

Dr. Jessica Lee: Yeah, absolutely. I think this kind of goes a little bit farther back. My initial interest in cleft mission work began sort of at an early age growing up in Seoul, South Korea. I witnessed my father operate on a child born with a cleft during his time in the South Korean army. So, I think this experience imprinted early on in my life just because of the profound change that I saw immediately after the child's surgery. And I think that also played a role in me pursuing a career in oral and maxillofacial surgery.

So, fast forwarding towards the end of my surgical training, I was fortunate enough to have the opportunity to apply to the OMS Foundation's GIVE Program to help fund some of the cost associated with being involved in the mission trips.

Host: Yeah. And then, what were your expectations for that experience?

Dr. Shahid Aziz: Yeah. So, I think my expectations were to actually just be able to learn more so than for me to "provide care" to these communities. I think that was my outlook on my involvement in the mission trip. I think a lot of people maybe consider doing the mission trips as something where you get to contribute a lot more to these communities than they contribute to the surgeon or the team. But I think at the end of the day, you get a lot more out of it than what you maybe are able to give, especially as a trainee. But it definitely exceeded my expectations that I had going into, going on my first mission trip to Bangladesh.

Host: So then, how did your experience match up with those expectations? It sounded like you just said that it exceeded it, so it did match what you were thinking.

Dr. Jessica Lee: Yes, you do get surgical experience, like Dr. Aziz mentioned, out of the mission trips when you're paired up with experienced surgeons. But at the same time, just being immersed into these different cultures and their way of living and how they view healthcare, how they view doctors and relationships between patients and doctors. I think it's very eye-opening, you know, beyond the surgeries themselves.

Host: Absolutely. So, you've continued to serve with the team as a volunteer OMS since then. So, what inspires you to return each year?

Dr. Jessica Lee: So, I think this goes back to my first experience at a young age, witnessing the surgery that my father performed and being able to give back to these communities with the skills and assets that I've been fortunate enough to acquire during my surgical training, and even with the small impact that I'm able to have going on these mission trips every year. But also, like I said, just being able to learn from these patients myself, I think it can get quite addicting in a sense where you can go on one or even two missions a year to be able to have a different perspective on your role as a surgeon in practice.

Host: Yeah. I would imagine so. So, does your experience as a GIVE recipient then help you mentor other residents?

Dr. Jessica Lee: Yes, I think so. Absolutely. I think the GIVE Scholarship through the foundation helps with one of the I think main barriers that someone might have being able to go on these mission trips, which could be financial; just the travel costs, for example, associated with going outside the country. But also, I think just having the information in one place in terms of what opportunities are there for a surgical resident in terms of which groups are going to which countries, what kind of work are they doing. I think that was very well laid out on their website, for example, so that someone who's interested in maybe getting involved, they'd be able to get all this information in one place. If they have any questions in terms of their experience or in terms of my experience rather, they're able to reach out to past GIVE recipients and just ask about their time on these mission trips. So, I think it makes a good networking opportunity as well for future and past GIVE Scholarship recipients.

Host: Absolutely. Well, thank you so much for your time as a volunteer OMS. We appreciate it. And Dr. Lee, if you could hang on, we're going to bring Dr. Agarwal. And Dr. Agarwal, welcome. So, another question here, kind of on the same path that we've been talking about, what inspired you to travel halfway around the world to serve with Smile Bangladesh?

Dr. Vickas Agarwal: Well, thanks, Bill. And thanks, Amy, for having us on the podcast. I appreciate it. So, I've always wanted to engage in some sort of international service trip. I didn't really know where or when that would be. When I was in dental school at Virginia Commonwealth University in Richmond, Virginia, I was very lucky to meet Dr. Neil Agnihotri and did a summer internship with his practice. Dr. Agnihotri trained under Dr. Aziz and he mentioned Dr. Aziz's grant Smile Bangladesh. And that was a great opportunity. I should do whatever I could to try to join on the trip. So ever since he imprinted that in my head I said, you know, I've always wanted to do it and this sounds like an even better opportunity. And I was lucky that I did my residency at Parkland in Dallas, Texas, where I met Dr. John Wallace, who as Dr. Aziz has mentioned, is very heavily involved in the organization, and he's committed to bringing one of us along on each November mission. And I was lucky enough to be that person last year in 2022.

Host: So, are there other volunteers among your family and friends who inspired you?

Dr. Vickas Agarwal: I mean, other family members who are in dentistry and in medicine. My grandfather's in his late '90s and still runs non-profit in India. It's non-medical related, but nothing specific other than those experiences that I see. And my grandfather really also always emphasized growing up, "Get an education, use it for good." And I think that's what I wanted to do. I've been very lucky to have the education I have and I feel like I wanted to use it for something beyond the borders of the United States. And to be honest, I've never really left the United States since I was young. I went to India once as a child. So, it was just a great way to experience a different life in a different country and experience what they experience on a daily basis.

Host: Yeah. So, do you have previous volunteer experience?

Dr. Vickas Agarwal: In dental school, I volunteered at numerous free clinics in the area in Southwestern Virginia, but never really traveled abroad to do so. So, this is my first time.

Host: So then, what was the biggest challenge of your Smile Bangladesh experience?

Dr. Vickas Agarwal: Honestly, the entire experience is incredible. Besides just the little bit of a legwork, getting a visa and the simple things, Dr. Aziz's organization is run like a well-oiled machine. I mean, from the time we hit the ground to the time we left, everything was smooth. I didn't know what to expect. And the organization, him and Christina really had everything organized down to a science.

And the best part in my opinion about Smile Bangladesh is that once we're gone, the patients aren't just neglected. And I think that's something I'd like to emphasize because I wasn't sure how that worked. But Dr. Aziz and his team are in constant communication, as he mentioned, with the doctors on the ground and local doctors there communicating by their postoperative course and care, which I think is huge.

Host: Yeah. So then, what was the most significant reward?

Dr. Vickas Agarwal: Other than seeing the happy patients and children post-op, it was meeting their families. Talking to them about where they came from, how far they traveled, and how grateful they were. And really, I felt I was so grateful to be there. So to hear them being grateful for me being there, it was just a special moment for me.

Also, it's really cool meeting the local doctors, residents, and medical students. Every morning, I tried to interact with someone new I hadn't met before, and actually became friends with one of the local ENT residents. And he used to take me to the different operating theaters in the morning before we had our own surgeries. And he'd show me and say, "This is an appendectomy and this is the chief of surgery." And, you know, he'd love to meet you or we're doing a tonsil and adenoidectomy today. Like this is how we do it, and he was so happy to show us. And I mean, I was grateful to be there. We share techniques and stories about our own patients and overall just a wonderful experience meeting someone and making friends with them.

Host: So then, how about preparation? How do you prepare for the experience?

Dr. Vickas Agarwal: Well, I talked to Dr. Greg Lohr, who's in practice in Kansas City, and he was a prior resident of my program who traveled to Smile Bangladesh before COVID. After talking to him, he said, "Read up on cleft lip and palate repair and things like that. But really, you should read about the culture and the foods of Bangladesh." And that's what I tried to do is, read up about how they lived their life there, and It was kind of interesting learning about that just because I'm not familiar with Bangladeshi food or culture. So besides just the typical resident stuff where you read about the surgeries, I try to read about their culture.

Host: So then, do you see yourself volunteering there again or elsewhere?

Dr. Vickas Agarwal: Absolutely. Whether it's in the United States or abroad, I fully intend on volunteering as long as my career lasts or I'm able to do so. It's just been a huge part. This trip in particular was such a huge impact on my career.

Host: And then, would you recommend the GIVE experience to other residents?

Dr. Vickas Agarwal: One-hundred percent Our specialty is so lucky to have organizations such as AAOMS, ROAAOMS and the OMS Foundation. There are so many opportunities out there for residents and graduates. And I'm just so happy that we have these supporting organizations who have fostered these opportunities for us.

Host: And then, talk to us about the GIVE application process. Was it difficult?

Dr. Vickas Agarwal: Not at all. I mean, the application was very easy, simple. And I highly encourage any resident who may be interested or listening to the podcast to apply and would be happy to answer any questions if they wanted to reach out directly.

Bill Klaproth (Host): Absolutely. Dr. Agarwal. Thank you so much for that. I want to thank you, Dr. Aziz, Dr. Lee and Dr. Agarwal. Before we wrap up, one final thought from each of you. Dr. Aziz, as we wrap up, any final thoughts?

Dr. Shahid Aziz: Smile Bangladesh has become something that I never imagined, that it would become and the impact that it's had. And it's really thanks to board, our executive director, Christina Rozario, who does all our logistics. And one of the things I'm really proud of is that this is an American oral maxillofacial surgery-led facial surgery outreach. And it's become a really significant part of my life and it's something I'm very proud of and I'm looking forward to continuing this. And I'm really happy that AAOMS gave us the opportunity to talk about it. And I'm really thrilled that the foundation has understood the value of providing global surgery experiences to our trainees so that hopefully they can in turn give back. And I think you know what Vickas said about Dr. Agnihotri, one of my former residents who came to Bangladesh with me, in turn inspired him to tell Vickas to come to Bangladesh. I mean, I think, it's a domino effect and I'm hoping that this will continue and we as American surgeons will have a real impact globally.

Host: Dr. Aziz, thank you so much for that. Dr. Lee, any final thoughts from you?

Dr. Jessica Lee: Yeah, I think I echo what Dr. Aziz said in terms of getting involved, being able to give back to some of these communities that maybe don't have as much access to care as we have. I think we're very lucky as surgeons to be able to acquire the skills and assets and train to become surgeons. I think being able to use those skills in a different setting than the everyday, whether it's private practice or academics. It really opens your eyes in terms of what you can provide to these patients in these communities.

But also, I think, like I mentioned earlier, you do get, I think, a lot more out of it than you think in terms of just being immersed in these cultures. So, I think getting involved, whether as a resident or early on in your career, I think you're more likely to stay and continue to get involved throughout your career. So, I would encourage anybody who's listening to this to apply to the GIVE scholarship ,get on these mission trips. I think you'll be surprised how much you get out of it more than just the surgical experience.

Host: That's certainly what it sounds like. Well, thank you for that. And Dr. Agarwal, let's wrap up with you. Any final thoughts?

Dr. Vickas Agarwal: I just wanted to say thank you to Dr. Aziz, Dr. Wallace, Christina Rozario, and the entire Smile Bangladesh team for allowing me to join the trip. And a huge thank you to the OMS Foundation and their donors for providing me and other residents with the means to travel on these volunteer trips. I just can't emphasize enough how grateful I am to have been given the opportunity to travel to Bangladesh. I still think about it and I'm encouraging residents here where I'm at now at Virginia Commonwealth University as a full-time faculty member to apply for the grant and hopefully join on trips such as these. So, thank you.

Host: And once again, that's Dr. Shahid Aziz, Dr. Jessica Lee and Dr. Vickaz Agarwal. To learn more about the OMS Foundation GIVE Program, register your volunteer team to host a GIVE recipient or apply for a GIVE travel stipend, visit omsfoundation.org/give. And visit aaoms.org for a list of OMS charitable organizations offering volunteer opportunities. And for the full podcast library, please visit aaoms.org. And if you enjoyed this podcast, please share it on your social channels and be sure to subscribe so you don't miss an episode. Thanks for listening.