Lesotho Story: Semen for the Americas


“Semen for the Americas is the world’s best project.”

These words were heard from the President of the Semen for the Americas foundation, whose purpose is to improve the strain of cattle for the agricultural industry of the Americas (US, Mexico, Central America, and South America) by supplying bull semen from superior livestock for artificial insemination. He spoke in a very loud voice, persuading the people at his table. Little did he know that the larger-than-life Stanford plastic surgery resident,the swashbuckling David Dibbell, “co-founder of Interplast,” equipped already with the arrogance of the recently trained Stanford person, had heard him. Dibbell, the hard-bitten former Air Force Colonel, who had volunteered for service at Vietnam, had gained over official orders (never before done) to direct his work solely in the interest of humanitarian work.

“Do surgery on all comers even if they happen to be Viet Cong, or on our side.” Now, you must know that Dibbell is a fearless champion of Interplast and a formidable person in the art of libation. Dave Dibbell acted out according to that description and true to form said, “No…it’s not semen thats the most important.The most important thing is the repair of cleft lips and cleft palates, correcting the disparity in distribution of medical services among countries.”
The intervention of Dibbell ignited the whole thing.

Furthermore Dibbell was “point man,” or the representative, for our entire group of trained killers (T.K.’s)*. And the story did not just stop here.


Simultaneous to that wonderful little argument in Houston in 1973, in Palo Alto, California D Laub was having a blissful night’s sleep. Nevertheless he was inured to the wake-up call in the middle of the night. Actually, his first “on-call”experience occurred in 1958 when he was an extern on call for the entire 2000 beds  at the VA Hospital in Milwaukee. This was a new experience, when DRL was a junior medical student. I knew that this first time on my new job was quite important and I wanted to not make the mistake of oversleeping a call. I elected to sleep with the light bulb on whenever I would be on call in the hospital. I wanted to be able to respond in the fully awake condition to medical situations which would be shouted in into my ear from of the nearby telephone. At that time those nighttime telephone calls were reserved for patients in need. This was and obviously newly acquired responsibility: it amounted to a huge and exciting body image booster. In order to be able to respond at full level of wakefulness in only a few seconds time frame, I slept in the lit room, usually downing a nice cup of coffee just before hitting the hay. I compared the situation to that of a cowboy in hostile Indian territory who sleeps with a loaded pistol under his pillow.

So it was natural occurrence when the phone rang at 2 AM at home in Palo Alto. “Hello, Don. I am here at a bar in Houston telling these guys at the next table that Interplast surgery is much better than improving the cattle in Africa with American semen from bulls. “Take a moment and please verify to them how great our project is,” and I did just that. I surprised the hell out of them by ending the encounter with, “I can meet you for lunch tomorrow to discuss details?” I was in Palo Alto, California; they were in Texas.

We arranged to meet at the hotel dining place. They were impressed at the response; I did not tell them that I had been already scheduled to be on an early morning airplane to Houston to attend the same meeting as Dr. Dibbell. They were further impressed when I showed up ready to respond. The outcome of these shenanigans was a needs assessment combined with a first working short-term trip to the landlocked country in Africa, Lesotho, situated entirely withing the borders of South Africa.The first trip soon matured into a schedule series of trips which were “emblematic” of the Interplast commitment to providing surgical services to those without access. The incredibly competent and helpful mentors and teachers from the University of Cape Town were the ad hoc Stanford “faculty.” Our residents did the work; this was their peak experience,or their necessary voyage as described by the psychologist the famed Eric Erickson. The experience in Lesotho transported them from the didactic learning phase of life into their own experiential learning phase: that time when decisions are made by their own free will and their own mistakes, and they grew into the equivalent of a teacher or young professor. The residents stood up a bit straighter and looked you more directly in the eye. The Interplast experience was a most important part of the teaching method at Interplast and at at Stanford. I felt it was no longer a teaching method. We had learned teaching expertise.


The law of paradoxes was at work. The University, usually featuring research teaching and patient care, had added a fourth objective. It was now, research, teaching patient care and community service. Objective number four was born. And for the 501(c) three foundation, the objective was not predominantly in the broad area of “bleeding heart”but rather the foundation had participated heavily in teaching and research, the usual job of the University.*

We consulted our Congressman in Washington. McCloskey, whose letter to Garcia attitude married, as to the federal program sister cities, Austin, Texas to Masero, Lesotho, linking them. The trained killer resident Terry Knapp linked via the program with Francois Malherbe in Cape Town, whereby Interplast connected with their university.

The program has been existing for years. Fogarty followed Knapp to Africa as reconstructive surgeon to their hospital. You can imagine the gold mine not of gold, but rather of good cases. The top of the world supervision was available, the unprecedented opportunity to acquire judgement and experience, to not make mistakes and report the outcomes of the program and the patients of the world. Wow!

1978 was the time line for that exciting chance to help organize a really good program. This episode was a source of happiness for most everybody involved: 200 patients, professors, students and residents at two universities. David Fogarty, David Fidel, Tom Constantino, McCloskey, the residents after him, and both foundations all came out shining.

It is 2013 and the book The Zealot has just been published about Jesus from the viewpoint of history. I cannot help thing that the man larger than life, DGD, fills the definition that I have learned to be “Zealot.”

Of course we have to pay the price for being a little bit out of the box, but it certainly helps to have your back foot solidly in the box with supporters who say this is okay, these guys are all right, talk to them. We were a little bit out of our little area, our university, and in fact, our continent, out all of the guidelines of our professional organization and that ruling class. Possibly, we were doing something which was not legal, “but this has never been done before.”

I noted the characteristics of the trained killers and their attitude: get the job done, unstoppable, they were committed, able to change and always in control of themselves (the three big C’s).

Knapp and Fogarty returned to that country and that hospital. Their friends who were lifelong in that which can only be measured in the logarithm professional relationship. They found happiness which can only be measured in the logarithm.

The Dalai Lama in his book verbalizes the axiom which characterizes this work which is done gratis, as of great significance to the life of the patient, and the patient may very well likewise to another. When the professionals do these things they contribute immense and great happiness to the patient, but the doctor receives immense happiness in the act of doing.


[1]The trained killers is the jargon and commonly used slang apparition for a group of people who always get the got done, no matter what. It does not refer to the military use of the word; it does not refer to literal killing, but rather simply getting it done.


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