All right, I think we have enough people to begin. So thank you everyone for coming to the South Asian member community for the APMR. I think a lot of you are part of our Sapna group but all of you have to be part of APMR. Hopefully we can get more people to join the APMR so we can kind of enjoy these kind of things. In terms of our Sapna announcements, I know we have a meeting coming up in the middle of June. We'll decide if this is good enough and we can avoid the June meeting and then do another one in September because we're doing it every three months. But this should be a good one. Our theme for today is community service. So just want to highlight some amazing work that people in our South Asian community are doing some amazing community work. And so I just want to give the floor, Mani, do you want to kind of introduce yourself and then I think you should be able to share a screen and then talk about this awesome work that you've been doing in Peru for the last, I think, 20 plus years. Thank you, Ravi. Thank you for having us present to this wonderful committee. And I want to introduce myself. My name is Supramani Sitarama. I'm a chief of PMNR and program director for the residency program at Hartford Health Care in Connecticut. I have been doing this work for 30 years. The residency program is very new, started about in 21. And I am very proud to welcome one of my chief residents, Dr. Priscilla Mapelli, who's going to present with me. She actually made her inaugural trip with us to our medical mission in Peru, which we have been doing since 2007. So I'm going to let her start off, Ravi, if you don't mind, and then I'll jump in and add in. And if you guys have any questions, just jump in in between. We are happy to answer. Thank you. Priscilla, take it away. Hi, everyone. My name is Priscilla Mapelli. Thank you again for letting us present to your group. I've never been part of a South Asian type of community, but my mom is from Bangladesh, so I'm pretty happy to be here. So maybe I'll start diving in more. But anyways, very happy to present on what we've been doing so far. So let me go ahead and share screen. Is it letting you share screen for now. I'm going to pop up for one second and I'll come back in so allow me after that. Yep. So I'll be right back. All righty, we are back. Can everybody see this PowerPoint? Yeah. Okay. Yes. Great. Okay. So the organization is called Dreaming and Working Together. But before I even get into what we did in Peru, I'd really like to highlight the fact that rehabilitation is actually kind of an untapped area in global health right now. So with the global burden of disease, we're seeing the need for rehabilitation in one in three people. That's a 63% increase from the 1990s, and low back pain is one of the leading causes for the need for rehabilitation worldwide. And it's not often prioritized in a lot of healthcare systems, and it's also very under-resourced. This was also brought to light by the University of Washington. They did the global burden of disease in 2021, and also projected that with the aging population that we have globally, and the increase in non-communicable diseases, we're seeing a projected increase in 2050 with stroke and diabetes, as well as other musculoskeletal issues that will lead to more years of disability for many people and a higher need for rehab. This was further highlighted in the World Health Organization when there was an initial call to action in 2017, and then a resolution that was actually made in May of 2023 to expand the integration of rehabilitation services in health systems under universal health coverage. So they have 10 areas of focus for rehabilitation in 2030, primarily leadership, planning, and implementing the implementation of rehabilitation in emergency situations, integrating it into the healthcare sector, and also under the universal health coverage. And then also focusing on how we're servicing and delivering these models, the workforce, financing, health information systems, promoting more research in rehabilitation globally, and then also strengthening the networks and partnerships that we have on the ground. And this was primarily brought about by the WHO member states, the World Health Organization member states, development partners, and civil society. So the World Rehabilitation Alliance came about because of this to further advocate and implement the Rehabilitation 2030 Initiative through lots of advocacy and other activities. And this was founded soon after that resolution in May of 2023 in July. And essentially, they come up with just guides to help a lot of countries start implementing these initiatives in these 10 different areas. And you can actually download the PDF online to see the kind of transition and phases that they help guide certain health systems into incorporating more rehabilitation into their health system. So as of right now, there's up to 72 countries. We are not seeing everything highlighted in this map, but this is just a little bit of a taste of who's actually using this guide. But overall, these are very much top-down type of solutions to address the gap in areas where rehabilitation is really needed. But there's also lots of grassroots, bottom-up type things that can work really well together. And then overall, the basics with any sort of global health initiative or even community service, I would say is networking, community buy-in, understanding what your available resources are, having humility, not just cultural competency, because I don't believe that we can be fully confident in any one culture, but having the humility to know that it's a very heterogeneous and very dynamic space that we're walking into, and being flexible as well as asking questions and staying curious. So now more about Dreaming and Working Together. We primarily work in Peru, but the person who actually started or was the catalyst to kind of bring about this initiative was Hernando Garcia. He was an employee of Hartford Hospital for about 20 years, and he collected bottles and cans and raised money so he can purchase fans and air conditions to bring back or to buy in Lima for the hospitals for his own community. And I'd like Dr. Sitarama to kind of chime in because he's closer to this story than I am, and so I feel like it might be more impactful if he shares a little bit about this kind of, the birth of this organization from that aspect. Thank you, Priscilla. So Hernando was in the medical records department, and then he kind of convinced a neurosurgeon, a plastic surgeon, and a dentist to go with him to Lima, Peru in 2005, 2006, and just work out of a government hospital that served the underserved and uninsured population of people in that country. And Dr. Andrew Wakefield, one of the top neurosurgeons in Connecticut, was one of them, and he's a very close friend of mine. I call him my brother from another mother. And in the cafeteria, I ran into Andrew one day, and we were talking, and I said, what did you do? And he said, I just came back from Peru. And I said, what'd you do in Peru? He said, oh, I went in, I stayed there for a week, and I did spinal fusions from Monday through Friday because apparently the people in that hospital cannot get any kind of plates and screws or ORIF spinal fusions unless they pay cash up front for the materials. So he had convinced a vendor to donate the equipment, and he had done surgeries on about 10 people. So I said, Andy, can I carry your bags when you go there next time? And he said, oh, well, you can. You might just be carrying the bags. I don't know if there's anything for rehab. Well, that's where the story starts. So I went there. They had a big rehab department. I call her the angel of Peru, Dr. Mary Corvalu. She was a physiatrist there. Now she's the chief of the department there, and she's the reason why this whole mission is so successful. She is so dedicated to the people and to the mission of that department. So she said, Dr. Sitharaman, you can see all my outpatients. So from Monday through Friday, I saw her outpatients, and every second or third person was an amputee. Average age, about 26, 27 years old. Most of them are above knees. Most of them had a traumatic amputation, either a mind injury or a gunshot, and they all lost their jobs because they could not get a prosthesis. And I said, this is interesting. And when I went back to Hartford in Connecticut, I had been working with Hanger Clinic and a very good friend of mine, Al Masunas, we run a multidisciplinary amputee clinic here in Hartford. And I asked Al, I said, hey, would you be interested in coming to Peru with me? There are these people here who can't get any prosthesis. And he said, are you kidding me? Apparently in the U.S., when you get a new prosthesis and your old one is put away in a warehouse, cannot be reused. The componentry might be just fine, but it cannot be reused on the population in the U.S. So there was all this equipment available in warehouses. He also managed to get some of the vendor companies to donate liners. And he came with me in 2008 and saw about six patients, custom made sockets for them. And that's how it started. Take it away, Priscilla. All right. So over here, you can see a beautiful picture of Dr. Sitarama way back in the day with Dr. Mary. And then the bottom picture was, most of the rest of these pictures are from this past time we went in late March. And Priscilla, sorry to interrupt. Far left is Dr. Mary Cargallo, the angel of Peru that I call. So, sorry. No worries. But as you had mentioned before, it is a collaboration between Hospital Nacional Daniel Alcides Carreon in Cayao, Lima, Peru, Hanger Clinic, Yukon Physical Therapy, Hartford HealthCare Department of Surgery, Department of PM&R and the Rehabilitation Network, as well as the University of Hartford Prosthetic and Orthotics. And what we do basically is, we don't necessarily do the neurosurgery. The neurosurgeons come down with us. They do the neurosurgery with the local neurosurgery team as well. We primarily focus on the rehab aspects. So building these prosthetics, making the custom socket with the componentry that we have brought down, as well as once they get into their new prosthesis, gait training, getting them up, and just also doing outpatient as well as inpatient rehabilitation consults, which I found super interesting. So we saw disorders of consciousness, patients, post-stroke. We saw the post-stop fusion patients. And then also in the outpatient setting, we saw a lot of MSK, which was really great for me personally. And I'll go into a little bit more about that. It was a true collaboration between residents for the inpatient and outpatient setting and the attendings as well. This was possible in the last two years, thanks to the Rotary Grant. And I'm also going to pass it off to Dr. Seetharaman to talk a little bit more about that. But essentially, there's fundraisers that happen throughout the year to help fund this. But then the Rotary Grant also gave a little boost to help continue the work as well. Thank you, Priscilla. So in 2008, we've made, DWT became a 501c3 organization. We started raising money. It's a totally a volunteer organization and it's expanded, as Priscilla said, with University of Hartford and their students, UConn students coming with us. But we've been there for a week. We went there around February and March every year. We would see an average of 60 to 100 patients. We would fit them with prosthesis. We were training people to do rehabilitation, but that was it. Nothing else would happen till we came back a year later. So the question was, can we train them? Can we make them sustain? Can we make this more of a sustainable mission? There were government hospitals in the neighborhood where there were prosthetics and people making prosthesis for insured people in Lima, Peru. So I was a member of the local Rotary in Cheshire, Connecticut. And I approached them about getting a grant to make this a sustainable amputee program at Callao in Peru. So I went to the different clubs and we raised about $64,000 for a two-year project to train six members of the team, two prosthetists, two providers, physiatry providers, and two physical therapists to do amputee fitting and rehabilitation. And that way that they can continue the project even when we are not there. It was supposed to be a two-year program, but then the COVID pandemic hit and we had to postpone because Cariana Hospital became an emergency hospital and they were not doing any other kind of care. And then we went back in 23, November and in 24, 2024, April, we did our final research grant teamwork where we did our final training and evaluation. And we successfully trained two prosthetists who I'm proud to say in our last trip ran a whole lab on their own when we were there in 24 when Priscilla went with us. And it was amazing to see them fit their local people with prosthesis. They are now working on Saturdays. They adjust and remodel sockets. They can build sockets. So there is a lot of work going on through the year. These two prosthetists are not even paid by the hospital. They volunteer their hours to work there and the grant, we paid them some money through the grant. So this was a great project that we were able to do thanks to the Rotary Grant. Thank you, Priscilla. No worries. So yeah, as mentioned before, we do a lot of various rehab focused things. And I've had an extensive background in global health. And before going into med school, I was like, rehab wasn't really the biggest thing. Like we would teach stretches, all this other stuff. But to see this kind of culminate together and really mesh, it almost felt as though hospital Carillon was actually almost like a sister campus where it was a very much a mutual collaboration between the local staff and ourselves, which I really appreciated. So just as more of a list of things that we do down there and some photos of what we were doing this past March. And then the research and the presentations and the training continues on throughout the year. I'm still in collaboration with the PM&R residents in Peru with the research that I'll present to you guys as well. The research was basically exploratory. It wasn't anywhere, we weren't testing anything. We just wanted to get a better idea as to what is the demographic that we're serving down there. And then we have neurosurgery residents down there who work with the neurosurgery resident that we bring from UConn, as well as this year, the first year, I had the honor of going with Dr. Sitharama and being one of the first residents to go down and collaborate with the residents down there. And hopefully we can continue to do that because I thought it was super, super valuable. Experience. And then also, as we mentioned before, the prostitutions and orthoticians that were down there and trained. And this year was we celebrated the official 20-year collaboration between Hospital Carillon and ourselves. And these are just some of the pictures from that. We have the Peruvian Medical Society who came by as well to celebrate. And then on the picture on the bottom left, we have Dr. Mary, Dr. Sitharama, Dr. DeGrucci, our associate program director, and then myself and the chief resident down there as well. And then I wanted to explore more when I was down there in terms of understanding the challenges to amputee care, but also just get a better understanding of who we're seeing. And it was an anonymous survey, about 30 questions, all done on paper. And we had 55 participants in that. And I couldn't really find anything super specific to this, to amputee care in Lima. So I couldn't really find very much literature on this. When I was down there, the PM&R residents were also interested in this type of work as well. So we're collaborating and it's just really interesting to see the things that they want to do and how well we can fit together in terms of collaborating and understanding our patient population. In terms of Peru and disability, there is no ADA down there like there is here. There was a law passed in 2012 that basically recognized that private businesses and public entities should intervene to benefit persons with disabilities and recognize the full legal capacity and try to prevent discrimination. But there really isn't too much that's like reinforced or enforceable down there. You still have, depending on where you are, there's still areas where there isn't running water, let alone people to enforce certain criteria in terms of like sidewalks or doorways to make sure it's fully accessible for all people. Just a little bit about physiatry in Peru. It's seven years of med school. Some go directly from high school with one year of serums, which is basically if you want to do residency in Peru, you have to do a year in primary care prior to your specialization, specifically in rural or marginalized areas in the more urban setting. After that, they have four years of PM&R training. That includes their one-year internship. And then what was interesting is that between 2017 and 2022, there was 11 universities who had PM&R residencies with 283 positions, 89.4% of them in Lima. However, that number decreased between 2018 and 2021, likely due to COVID as Peru was one of the worst hit countries in Latin America. And then in terms of curriculum, seven of the 11 universities had curriculums that met at least 75% of the core competencies recommended by the International Society of Physical and Rehab Medicine. However, none of these address the competencies completely. With that all being said, the training is very variable depending on what university you go to and then who you're with. So it was interesting going down as a PGY-3 and interacting with the PGY-4s and PGY, and my peers in PGY-3s and 2s, because some of them, though they have a vast knowledge of medicine in terms of like the rehab aspect of things, wasn't quite there. So it was really cool to collaborate and discuss certain things, very PM&R specific, and really get an understanding of what their knowledge base is and how varying it was, even though like some of us were in the same PGY year. In terms of Peru's healthcare system, just as a caveat, one in three people live in the capital of Lima, so it is a very, very huge city. This is also a picture of Hospital Nacional Daniel Alcides Carrion, so Carrion Hospital. And then as of 2023, 99% of Peruvians are covered under some sort of health insurance. While that sounds really awesome on paper, the types of services available are very variable, to say the least. 60% of people are typically covered under their free basic healthcare, Seguro Integral de Salud. And then those who are in the more formal economy, who are able to pay into taxes, they're able to get a Salud, which is not free, but a little bit cheaper than paying for it. Not free, but a little bit cheaper than private insurance, and that covers about 30% of the population. And then I lumped together the Armed Forces, National Police, and the private sector, and overall that covers about 10% of the population. NGOs, they have a place here as well. A lot of NGOs can sometimes impact policy within the Ministry of Health. One huge example is Partners in Health and their protocols and policies with treating TB patients. So while we don't want to have countries depend on NGOs, the level of inequality sometimes creates a system where NGOs do have a place for those with very limited resources. Another reason why I wanted to bring this up too is because after doing this type of work and other work in my past experiences with global health, a lot of it has to do with inequality. We have a lot of inequality in the United States as well. So I just don't want to brush over this and say, oh, Peru, their health system is like, there's not enough things to help all these people. There definitely is in the private sector and the hospitals that are primarily catered to the Armed Forces and National Police. The PM&R residents were telling us that they're fully equipped, have ultrasound, have all the imaging that you need. However, for other places where they have insurance completely free, but this is a public hospital that we were at. And oftentimes even to do wound cleanings and checks like that, we had to leave the hospital and buy gauze. Or if we had a post-stroke patient, we didn't really know where the stroke exactly was because they would have to leave the hospital to then get an MRI and then come back. So this level of inequality, I'm not saying that America's going into that trajectory, but there are areas in the United States where we definitely have a lot of under-resourced areas. and I feel like Global Health also helps you to kind of learn from these and also apply it to your own community wherever you are. So I feel like it's a mutual benefit on both parts. In terms of the demographic of patients that we had this year, we had about 72% were male, 27.3% were female. For the most part, 40% of these patients were an amputee for at least one to three years and 20% 10 years or more. And then for self-described socioeconomic status, about 76% said they were of low socioeconomic status. Origins of ethnicity, over 55.6% were mestizo. And then for education level, a vast majority of them had completed secondary education or above. More than half lived in a single-family home and 84% of them lived with immediate or extended family. And in terms of the age, it was pretty, I categorized it 35 to 54 and 55 to 64 were pretty much even and that was the largest age group that we had. And then in terms of health insurance, over 70% said they had Seguro Integral de Salud, so comprehensive free health care. And about 13 or 23% had the more private sector. I also clumped S Salud in there as well. In terms of the cause of limb loss, diabetes and vascular issues were the main cause for most of the participants through our one-week initiative. And then in the second most common cause was motor vehicle accident, which I found surprising because I was expecting it to be more motor vehicle accident or trauma as the cause for amputation. And then in terms of working prior to limb loss, the vast majority of them, 84.9%, were working prior to this but then after their limb loss, that number decreased. About 29.4% were continuing to work while others, for the most part, were not working or sometimes working. About 31.4% were sometimes working. And then in terms of complications for their residual limb, most of it was phantom pain or pain within the limb itself. And other was just a combination of all of those. In terms of the amount of time without a prosthesis, 48%, almost half of them, went a year to three years without a prosthesis. And then the biggest, one of the biggest reasons, or not reasons, sorry, one of the biggest challenges to access for care was transportation and financial burden. This photo over here is actually a prosthesis that one of the participants made and he would actually use it and often broke on him, but then he would continue to try and remake it. So he was very appreciative to get one that was a little bit more form fitting than the socket that he made here. And then overall, I had a couple questions that were more open-ended to kind of get a feel for what people were saying and feeling and thinking. And the biggest, I clumped it up into three categories of what the challenges and barriers were. Mainly limited healthcare services, structural and material inaccessibility, and then prejudices. So the idea of having people being different to them or the lack of independence was a huge one. The lack of visibility in their community, in terms of structural and material inaccessibility, having no prosthesis was a common theme throughout, as well as the lack of ramps or proper conditions of the grounds and sidewalks. And then limited healthcare resources, such as not enough follow-up and the lack of finances and insurances, as well as the lack of specialties or specialists for their specific issues. And so that is pretty much it that we have. And we can pause for questions. I'll stop the share. Ravi, I just wanted to add that Priscilla is the recipient of the Community Service Award for our residents this year. And we are very proud of her because she has done a lot of work even prior to going to medical school. And she was a perfect candidate to join us on our mission as our first resident. So thank you. Thank you. That's amazing. I think I'm just my only comment is that's amazing. And we're also impressed. So and I think the this slide, the one of the earlier slides about how to get this ramped up for different countries is was very crucial. So I know there's some, I know Chandan is gonna be one of the residents going next, but maybe some of the residents and the students in the crowd could use that as a guide to kind of start their own project. Definitely feel free, I can put my email in the chat as well. And you can totally reach out to me. I'll try to help as best I can. And Ravi, as far as I know, one of the biggest handicaps for amputees in Peru is they don't have a prosthetic maker in that country. I think they have their closest place is Bolivia, I think where they have a prosthetic. So so even when they get prosthesis, they're very archaic and not very functional. So we even had one of the participants come from Ecuador. And it's it's really amazing to we also had a Paralympian and many people would come all we had a handful of people who came back from previous years, just either say hello or get some adjustments done. So the impact there is, is a lot. And it's amazing. So thank you, Dr. Sitharama for your commitment to that. Thank you. And I think Dr. Anaswamy has a question. First of all, congratulations on the 20 years of mission activity, almost 20 years and an outstanding presentation. Thank you so much. Thank you. Question slash comment is about your pointing out the need for cultural humility. And your comment about the lack of like a PDA or Peruvian equivalent of the ADA. What are your thoughts on what the community, the members that are seeking health care there feel about the lack of protection? Similar to an ADA, what an ADA would give persons with disability in America? What are what does the population feel about what the society, the government should do to protect them better and consider them as a equal member of the society? Um, so I'll take that Priscilla, and then you can add up. That's a great question. I haven't really had a chance to sit down and chat with them. The interesting thing is the local government, the government system is very weird in Peru and the local government has started coming and attending our mission and being more involved in the last maybe five to six years. So it's benefited the hospital a lot, especially with the structure, architecture, the neurosurgeons have brand new ORs now. They used to shut the water off at 12 noon when we first went. Now we have water till the end of the day, access for the patients to come in. So some of those things have changed. One thing that we noticed within a couple of years of us starting the amputee program, we started a peer society here in Connecticut, Hanger started this, where if we had a cop here who got shot and he got a mangled leg, did not want to get an amputation. He was extremely depressed and we took a BK amputee. This is, I'm talking, I'm old, so this is, I'm talking about 25 years ago and we took a BK amputee and we took him in and he talked to this cop for about half an hour and he completely changed his mind and said, okay, I'm going to go get this surgery. He got a BK. He went on and became a beat cop in New Haven. He didn't go behind the desk. He would come back and say, I chased down a perp yesterday, you know. So we had started that peer society here and we didn't even start it in Peru, but when we started having more and more patients come in, they started supporting each other and they developed their own peer community. So people started helping each other. We noticed that. So there's a lot of community initiatives and work that goes on. We have had people come in and say, people come back and that's one thing that makes me go back to this country. People are extremely grateful. They help each other. They are very industrious and they just, we had a bilateral AKA who would take a minimum of two to three months in this country starting with a BK amputee and then they would go on to a BK amputee and then they would go on to a BK amputee and then a minimum of two to three months in this country, starting with stubbies and getting balance and core stabilization and walking with a regular bilateral AKA prosthesis almost takes three months. This man was able to walk with a full AKA bilateral prosthesis by Friday. That is how amazing they are. So that was the one thing that I saw, but I haven't really broached the subject of how they are looking to be politically active to get an ADA law passed out there. Dr. Mary Carvalho has tried to politically be elected into the local society. She's a part of the Rotary too, but I don't think she's made any big headways trying to pass laws, but the people are very close to each other and they work very close to each other. Priscilla, I don't know if you had anything to add. No, that's a really great question that you had. I think my preliminary research is hopefully the idea is to have for it to be like a jumping off point to get more detailed answers. When I did the open-ended questions about what are the challenges that you're facing? What do you think could be improved? A lot of it always got redirected to I'm very grateful to have the prosthesis here because it was all handwritten and I just wanted to keep it free form. But I think that'd be a really valuable question to ask moving forward. I don't want to assume, but picking apart some of the answers, I don't know if it's whether people are too focused on making sure that they're able to provide for their families versus I want to do something bigger and have an organized fashion of just moving forward politically. That would be an interesting thing to look into. Because I just know that a handful of the participants that we had, some of them, we would say, make sure your other leg is your best friend. Make sure you're taking really good care of it. You don't want to have another amputation. But then it's hard to say that when they're a farmer or they're a street vendor and they have to do that because they have to support their children. It'll be interesting to look at that and see what are the challenges that keep people from being organized politically to move forward for much larger systemic policies. Little long-winded, Dr. Anasanami. Hopefully, it answered your question. Yes. Sorry for starting off the question with that one. That was quite a doozy. I apologize. No, it was a great question. Yeah, great question. Thank you. All right. Thank you so much. That was awesome. Our next couple of speakers, I think, may not have been AAPMR members, so they're not able to join. We will let them come to the next SEPNA meeting to be able to present. Chandan is part of SEPNA, and he's a resident at Rush. He's in charge, along with some other residents, about the resident program. I wanted him to be able to throw out some ideas that we can flesh out so we can get more of a resident program for the South Asian community. Chandan, the floor is yours. Give us some of your big ideas. Yeah, definitely. Hi, everyone. My name is Chandan. A bunch of residents, we got together yesterday, really, but I got some good ideas. To start off would be mentorship, first and foremost, but with jobs and fellowships, it could be a med student with a resident pairing for residency, then a med student with an attending, sorry, resident with an attending for fellowship or even jobs, just career advancements. Then another one would be in terms of pain in South Asian communities and diving into that, maybe analyzing research-wise, whether it's pain can also be not just a peripheral aspect, but a central aspect to it and central somatization. It can be interesting to explore that in the South Asian community. Just journal clubs, also specifically journal clubs focusing on research, again, within the South Asian, whether it's nutrition, diet, lifestyle factors. Then maybe a stigma awareness panel in the South Asian community as well, whether other people's associations or stigmas against South Asians or just within the South Asian community itself. Then another one, I've kind of thrown a lot, but the last one would be a cross-cultural rehabilitation talk series. It'd be really cool to partner with LMSA, PAPA, which is the Filipino Association for Physiatry, and other DEI organizations. Then maybe do one big talk about rehab and physiatry within each of those ethnic populations. That's kind of a lot to throw out. Any thoughts, opinions? No, thank you, Chandan. Thank you for talking to the other residents as well to come up with some ideas. I think one more thing that you had mentioned to me was getting a Zoom. We have a meeting and we have these Zoom groups and people that are pain specialists, neurorehab, inpatient rehab, each of us would have a room as the attending. Then residents that have an interest in that field could come and get some mentorship to then help cultivate their career. Obviously, I'm biased. I want more people in inpatient. Hopefully, we can convince some of the residents, but I think we want to do a resident mentorship day and open to all people, hopefully as many South Asians as we can get, but open to whomever wants to join as well. Chandan, I think that's what you had mentioned to me before. Yeah, definitely. Maya, I think go for it. I was wondering, Ravi, now at this point of time, we probably should have a directory so that we have our members' names, contact information, things that each person has expertise in or interested in to do the pairing because I heard a lot of resident to student pairing, resident attending for fellowships, for jobs, for things like that. One of the easiest things or it's a really basic, low-level, low-tech thing, but having a directory of everyone would be very useful. If we can have someone, maybe the residents can take the lead on that initiative and try to put it in order, it would be great. Yeah, I don't know if I agree. I think it's a very simple thing to do and just send out emails to everybody and get contact information. Chandan, we can talk about it tomorrow because I don't want you to take it on yourself. We want to get as many residents to help you with that project, which I think, Maya, I agree. I think that'd be really amazing. I think Dr. Anaswamy has a question. More of a comment. You mentioned inpatient rehab, Ravi, and as a career-long spine and electrodiagnostic PM&R doc, I wanted to add a plug for future physiatrists, physiatrists in training to develop an interest in inpatient rehab. Ravi, you probably didn't see me telling that at the end of that statement. I think, yeah, there you go, Maya. Thank you. I think at its heart of the PM&R specialty is inpatient rehab, and that is probably the biggest differentiator between a PM&R as a specialty and any other specialties is our exclusive expertise in inpatient rehab and patient management and inpatient rehab. With the growing population, I'm sounding like an infomercial, I'm sorry, but with the growing population, the need, especially in this country, will continue to rise for more and more inpatient rehab, and we need all hands on deck from all sectors of the population and the diaspora because we will be, I myself now, the future recipient of perhaps inpatient rehab, and I would like our top doctors to serve me, to take care of me. So not a selfish interest and motivation, but I do think the needle is pointing in that direction, and you'll never run out of a job to do. So a plug for inpatient rehab is what I'm basically making. Amazing. And then Chandan, keep working hard, and hopefully we'll see, obviously, the progress next month. And then I think finally, just, oh, I think Atul has a question or a comment. Yeah. Hello, everyone. I want to just follow up on what Thiru just said. I would just broaden that a little bit. Not only would I say inpatient, but neurorehab, because there is so much need for neurorehab, both in the inpatient setting, but especially outpatient, because the length of stays have gotten so short, patients get discharged, and they typically have no place to go. I mean, in the academic centers, yes, but outpatient, I would say, no place to go. I mean, in the academic centers, yes, but outside of that, outside of the big cities, all these patients have nowhere to go for further management of their rehab needs once they've been discharged from the hospital. So there's a huge opportunity for us to take, and it's for us to lose it as PM&R physicians. I think it's so important that you guys keep your skill sets up to date with neurorehab, both inpatient, outpatient, and you can manage these patients. As Thiru said, you'll have a job forever, and it's extremely gratifying. Good to see you, Atul. Good to see you, Thiru. Good to see everybody. Great. And I think, since a lot of the speakers couldn't make it today, we'll get them to the next SAPNA meeting. I'll send an invite to everybody. The social media team just wanted to let everyone know that for SAPNA, they have access to the Instagram and the X or Twitter, and they're going to try to post a little bit more frequently. We'll get more information and things that they can post, but I think the amazing work and the commitment that you guys have put into this, I think the amazing work and the community service in Peru would be a great thing to make a series of posts just to promote what's being done by South Asian community all over the world. As we do these meetings, we'll get this social media team to be very much on top of this and post, which they will. I look forward to that. I think that's all we have, which is great, because I think we did a really good job. So, anyone else have any thoughts? Or we can let you all get back to your evenings. Ravi, I wanted to say thank you so much for inviting us and giving us an opportunity to present. It was great. Thank you. Awesome. No, no, this was amazing. So, this is awesome. Thank you for presenting. Thank you. Good night.

South Asian community

APMR

Sapna group

global health initiative

rehabilitation services

amputee program

mentorship

neurorehab medicine