The Basic Idea

The Interplast November 9, 2009 recall of a meeting in 1968 in Tegucigalpa, Honduras, in the presidential palace with the Minister of Health, the General of the Army, and the second-in-line Secretary of State.

As a third-year surgical resident, I was motivated by the humanitarian principle; and our concept was to spread out the advances and new knowledge and skills in medicine to the rest of the world. They nodded their heads up and down, meaning “yes.” They opened their eyes a little bit and took another sip of coffee. We had taken note of the fact that the disparity between the developed countries and the developing countries was greatest in medicine – much more than in agriculture, finance, teaching, business, architecture, fishing, hunting, manufacturing, arboriculture, advertising, or in legal things. The idea of doing medicine and surgery in developing countries was not an entirely new concept, as many individual role models had accomplished great things: Tom Dooley, Albert Schweitzer, Ron Rees, Paul Brand, Robert Chase. Missionary hospitals had been part of our culture and had brought about amazing improvements in lowering the incidence of human mortality, and they had helped to eradicate a number of diseases, such as leprosy.

The U.S. State Department A.I.D. (Aid to International Development) Program had used medicine to a certain extent to successful accomplish the purposes of our foreign policy. A university-to-university academic interchange under A.I.D. was underway in those years. Professional medical journals were doing their job of international communication of medical information, and they were deemed successful.

However, I want to speak about the power of personal contact. Let me talk about the person – a new friend, albeit it in a straight business milieu, in this exact situation immediately forms a bond between not two persons but among many persons, which union easily results in action or “help.” For example, the minister of health and the army general [two people or one?] sitting in front of us visualized help to their countrymen and desired to help us right then. Although his official position and his uniform and the nice suit that he was wearing indicated that the political stance of the Honduran government and the profession (medical, military, commercial, historical) would make him so no if we were to send a similar email request or electronic inquiry. Also, he would probably say no to a formal, physical letter. But sitting there, even in his uniform on that Saturday morning at 8:00, he reacted with interest. But it was hard for him to be able to go directly to “yes.” The conflict was that it was good for his countrymen, and it seemed as if this might be the right thing to do, but yet he began to think that he had to say, “No. Go home, go home,” as the Mexican government had done. “Our professors and our politicians and our commercial community want you not to be on our turn.” [1]

The Background of helping people and the service concept.

In Central Europe, it was passed on to progeny who moved to the Midwest U.S. that helping others was “the thing to do.” The dream was that if you were an M.D. you could own a house up on the hill, be regarded highly by the townspeople, could be competent in every part of the field you had chosen, and be the world expert in one thing; holding a dream of really contributing an invention, some invention even as small as a can opener but significant to many people. Indeed, ths was my dream and it was my general line of pursuit. [2] [3]

Interplast is an organization which was formed to help other people. It is a charitable organization designed to help other people with plastic and reconstructive surgery when they don’t have access to such care, particularly in developing countries.

We had a grand idea and we all knew the idea was grand. On our first trip to Mexico, to Culiacan, Sinaloa, we performed thirty-nine cases and enjoyed great success. Of course we were proud of the accomplishment. Being proud of our record, we immideately planned a repeat trip. The second trip was outfitted with a nice team, in fact a superb team. But we were kicked out of Mexico because we had generated international publicity on the first trip. This very small bit of notoriety had traveled to a Mexico City newspaper and was noticed by key people in the central government, who were embarrassed because their socialistic government was supposed to carry out medical care for all of Mexico’s poor through their health care plan as it had originally been designed. So the Mexican medical ministry responded to the well-written, well-articulated editorial opinion in a major newspaper by implying that we thought too highly of ourselves, and in fact they quoted us as using the words of MacArthur: We will return.

After leaving Mexico at the personal request of the governor of the state of Sinaloa, we first pouted; we knew not what to do. We decided to find other places for this work that was so good. So we called the U.S.A.I.D. in the State Department and asked to talk to the chief medical officer. We explained to him personally about the magnificence of this program, its power to help people and its power in international diplomacy. He surveyed all the Central American countries for places that needed help with plastic surgery. We personally contacted the chief medical officer of the American Embassy of each country and also the wife of the president of one country, who at that time was emulating Jackie Kennedy not only in dress and hairdo, but also by controlling the lottery money and using it for the benefit of children. We hoped to provide her a good project for her good intentions.

Jacaltenango, Huehuetenango, Guatemala. When you know you’re right, how can you be wrong? Wait for ten years. Your initial premise was that all people are equal. But in 1971 a Maryknoll missionary in a remote hospital that she built in the highlands of remote Guatemala was trying to tell us a different theory. The theory was liberation theology, [4] and it supersedes Hippocrates’ oath. When you know it, it fits the situation. Why not practice it? It might be the way of the future. I did not catch on. We had come to Jacaltenango on a grand trip. Six months earlier we had reached the place on mule back on a five-hour ride through incredible mountainous cliff trails, beautiful scenery. A road had been built in the meantime and we were able to return there via four-wheel drive to the hospital that the nuns had packed in piece by piece by mule in 1968. Actually, we had the plan of going to each country in Central America, to those places that had responded as possibly desiring to find out more about the help we offered.

On a Sunday morning in Honduras we were sitting there just as we are now, and the minister of health said, “We don’t need you because a plastic surgeon came here a few years ago and he did four cases.” I cast my eyes down. The minister saw that I was sad; he thought we shouldn’t invade the medical profession’s turn in Honduras. But he switched his attitude and said, “Well, maybe in San  Pedro. Perhaps it will work there.” He picked up the red telephone and said, “Rene, you have a lot of cleft lips up there. See if you can get them ready. I’m going to send some people down. They’re here with me right now.” In one hour we were back at the airport. In 90 minutes more we were in San Pedro Sula. The surgeon was Gil Snyder of Miami, previously of Salt Lake City. I had had some nice correspondence with him. [5]

We headed off to Rene Bandana.

[1] “Turf” means “our area of making money.”

[2] Although we had no funding at that time, we generally were so enthused about the idea being so good in every way, and we were sure that everybody in contact with this project would be benefited. We had a general attitude of unstoppability.

[3] (David Werner encounter. Setbacks are the most wonderful and opportune events.)

[4] Definition from Wikipedia: Liberation theorlogy is a movement in Christian theology that construes the teachings of Jesus Christ in terms of a liberation from unjust economic, political, or social conditions. It has been described by proponents as “an interpretation of Christian faith through the poor’s suffering, their struggle and hope, and a critique of society and the Catholic faith and Christianity through the eyes of the poor”, and by detractors as Christianity perverted by Marxism and Communism.

[5] Snyder had succeeded David Ohlwihler, who was first a pilot for Taca Airlines of El Salvador. I had talked to him like a pilot, saying “Say again,” “Repeat,” “Roger,” “Affirmative,” “Niner,” and all that sort of thing. And he told me he had been so moved by the cleft lips he had seen in Central America that he gave up being a pilot, went to medical school, and began doing cleft lip surgery in San Pedro Sula. His plan had been to charge the patients a little bit and donate that money back to the hospital, but his medical colleagues unfortunately felt this money was being subtracted from their general incomes, so he had been asked to leave.




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