My father and other good guys: plastic surgeons abroad.
Thirty-seven years ago, when America boasted fewer plastic surgeons than states in the Union, one of them--a spiffy, 510 adventuer --arrived at the Karachi airport in West Pakistan. He was accompanied by his elegant wife, Ruth; three shy children under the age of seven--Mary, Dewey, and Julia; his sister-in-law, Frieda Enss; and supplies for a new hospital, carefully crated and stenciled: Dr. Ralph Blocksma, c/o United Christian Hospital, Lahore, West Pakistan.
It may have been a historic moment. As far as I can determine, Ralph Blocksma was the first plastic surgeon to venture professionally into the Third World. Even if he wasn't, I was amazed to be there, the oldest of the wide-eyed children, peering through the mountains of marigolds we were eagerly welcomed with.
The cool blossoms around my neck were a startling contrast to the oppressive heat. Aggressive beggars, mostly children, swarmed upon us, shouting. The very air seemed to shout, the open sewer system easily announcing itself through the garlands' pungency.
We'd never seen, heard, or smelled anything like it in Grand Rapids, Michigan, the shipshape community we'd come from. As we were driven through the crowded streets of Karachi, I expect dad must have wondered if he shouldn't have stayed at home. The dismay was surely complete when we reached Lahore and Dr. John Vroon, the missionary who had invited us, showed us the United Christian Hospital. Lacking equipment, beds, even bedpans, the former college dormitory did not remotely resemble a hospital.
Considering the times, the hospital's condition was not surprising. In 1949, the nation of Pakistan was only two years old. Seven million Hindus and Sikhs had left the area for India, and 6 million Muslims had come in. Not only was there heartbreaking bloodshed, disease, disfigurement, and death, but the leaders of the area had gone--the doctors, nurses, politicians, and bureaucrats had been mostly Sikhs and Hindus. What remained was chaos.
Enter my mother's sister, the administratrix of this hospital-to-be. Frieda Enss was, to use one of her favorite phrases, one smart cookie. Her no-nonsense approach was so unexpected that most people were too startled to oppose her. (They never saw her, as we children did, helpless with laughter as she improvised bedtime fairy tales, or weeping as she searched for shoe-box coffins for the bodies of newborn infants --usually girls--fished from the nearby canal.)
Without even a typewriter, Frieda helped staff the hospital, start the nursing school, and unsnarl red tape. She made things appear out of thin air, it seemed. (Her adding machine --when she finally got equipment-- made such a hit in Lahore that its American company had to set up a local repair shop.)
My father was so inundated with work that he couldn't limit himself to plastic surgery, much less to running a hospital. Working frantically with Dr. Vroon to care for the worst cases, he was frequently forced into heartrending decisions.
"I went down the line at the United Christian Hospital to pick out the people whose lives I felt I could save,' he says. "If there was one guy that would take me five hours to do and there were three others that I could do in an hour and a half, I'd let the guy die who required five hours, because that way I could save more lives.'
Meanwhile, our family moved into a bungalow, which was--to my eyes--a mansion, spreading cream-white into large gardens and surrounded by a six-foot hedge. Our pansy-lined driveway, boisterous with parrots, swept up to a veranda where hornets hummed along with an old Singer that our tailor ran with his toes. Inside our home, I was allowed to rollerskate down the long, cool hallways.
I felt like a fairy-tale child who, having shown unexpected compassion, had turned into a princess. My brother and my sister were fine, too. At six, Dewey was soon playing marbles with the boys and two-year-old Julia charmed everyone in sight.
Even mother thrived. With natural and unquestioned authority, she took over a household of servants--we had five--and her children's education, and taught us herself. Beauty and a refined character did not stop her from cheerfully "making do' or showing unusual sensitivity to the local customs.
As more doctors and nurses were trained, my father began concentrating more on cases that required plastic or orthopedic surgery. Problems rare in the West were often epidemic --many of them birth defects. There were so many cleft lips and palates --that awful hole in the face called a "harelip'--that my father would sometimes do 12 in one day.
He also held a special clinic for clubfeet--some so twisted that patients walked on the backs of their ankles. "Sometimes I had to lengthen the Achilles tendon and take a wedge out of the bone,' he says. "I rotated the whole foot around and fused it into a new position.' He did hundreds of these operations, with the help of Campbell's Orthopedics, a tome that came second only to the Bible.
Infections caused many more deformities. Dad balanced the paralyzed limbs of polio victims, did extensive bone grafting on spines painfully twisted by tuberculosis, and excised tumors that mushroomed on top of heads or hung from the genitals to the knees. He did whatever he could for the sad victims of cancrum oris, a condition caused by infection that caved in children's faces.
The most horrifying to me of the third group--trauma--was the maiming of women. In some cases a husband would punish his wife for even suspected infidelities by slicing off her nose and, if he was sufficiently annoyed, her ears and lips as well. Taking such revenge on an enemy's family was not uncommon, either, and in such troubled times there were many of these faceless women.
Despite his work load, dad never just "did' these cases. Each one had to be just right. Sometimes, using clay, he molded a nose directly on a woman's face, to see what shape might look good on her, or he made a mold of her face.
Once, he tried a plastic moulage on my brother before applying it to a patient. Dad gave Dewey a straw to breathe through, carefully spread the plaster over his face, and let it dry. But when he peeled the mask off, he yanked out all Dewey's eyelashes.
"Your mother was madder'n a hornet!' dad says with a laugh now.
It took more than family, though, to help with the complex hand problems. Dad says: "We saw people hacked up by swords because they had held their arms up to defend themselves from attack. People had their hands cut off, tendons severed, fractures that were maltreated or had never been treated at all.'
The situation was so awful that he wrote to one of the best hand specialists he knew, Dr. William L. White, sent him pictures, and invited him to spend a month in Lahore.
The eminent plastic surgeon wrote back, "In Pittsburgh we'd amputate the lot.' Nevertheless, Willie White, as we called him, came. He operated every day for a month.
"I had two tables in the operating room,' dad says. "One table was just for Willie doing hands. I'd help him for a while and then I'd drop out and maybe repair a cleft lip. After a while I'd come back and work for a bit before I'd drop out and, oh, resect a bowel on another table.'
The emotional and physical toll of such work, often performed in temperatures over 110 degrees, led dad to take an occasional week or two off. During these times, he would visit the family in Muree, our summer mountain retreat. We would chase butterflies through the pines and play ring toss with other vacationing families over a rickety net in front of the old converted barracks, where we all lived.
The first time we toiled up the steep hill in the '49 Ford, stopping every time the engine boiled over, we were puzzled by many ill persons struggling or being carried along the road in our direction. The news of my father's coming appeared to have flashed almost telepathically up the mountain--there were no telephones --and our arrival was greeted by a crowd of patient, suffering persons who could not be ignored and whose numbers increased daily.
Sometimes the only doctor in the area, dad delivered babies, even doing surgery on a missionary's wife while she lay on her own kitchen table. Once, having gashed himself on a can of Ostermilk for Carter (his youngest child, just born), he put four sutures in his left hand with his right. The wound healed fine.
"Lucky I had a good surgeon,' he wrote wryly in a letter to his sister.
For nearly five years I walked this world of disfigured people. They were not just lined up in and around the hospital. They were a highly visible part of the population.
It did not especially upset me. It was, as far as I knew, the way the world was. And a plastic surgeon's job, as far as I knew, was to put as many of them back together as he had time for. I simply was grateful not to be one of them.
Upon our family's return to Michigan, I was asked whether my nose had been "fixed' by my father. I had never heard of a "nose job,' or a face-lift, or any other cosmetic procedure. A plastic surgeon did not, to my knowledge, improve noses--he made them from scratch!
In the 30-odd years since our return in 1954, my father has frequently paid his own way to operate and teach plastic surgery around the world. Until recently, I was unaware that others were doing it, too. Most magazines I read gave the impression that today's plastic surgeon is concerned only with cosmetic surgery; that he is invariably a Dr. Big Bucks, a kind of oracle at the fountain of youth.
My father could name only six plastic surgeons who worked regularly in the Third World. Six, I thought, was a shabby representation for a profession of 2,700 members. But the longer I investigated, the more the numbers increased.
Dr. Michael Gerber, the American representative of the African Medical Relief Foundation (AMREF) in New York, informed me that Dr. Thomas Reese, known to many as "plastic surgeon to the jet set,' has spent at least one month a year for the last 28 years in East Africa. There he repairs burns, cleft plates, and many other afflictions similar to those my father had seen in Pakistan.
"AMREF was started in Nairobi, Kenya, in 1957 by three plastic surgeons,' Dr. Gerber explained. "One was Sir Archibald McIndoe from Great Britain, and the other were two young doctors under him, Tom Reese and Michael Wood.'
These "flying doctors' reached previously isolated areas by air. Today 15 hospitals in East Africa are served by a general surgeon as well as by Bill Adams-Ray, a Swedish plastic surgeon who has been flying the circuit full-time for nearly five years.
"He'll leave Nairobi at 7:30 in the morning,' Dr. Gerber said, "fly someplace, and two hours later he'll be operating. He'll operate all day long for the next two or three days, fly someplace else, work under the most adverse conditions you can imagine, and get back on Friday afternoon.' Dr. Adams-Ray does about 600 procedures a year--three times the American average--for "less than $30,000.'
The next person on my list, Dr. Ian Jackson, headed the plastic-surgery unit at the famed Mayo Clinic. "I've made three trips to Peru and more to Barbados,' he said with a Scottish burr. "We work mainly on patients with deformities of the skull, orbits, and face, the most hopeless cases.'
Dr. Jackson has been building facilities in Barbados, often at his own expense; on his last trip, his team saved the Barbadian government between $80,000 and $100,000. But Dr. Jackson's surgical contributions were not the reason I had called him. "I understand you've adopted a Peruvian Indian child with a cleft lip,' I said.
"No,' he answered. "David had lost his whole face.' He referred me to his wife, Margery, who had just written a book about David.
Margery Jackson explained that David had lost all of his palate, nose, upper lip, and jaw to leishmaniasis, common in South America. By the time she took him into their Glasgow, Scotland, home, all that was left in his face were two beautiful, big brown eyes and a hole where his mouth had been. The four Jackson children, the youngest of whom was seven, had seen deformities before, but they had never seen anything like David. Still, they took him over, loving and protecting him.
Eight years and nearly 50 operations later, David has a face, but another 100 operations may yet be required before he will look normal.
There was more courage to come. In Norfolk, Virginia, "Operation Smile,' run by two charismatic plastic surgeons, William Magee and James H. Carraway, has been making headlines. The excitement began last year when Mrs. Soledad Fernandez, supporting in her arms a 36-pound tumor that grew from the top of her head to her waist, made a 15-mile trek to the Philippine hospital where their team was set up.
"No one in the Philippines could handle something this big, and she had no money,' explained Laurie Catena, the full-time director of the three-year-old program. "So we raised the money for plane fare, and last June she came to Norfolk. The Filipino community took her in and the surgeons took off the tumor.' It was a 12-hour operation. Mrs. Fernandez lost 50 units of blood, and although her progress was desperate, she recovered in just a week.
A "700 Club' interview with Mrs. Fernandez before she returned to the Philippines generated even more enthusiasm and support for Operation Smile. In 1986, 50 people--including five plastic surgeons and five plasticsurgery residents--will go to the Philippines.
My list of six names was growing fast!
Then one night, Dr. M. Samuel Noordhoff called me from his Toledo hotel, where he had just been inducted into the most prestigious plasticsurgery organization in the world.
"Good grief,' I though. "How could a missionary who's been in Taiwan for 25 years have become so distinguished?' My father's first plasticsurgery resident, Sam Noordhoff had always impressed me as a big, unflappable Iowa farm boy, short on ambition and long on generosity.
He'd been a medical missionary in Taiwan since 1960, he told me, having taken time out to do his residency in plastic surgery in 1964. Today he directs Chang Gung Memorial Hospital, a world-class medical center in Taipei, where ten local plastic surgeons, whom he has taught himself and sent abroad for more training, work under him in various plasticsurgery specialties. My father describes it as one of the biggest plasticsurgery centers in the world. Dr. Noordhoff has taught so well that the place can go on without him.
He told me the story of a man with a bilateral (double) cleft lip. "He's poor,' Sam explained, "so I take care of him without charge. Then he gets married and his child is born with a bilateral cleft lip and I do the kid for nothing, too. In fact, I have to pay for part of his care out of my pocket.
"Well, here he comes in with a second baby. And I tell him, I'll take care of it if he'll get a vasectomy. Well, he isn't going to do that, because he thinks it will interfere with his sex life. But when he comes in with a third baby, I convince him.'
"All his kids had bilateral cleft lips?' I asked.
"Yeah,' Sam drawled. "Three out of three. So you're concerned here with more than just the physical problem. You're concerned with their emotional and social and financial problems.'
Mark Gorney later said of Sam Noordhoff, "Well, he's a saint.' Dr. Gorney and his colleague, Dr. Edward Falces, are San Francisco plastic surgeons who do surgery abroad through an organization they started called "The Reconstructive Foundation.' It all began with the gift of a black Cheshire-cat clock.
"One year,' Dr. Falces had explained on the phone, "we got so much booze and bric-a-brac--including the cat--that we said, "This is a foolish way for our colleagues to pay us.' [Doctors often work on each other's families without charging them.] So we called up our attorney and said, "Make us a foundation.' So he did. And we said, "You can't charge us for it.' And he said, "I won't.''
Dr. Falces, the head of the burn unit at Saint Francis Hospital, has begun other burn units abroad. With his wife, Suzanne, who organizes the foundation's trips, he's been working in such places as South America, Sri Lanka, the Philippines, Guatemala, Nicaragua, and Micronesia for about 11 years.
Dr. Gorney, past president of the American Society of Plastic and Reconstructive Surgeons, is often quoted by the press. I was therefore startled by the spareness of his office. I'd hardly had a chance to inspect the display case in the waiting room, where flags and photos verified a world of good works, when a pale man in worn Levis and a rumpled sport shirt waved enthusiastically at me from behind the receptionist's glass.
"My God,' I thought. "That can't be Gorney!'
It was. He ushered me vigorously into his small office, where slim and dark Dr. Falces seemed content to let Dr. Gorney do the talking.
Dr. Gorney was happy to do so. He'd just returned from Colombia, where his surgical schedule had gone on despite revolutionary warfare and a major volcanic eruption. The drama seems commonplace for this man, who, when lacking sterilizing facilities, has been known to dump his instruments in a bucket, douse them with ether, and toss in a match.
I could now see why he was once infuriated when characterized as "a nose man.' If Dr. Gorney sees himself as anything special, it is as a champion of deformed children. It began, he says, when he was a medical student watching his first cleftlip operation.
"In about an hour the surgeon converted a gross monstrosity that looked like it belonged in a pickle jar in a laboratory into a really beautiful human being,' he says. "I was absolutely pole-axed --I'd never seen anything more fantastic in my life-- and I thought, my God, that's the only thing to do.'
He has pursued his work with a vengeance, going abroad countless times ever since he sailed on Project Hope in the early '60s.
Gorney and Falces believe strongly in teaching. "Once, in a mountainous area of Peru,' Gorney explains, "the clinic opened its doors to 600 people. The team couldn't possibly, if they worked 24 hours around the clock, have done more than 150.' The only solution was teaching local doctors their techniques. "It's like dropping a pebble in the water,' he says. "You teach one, who will teach two, who will teach 16.'
The two often travel with Interplast, an organization begun 15 years ago by Dr. Donald Loeb, the head of plastic surgery at Stanford University Medical School. Interplast last year sponsored a half-dozen trips to the Third World, in which 60 plastic surgeons participated. Everyone spoke with great affection of the youthful, energetic Dr. Loeb, but he could not be reached for comment.
So let the statistics speak instead, as they eloquently do: In 1985, Interplast personnel performed 1,315 free surgeries in host countries, representing more than $2.5 million worth of free surgical care.
My list of six names was now more than 100, according to Dr. Falces' estimate of plastic surgeons doing free work abroad--more than any other medical specialty. "We can go anywhere with a handful of tools and some heart and do a lot of good in a short time,' Dr. Gorney explains. "And our results are dramatic--we work at the end of your nose!
"I've tried to publicize the fact that you should go out and work for your soul, and not just for your pocketbook. Everybody says, yeah, that would be awfully nice, but few actually sacrifice the time to go.' He also mentioned that not everyone can deal with the sometimes primitive operating-room conditions.
In truth, however, the roving surgeons seem to enjoy the demands on their creativity by such things as defunct generators--nocturnal emergency surgeries have been completed by flashlight, by the beams of frantically pedaled bicycle lights, and even by the headlights of a Volkswagen propped up on a window.
And the heat? "Sometimes we scrub in our underwear, which the local people think is hilarious,' Dr. Falces reports with a grin. "And once, we made a tent of bedsheets to keep the flies off the operating table.'
So why do these surgeons do it? Although some, like my father, may have religious motivation, they all do it because it makes them feel good, it puts sparkle and adventure in their lives--and it makes them feel better about their wealth.
"I don't do this for any moral reason, you know. I just have a good time,' says Dr. Jackson. "I think you only come this way once, and you might as well do what you can.'
Mrs. Catena of Operation Smile thinks people get hooked on the deep satisfaction and adventure of it, an opinion shared by Dr. Gorney, who says, "We make every resident that has trained with us here at Saint Francis go out and do this. Once they go, they're hooked.'
Dr. Noordhoff sums it up with a kiss he received from a university student: "It's very unusual for a Chinese girl to come up and give a kiss to a foreigner like that, you know,' he says. "It sort of chokes you up.'
No surgeon seemed to feel he had sacrificed much to donate his miraculous skills to the children and the needy of the Third World. On the contrary, many of these men have risen to the top of their profession. Like my father, they are highly respected, highly successful, and certainly well-off.
Why then, don't more physicians step onto the Third World welcome mat? Perhaps the "sea of broken faces' that men like Gorney find inviting, others find intimidating. Raw need that huge is truly frightening. One cannot look into those faces and easily sink back into a comfortable life.
That is the real sacrifice these doctors make--the inevitable uneasiness with affluence after facing Third World realities. Walking the tightrope between delighting oneself and meeting ethical demands takes courage. No one feels he or she does it well, but we must salute anyone, of any profession, who tries.
Photo: Dr. Blocksma poses with a post-op patient in the British Virgin Islands--another abnormal face replaced by a happy one.
Photo: On a rare break from work, circa 1949, the surgeon goes butterfly hunting with his family, in Murree (author is front left).
Photo: Clubfeet that walked on the tops instead of the soles were made straight by Dr. Blocksma's surgery.
Photo: Newly trained doctors and nurses at the United Christian Hospital in Lahore freed Dr. Blocksma (center) to concentrate on plastic surgery--a necessity, for many Pakistanis had been disfigured by war, birth defects, and disease.
Photo: Cleft-lip surgery, often done by surgeons abroad, can produce dramatic results, as before and after photos of a West Pakistani patient show.
Photo: Dr. Ian Jackson, the head of plastic surgery at Mayo Clinic, travels to Peru and Barbados to work on "the most hopeless cases.'
Photo: On his recent mission to Colombia, South America, Dr. Mark Gorney of San Francisco had to sandwich surgery to aid deformed children between episodes of revolutionary unrest and a major volcanic eruption.
Photo: Dr. Edward Falces (left), cofounder of The Reconstructive Foundation (with Dr. Mark Gorney), performs plastic surgery on a leprosy patient in Brazil.
Photo: (Left) Mrs. Soledad Fernandez' 36-pound tumor was too much for Philippine hospitals to handle. With funds raised by Operation Smile, she was flown to the U.S. for surgery. (Above) Dr. William P. Magee, Jr., shows a happy Mrs. Fernandez the results.
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|Title Annotation:||practice in third world countries|
|Publication:||Saturday Evening Post|
|Date:||Mar 1, 1986|
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