Interplast – international humanitarian surgery – is a spirit, a group of people with an idea. This blog is the first in a series that will tell its story. Interplast has a value system and has many aspects and wonderful facets to relate.
The “Many People, Many Passports” title indicates that the authors of the blog, the values of interplast and the ones who carved out these facets are many, from many countries. The aspects of Interplast to be revealed include:
The history of Interplast (this first blog)
The values of Interplast
The origins of the method
The many independent Interplasts
The evolution of the goals of Interplast
The obstacles and the hurdles which confronted Interplast are worthy of reading because they may save you 35 years of seeking answers. The commitment and work necessary to overcome these “rocks in the road” were sources of enjoyment, even fun, and were necessary.
The many Interplast organizations worldwide, now over 20 independent 501.c.3 foundations, are each of significant “vertical and horizontal” size. These organizations are surprisingly united with common purpose and method and through high quality, the helping concept and the idea of tackling significant world problems.
The funding sources, the human relationships which we now call “politics,” the ideas for the application of all this to the next step, the future, is waiting for your discussion and conjecture. It is interesting that the goals of the organization have changed little through natural evolution. Please be patient and stay tuned as the story unfolds.
The Beginning: Interplast and Project Piaxtla
Compassion may be underappreciated by wild animals. It was Midnight on December 13th, 1964. The phone rang. “Dr. we have a bite wound: raccoon versus human in the emergency room, bed number six, blood pressure 120/80, pulse 72. Patient has dressing on the metacarpal phalangeal joint of the right thumb. The patient requests Dr. Robert Chase, our new chief of surgery here at Stanford.”
“Get an A-P and lateral (front and side view) X-ray of the area; I’ll be right in.” As soon as the nurse mentioned the Chief’s name, a fire was lit under me. I was Chase’s number one voluntary slave.
I quickly got on the white shoes from Yale, white trousers and a shirt, a long white lab coat, poured instant coffee into my esophagus, lit up the gray VW beetle, slipped through the gears to third and hauled off down Alma street, directly to the emergency room. I reminded myself, slow down for the cop parked on the on ramp from Oregon Expressway. But he pulled me over anyway.
I told him, “I’m on an emergency, officer.”
He said, “I’ll follow you in to be sure of that.”
He came right in to the desk of the emergency nurses station and asked, “is the doctor really on an emergency or is it a story for me?”
I had the nurses trained as to what to say to Palo Alto’s finest whenever they followed me in:
“Oh yes officer we need him here. I called him to come.” This was no lie, but not exactly true.
“Okay. No ticket once again.”
The patient was David Werner, biologist and village health worker, up in the Stanford area from the mountains of Mexico, where wild raccoons had been undergoing David’s domestication project involving treating wild animals with doses of compassion and nutritional supplements.
“Here it is, David. This x-ray shows it here: the bone splintered and broken. Are you sure it was not a bear rather than a raccoon? It is important that it be put into place and aligned perfectly. We must do an open operation to manipulate the bone directly with instruments. This means a surgery. I’ve already called Dr. Chase and the operating room nurses. Don’t eat anything till after your surgery. I see your health is good, and you have no allergies. You take no medications, and are dealing with hereditary Charcot-Marie-Tooth condition, which causes no problems at all. Please, Nurse Grant, obtain a complete blood count, urinalysis, give tetanus booster, penicillin and streptomycin, and elevate the hand a bit.”
We opened the wound in the operating room, further exposed the bone and irrigated with 1.5 quarts of saline to flush out the raccoon mouth bacteria. We debrided the damaged skin and soft tissue, cleared some periosteum (the covering of the bone), placed drill holes in the bone, put in some screws and wires, sutured up the soft tissue with chromic catgut, immobilized the joints above and below the fracture with a plaster cast, and elevated the hand. We then started powerful I V. antibiotics against the bacteria from the wild mouths of Mexican animals who had not quite finished the evolution process under Werner’s controlled study that aimed to achieve their domestication.
Late that afternoon, the patient desired quite a bit of information, especially on the theory and practice of bone and tendon restoration and how to do suturing. He wanted to learn the nuances of first aid and medical care when no doctor is around. He made a few notes for himself.
David Werner healed well. His rehab, physical therapy, and occupational therapy were all fantastic, and he was acting with collegiality. He was obviously a very smart guy and was very quick to ask highly intelligent questions about surgery and burns. We became friends. By the time his plaster cast was thrown in the trash he had told us his story: he did research in various biological aspects of butterflies, and produced beautiful hand paintings of birds and Flora in Mexico. The proceeds from his artwork helped support his village health work, performed gratis in the Sierra Madre. His location had been south and west inland from both Mazatlan and Culiacán in the state of Sinaloa, Mexico.
Amazingly, this patient was working by himself without help of a physician around, having treated three cases of clinical tetanus, more than almost any ordinary practicing physician had ever seen – wow – and he described a very great need for attention to the advanced human pathology right in his area in the mountains of northwestern Mexico! This concentration of cases was closer to us than New York City – wow again – and then he declared, “I would like to learn to be a doctor.” After three or four seconds, I answered, “I’ll do it. I’ll teach you.” At that point I added, “but in return, I would like to go down there with you to help out. By the way, are there any unrepaired cleft lips or palates in your area?”
“The place is full of them. There are several in the four villages right around where I work.”
In that moment I realized that David had caught the virus, which comes from the psychic income derived when you cure another person of a significant medical or surgical problem. David had used a Merck manual book for physicians, which contains the nature and treatment of virtually all medical conditions. He had enjoyed and become addicted to the psychic income of seeing the good results and subsequent happiness in persons responding to the science of medicine. It was like performing a miracle every day. David had been able to use the social tools already present within him, which complemented the science of medicine.
It was written, in the Merck manual as well as in the Qur’an.
Don, I have six weeks before I must return to my patients.”
“David, I can’t teach you to be a physician in only six weeks,”
He looked at me as if to say, “Baloney, this should be easy. I’ve treated all sorts of advanced pathology myself already.”
Then I said, “OK. Perhaps it is possible if you apply yourself ardently with your huge intellect. Go immediately to the ER to learn skin suturing and extensor tendon repair.” How things have changed! These days, you can barely set foot in a hospital without 12 copies of your paperwork and an official photo ID.
I gave David a white coat, covered the name Laub and placed the name Werner on the left front pocket with a sharpie. For some weeks we enjoyed professionally conducted patient rounds and grand rounds conferences.
(Continued on Page 2)