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STUDY PLAN

Abstract:
It is demoralizing for an Orthopedician to amputate an arm/leg knowing that, there is
no good solution. We have many arm/leg amputees-both above and bellow elbow/knee
because of our liberation war and general lack of medical care. Ours is an agriculture
society, where nearly everyone is a subsistence farmer. Although these day’s traffic
accidents are a more likely cause of disability, while children also born here with spina
bifida, cerebral palsy. If one is missing an arm, he is not very functional in this society.
They become totally dependent on the family & have difficulty for marriage (which is
also very important in Bangladeshi society). This study attempts to develop a new era
in the history of Orthopedic surgery with advanced technology and invension of new
hope for thousands of disabled/limbless poor people in our country which will not only
improve our socio-economic condition but will play a vital role in improving China-
Bangladesh evergreen friendship.
Statement of objectives: I am dr. Sudhangshu Adhikary, completed my bachelor of
medicine & bachelor of surgery from North East Medical College Hospital in 2013 &
for the thrust of acquiring a wide variety of knowledge I have completed my 1 year of
rotatory internship in one of our countries top medical college Sylhet M.A.G.Osmani
medical college hospital in 2014. I am very badly shocked with these disabilities of our
communities which throws them back on there families & intensifying any hardship &
poverty, which make them rely on the goodwill of their families. Without a prosthesis
/artificial limb there is no expectation but its only the prosthetics which can change the
sceneries dramatically. It is not really a lack of money that denies people these devices,
since simplified forms cost little & generic Chinese models are improving fast. The
components can cost just 30 USD. The big hurdle is the lack of trained Orthopedician
along with technicians to fit the artificial limbs. This is the key point for my desire of
completing masters in orthopedic surgery along with advance research on developing
an artificial limb transplant module under the circumstances of Bangladeshi socio-
economic condition & make it cost effective as well as user friendly.

Research question:
1. What are the main obstructions in our country for starting artificial limb transplant
procedures?
2. How to minimize the cost for artificial limb production and set up at least one limb
transplant centre in all Government Medical College Hospital in our country?
3. How to develop upgraded device combined with artificial limbs with bio-robotics?

Introduction:
My desire for being an orthopedician, different from traditional professionals came in
my dream after a heart breaking incidence during my internship. While I was placed in
orthopedic surgery a middle aged male came with History of Road Traffic Accident
with complains of active bleeding from his near amputed lacerated right leg (distal
fractured fragment was missing), who was a Rickshaw puller & only earning member
of his eight member’s family consisting of older father & mother,3 daughters,1 sister
& wife. His all major blood vessel was badly injured & distal neurovascular status was
not intact. So along with my professor we amputate his right leg. While discharging
the patient on 15th post-operative day, he was crying- “doctor you saved my life, but
now how I will save me & my whole family as my earning machine-my leg is no more,
how can I drive a Rickshaw? how can I earn? “It was really pathetic for all the
orthopedician who were present at that moment. From that time, I promised to myself
I would be a good orthopedician who will treat Orthopedic & trauma as well as total
rehabilitation & decrease the number of disabled people from my society. There was a
time when saving remaining part of an injured limb was the main concern for
orthopedician but for me its not the end, it’s the end of beginning by providing them
artificial limb to restore the lost function of that limb & return them to their normal &
regular activities.

Literature Review:
Orthopaedic surgeons conduct a careful examination; obtain x-ray or other imaging test
to assess damage to injured limbs and area which is to be amputed will be based on the
extent of injury and healthy part of the body. Then surgeons close the site of operation
by shortening bones or tendons and rearranging skin in many cases from other part of
the body. Prosthesis usually begins after 3 months from day of surgery when patients
wound completely healed and swelling has subsided. Prosthesis is usually made from
an impression cast, which is taken from residual limb of finger, & the corresponding
part of undamaged hand/leg as it can create an exact match specific to details of entire
hand/leg.
Fitting a body part or prosthetic limb in a traditional way without any permanent
attachment to the body can be too difficult to manage for some patients. This type of
patients may benefit from osseointegration, which is a relatively new methodology
designed to permanently attach prosthesis or artificial body part to the human body.
Osseointegration associated with prosthetics involved inserting implants which are
accepted by the body as part of bone and allow body part and artificial limb to
permanently attach like joints and fittings. This type of prosthetic implant will not
easily loosen and enable prosthesis become permanent. Similar effect can also be
obtained when metal implants are coated with special layer like hydroxyapatite which
mimics bone. Specialized orthopedic surgeons are now performing these implants
transplants so I am very much interested in it and wish to learn A to Z from the
University under supervision of my honorable professor during my masters and thesis
program in China.
It’s very shocking for Bangladesh in health sector specially in Orthopedic and
Rehabilitation that there is no artificial limb transplant centre in our country till
2018.After RANA PLAZA TRAZEDY an Indian Charity (JOYPUR FOOT) came and
provided approximately 1400 prosthesis to the victims. Around 700 physically disabled
people got second chance in life with the help of this Indian Charity, Joypur Foot at
National Institute of Traumatology and Rehabilitation Centre(NITOR) in
September,2017 (Dhaka Tribune). Some business companies are showing their interest
in this sector but due to severe shortage of specialized Orthopedician and trained staff
all their interest are being disappointed. So I want to take it as my greatest challenge to
prepare me self-confident enough and along with collaboration of standard Chinese
companies establish a good limb transplant centre in my City from where we will start
our service and day by day we will increase the number of centre and thus we will
spread the blessings of Prosthetics to all over country.
I am working as a medical officer in a multidisciplinary tertiary hospital IGMH, male,
Maldives where physicians from different countries are working together. Here in
orthopedic department we have very talent and skilled orthopedic surgeons from
India, Maldives, Nepal, Pakistan, Egypt. They all encouraged and appreciated my plan
to study in China especially for my desire on this particular topic. The fast growing
economy, technological advancement, cost-effective new invention and global
ranking of Chinese university are most important reasons for choosing China as the
best option to fulfill my dream. Study in China is the start of a life with full of
excitement and have adventures as well as a chance to immerse myself in Chinese
culture with a history of more than 5000 years. With a huge population, the nature
loving Chinese scientist is the pioneer of the oldest acupuncture therapy and so many
inventions that changed human life positively. Computer Assisted Surgery(CAS),
Minimally invasive surgery(MIS), Tricompartment knee resurfacing-these all are latest
development in Orthopedic Surgery where China has improved a lot. So after
completing my Masters from Chinese University my knowledge will be up to date with
the modern world.
In many countries like that of mine people does want treatment but good manners can
relieve many of their suffering? I would devote myself to learn manners and good
behaviors from Chinese people the great ancient people of YIN-YANG.
More interesting is that my best friend is from a carpenter family. I spent most of my
leisure times working with his father because I am interested in fixing segments
together. I learnt how to drill the wooden board and how to increase the strength of a
weak point of a joint, and how to repair broken tools. The same thing Orthopedicians
are doing with the human body in operation theatre. In Operation Theater, sometimes
I feel like that, I am just doing my childhood leisure works with human body instead
of wood but always in a conscious mind. As for an example: for close fracture shaft of
femur, orthopedic surgeons fix it by inserting an IMIL Nail, which is very similar to
carpentry works that I learnt from my very childhood. That is why I am very hopeful
that by the grace of almighty and proper care of my respected orthopedic surgeons I
will gain exact knowledge and would be able to serve the community. The reality is
that if we observe a situation, it gets better, if we shine a light on a problem, it gets the
better. Therefore, I will regularly meet the departments’ orthopedic surgeons and will
provide good feedback.
Conclusion:
My immediate goal is to join an orthopedic residency-training program at a large
academic centre. This environment will enable me to work with a diverse population,
explore fellowship opportunities and will give me the personal enjoyment of living in
a metropolitan area with a freedom of having wide variety of delicious Chinese food.
An academic environment is appealing because it fosters intellectual curiosity and
permits ample teaching opportunities. I hope this application will receive your
favorable consideration and I will be happy to meet you at your convenience and
provide you with any additional information you may need. I will look forward to
receive your warmth reply. Quality, safety and value-a triad of related and independent
compartments which I want to learn from my desired medical university. I am excited
to future my career goals through Orthopedic surgery residency.

Sincerely
Dr Adhikary
Reference:
1. Journal of the American academy of orthopedic surgeon spring 2016( Vitale MG, Riedel
MD, Glotzbecker MP, Matsumoto H, Roye DP, et al. Building consensus: development of a Best
Practice Guideline (BPG) for surgical site infection (SSI) prevention in high-risk pediatric spine
surgery. Journal of Pediatric Orthopedics. 2013 Jul-Aug;33(5):471-78.)
2. Dhaka Tribune. (Published at 03:48 PM October 05, 2017)