The Grand Coincidence of Mexicali, or Was It?

The magic of Mexicali – why one of the most inhospitable climates in the hemisphere and almost in the entire world would be the site for truly fantastic patient care, teaching by role model, and research; why almost every resident on their debriefing summary mentioned an Interplast incident as one of their most significant endeavors of the 6 year Stanford training. The paradox of Stanford Medical working hand in glove with a city that the Mexicans themselves did not colonize and settle, that was a sin city at one time, and when mentioned, inevitably brought up the query, “Why Mexicali?” indicating the obvious improbability.

Using the paradigm of George Chippendale (retired rocket and satellite aeronautical engineer, MIT math grad, and Interplast pilot), God arranges the coincidences.  If He/She sets the stage for these coincidental happenings, but least a “miracle” to then occurs a person must act on the coincidences. The coincidences set up plus the action of free choice equals a miracle: happening not otherwise easily explained by deductive or inductive algorithm, nor reasonable thinking.

The magic of Mexicali consists of a series of coincidences, acted upon by Interplast, Inc., a 501(c)(3) foundation. The miracle produced was the Stanford/Interplast/Medicali trifecta, a great synergy that was a part of our history. On analysis, it was 26 factors which combined into a grand coincidence, which made the success of Mexicali possible. Interplast was at the central core of the coincidences and committed the action. Making out 50 (check SA) working surgery trips in concentrated teaching interchanges, short-term, multi-disciplinary, reconstructive plastic surgery and hand surgery. Always with excellent faculty, the brightest students, repeated and on schedule, more frequently than twice a year, usually quarterly, with follow-up and treatment of complications as part of standard operating procedure (SOP), which served to perfect the template for confronting the disparity in health services between the higher level of medical skill and knowledge in developed places compared with the developing sites, the template of a method especially suited to collaboration with the medium-resource countries.

The method evolved and matured, and the overall result happened that 58 organizations [see appendix] use it, not necessarily because of spreading the motive and philosophy, but chronologically simply happening after November 1968 [1], not proctor hoc, but post hoc. The seed, or rather, the primacy occured with Stanford Plastic Surgery and LAMP (the Latin American Mission Program) Mexicali. I’ll review the coincidences and follow later with their piece towards the coincidence, the parallel happenings, and divergent topics from our teme here, e.g. General Surgery, M2H, Dr. G. Geelhoed.

What eventually happened was 5,000 operative cases were performed in mexicali and as far as the big picture is concerned 500 subsequent trips to 35 cuntries were made by 58 organizations utilizing similar models. 200,000 operations counting only the Interplasts. The fact of this success is not to be treated as outmoded as perhaps Dr. Geelhoed implied in a recent document (M2H – Plans and Processes for a Global Healthcare Legacy, p.6).

The fact of coincidence depicted so beautifully by the Pulitzer Prize winning work of Thornton Wilder and spoken about in the fiction The Bridge of San Luis Rey has given us the ideas of coincidences perhaps are arranged by God, but it is up to the free will decision making ability of the human to make the action. The theory minimizes the power of the visionary and attributes the action that took place more to God or to pure random chance.

These factors were:

  1. The Spirit of Interplast was born from the complexity of the combined activity of many people holding many passports working together. The commonality of purpose is remarkable and was a glue that held these groups together.  Started as med-school then SUI, C, 3, then a spirit practiced by MP.
  2. Essential to success was the wisdom of the Stanford academic full-time professorship, for example, in 1968 the wisdom was to encourage a more permanent teaching post with the theory of tenure, the theory of sabbatical that extramural teaching and research, and even patient care, is acquired and brought back to the university for the benefit of the home base.
  3. The wisdom of Mr. and Mrs. Leland Stanford to “adopt all of the children of California” when their only beloved son, for whom the university is actually named, died of typhoid in Europe. The preamble states that the university is to produce educated students who possess the ability to acquire actual usefulness in life.  This was mentioned in the preamble to the actual charter for Stanford University, to address the difficult, “to be useful in life, unlike the Eastern Universities.”
  4. The acuteness of thinking of David Starr Jordan, the first President of Stanford, in setting the tradition at Stanford, “The tradition at Stanford is the freedom from tradition.”
  5. Another fortuitous factor was not only from Baja California, but all over Mexico presented, which revealed a high incidence of cleft lip and palate birth defect, some of which were grotesque, some with cleft palate closed had real problems in communication and speech.
  6. One unforeseen factor was the compassion of the transsexual community, who showed that they were real people; they helped to finance the program in Mexicali at up to 70,000 dollars per year.
  7. Great goodwill at the surgeon’s standard affiliate at San Mateo County Hospital formed a Surgery Association and made possible similar largesse in time of need for Interplast: a critical rescue.
  8. The fortitude of the Mexicali surgeons in Colegio Medico, also known on the American side of the Border, as the county medical society, for obtaining federal permission in Mexico for the international program.
  9. The coincidence of the Federal U.S. FBI Witness Protection Program as placing Phil Collins as Community Developer for the Latin American Mission Program, AKA LAMP, in the forbidding “furnace” – Disierto de Altar, just south of the border in Mexicali.
  10. The possibility that Jesus, in his absence from Nazareth during his 12-30 years, learned the principles of Eastern religion as he was on the trade route would be  exposed to Eastern Religion Principles of working for the whole rather than the self. Perhaps a factor which was imbedded in his Christianity religion.
  11. Hippocrates, in year 431 BC, founded the sacred profession of the physician: use your achievement and science and skill to help other individuals who have medical pathology.
  12. The role models were Paul Brand, Robert A. Chase himself, Jim Turpin (Project Concern), Tom Dooley (in Laos), were predecessors and role models to young physicians in their formative years in the 1960’s. were fortuitously made known to young physicians in their formative years in the 1960’s.
  13. The AMA / USAID program, encouraged physicians to work as in a “sabbatical” in Vietnam, mimicking the success that the communists had in winning the hearts and minds of the people. The AMA program used medical programs. Colonel David Dibbell worked 1 full year in Vietnam on humanitarian surgery, performing operations for both sides Viet. Cong and the Vietnam Army.
  14. Robert A. Chase’s Division of Plastic and Reconstructive and Hand Surgery had primacy in being the first to mount short term multidisciplinary single focus surgical trips to developing countries, repeating them biannually, twice a year for 20-30 years. Chase backed the international trips with his political muscle, his particular standards of care, and his standard operating procedures for international interchanges. These trips consisted of multidisciplinary, international teaching, research, and patient care, short-term, repeated trips, featuring graduated responsibility, early schooling in psychomotor skills (of surgery), and being responsible in caring for complications and follow-up. He’s responsible for a sort of entirely new medical system, a single unified single-team consisting of members from two countries. Thus forming.
  15. DRL instituted the concept of the fourth dimension, which mimicked the three Peace Corps. directives: direct care, teaching, and medical independence. He added the fourth dimension: that the two countries form one unit, which in turn, becomes the provider for a third and even fourth country, as a new task force.
  16. Not a coincidence, but as eventual product of all of the factors was a “How to” of the international trip at work. The Interplast SOP. The first trip, not a parachute, but a needs assessment. The second trip involves producing the letter of intention, the LOI, a collaborative model, formally signed by both countries, designating which groups are responsible for which: who brings the equipment and supplies, i.e. do not parasitise the other hospital; who brings the professors and teachers, which unit takes care of the noon meals, who becomes the social chairman and sets up the social acts which forms friends from those who are not yet friends; who will arrange in-country transportation, the international transportation, the contributions of each to the research projects, the team members who carry out the public relations both for television and for newspaper.
  17. The task analysis deals with persons rather than countries and organizations, and delineates the exact duties and responsibilities for each individual.
  18. The theory of gradual responsibility is mandatory for the training of all residents at all levels from both countries. In fact, graduated responsibility is used all over the world in surgery training. “Residents do!”
  19. The coincidence that in cyclical Vatican II advised that the clergy of the Catholic Church go out and work with the people to a much greater extent, and to “face the parishioners while saying mass” (this was a very small signal that change would be on the way, and that the self). Interestingly, Ignatius, in the 15th century, had founded an order of Priests . The Jesuit’s great thrust was to work directly with people in the field. It was Francis that said the same, thank you. Ignatius added the concept of service directly to the down and out people and to go out into the lowest circumstances. Ships were not meant to be in the harbor, they were trained to be at sea. Priests were trained to be out in the world with people, Vatican II reminded the clergy to go out into the lowest circumstances to work with people (and Francis repeated this nowadays).
  20. In 1958, a group of priests from Mexico, and others from the U.S., went to Mexicali to form LAMP, Latin American mission program, to work in one of the most inhospitable places imaginable.
    Washing Feet
    Pope going to inhospitable circumstances

    That group of priests worked directly with the persons in those circumstances doing ecclesiastical and most importantly social work. When a needy patient came asking for help, that cleft lip and palate  patient was referred to them, and they consulted Stanford, Dr. Robert Chase, who performed a brilliant humanitarian act in repairing his cleft lip and palate.

  21. An evaluation was requested form a disinterested outsider. That expert reviewed the social program of LAMP, and they stated in the evaluation circa 1973 as follows:
    1. From the point of view of motivation, commitment and dedication it is certainly superior… “
    2. “The first day they review patient records and see the patients if necessary. The next two days they operate for two full days in the surgery department of the Hospital Civil. Primarily they treat cleft palates and hair lips (el labio leporino), but they will also deal with other plastic surgery cases. This program has so many pluses that it is easily one of the most outstanding programs of its kind in the hemisphere, and with such dramatic results that is should be better known…”
    3. “The doctors profit by having the opportunity to perform and acquire practice in this type of surgical procedure that is not available to them at home. The Mexican doctors who are encouraged to work along with the visiting team receive experience and training from experts.”
    4. Besides the obvious benefits of these medical programs to these most immediately affected by them, their development as “partnership” programs (i.e., jointly planned and implemented by the American and Mexican people) is an outstanding example of aid to Latin America that does not smack of paternalism nor of exploitation.”
    5. Recommendations: “Certainly these medical programs should be continued and expanded on all levels as much as possible. Join planning efforts should also be further developed. Also, LAMP should continue and extend its efforts to obtain medicines medical units and supplies provided that the receptivity continues to grow with good will on both sides of the border.”
  22. The trips were short term, multidisciplinary, scheduled, repeated, single focus, teaching research, and patient care, with an eye on the long-term professional relationships (LTPR’s).
  23. Plastic and reconstructive surgeons, and the field of PRS as a species, were the first ones to do concerted international humanitarian surgery.
  24. The second generation: those who in turn did humanitarian activities because they came in direct contact working with Interplast. Before that, they were not of the humanitarian ilk in any way, aside from a few examples: Ed Walsh – member of secret government organizations (FBI, CIA), Henry Hen of the CIA, Edgar Rodas, Mac Small – the legal profession can be your friend, the Mexicali girl who had 22 operations, Gayle Milla, the Rotaract, Guillermo Peña – became a craniofacial surgeon, Don Laub Jr., and Aresteo Villalobos.
    1. Edgar Rodas was an Ecuadorian native surgeon who trained in Miami and founded Sintorandes. As a second generation he has done 7,000 operations in a truck operating room in jungle seashore, and high in the Andes. He has no mortality in cholecystectony, huge hernia repair, and C-section.
    2. Those who were influenced by working with Interplast as children were Marianne Kafati, Guillermo Peña, Donald R. Laub Jr. Marianne Paz Kafati built a burn hospital in San Pedro Sula and continues to raise money for maintenance. Guillermo Peña has become a world-class craniofacial surgeon. “D2” is a professor of Plastic Surgery, University of Vermont, making Interplast style trips to Brazil, Vietnam, and Mexico.
  25. Spies from each country. In each site in Latin America, the equivalent of our County Medical Society is the Colegio Medico. Colegio Medico is responsible for safety and efficacy of the visiting surgical interchange. Customarily they assign for esteemed physicians to spy on us and report back to their society. We have been approved by each of 7 Colegio Medicos.
  26. The other factors, many of them coincidental, were the people of Many People, Many Passports. Anesthesia, laboratory technology, OR nurses, PACU (post-anesthesia care unit), those in the audience of lectures, the application of business principles to humanitarian work, pediatrics. Each deserves a paragraph.

[1] the poem was first heard by me through Dr. Jorge Palacios, but is originally attributed to William G.T. Shedd, 19th century theologian


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