The project of International Humanitarian Surgery came into existence as a result of a confluence of events which inspired the participants to engage with patients and communities outside of the U.S.A. The project was extremely worthwhile since it brought through surgery an almost miraculous change in a person’s life. The patient’s body image and self-confidence were rapidly restored and many of the psychological problems associated with deformity quite rapidly reversed. This work has matured, evolved, and developed into a tried-and-true process of developing a two-way interchange program in the profession between counterparts in two countries. Here we will discuss how the process is successful, how the participants become friends, and how the process is successful and sustainable.
Once the decision was made to embark on an international medical trip, based on our experience in Mexico, we corresponded in depth with all institutions, hospitals, and foundations, as well as all persons that might be involved in our performing surgery in these Central American countries: the American Ambassador, the Chief Medical Officer in our USAID (United States Agency for International Development) team, then the Minister of Health and the President of the Colegio Medico (equivalent to our AMA), and also the plastic and reconstructive surgeons themselves, in each country. All the potentially necessary channels were tapped into in preparation. The first team of Stanford University physicians and nurses undertook a medical journey in November 1967.
Initially, the program was supported by physicians from San Mateo, CA, who in effect were surrogates and therefore engaged in the project from their homes in California. These San Mateo physicians had generously underwritten the project of bringing patients up here who were not suitable for surgery in Mexico because of repeated or staged surgery requiring longer post-operative care.
In embarking on these trips, we were very scrupulous in how we attained and transported resources. Our surgical supplies and equipment had been shipped by United Fruit Company in their banana ship returning empty to Honduras, at no cost to us. Most of the sutures and surgical supplies had been donated by the pharmaceutical and surgical supply houses. There had been so few funds available for this project; it is only with this kind of help that we could take the first step in our program, which would prove to be ever-growing and extremely worthwhile.
The idea for this project was first seeded by a patient in the U.S.A. He was a scientist working in Mexico on research, who’d taken it upon himself to provide rudimentary, Western-style medical assistance to the local population. From our association with this David Werner, and his knowledge of the many un-repaired cleft lips and palates in his area, we were encouraged to plan a trip to Sinaloa.
In the future, we would follow this model and identify someone already on the ground who could connect the physicians with the patients, as well as work in synergy with all the legal, political, professional, and community leaders, addressing personal problems with such foreign or “gringo ” motivation. For example, it was a difficult decision then that San Pedro Sula has been chosen for the first surgical trip to Central America. Once we decided to go to the bigger city with more patients, we worked at the Hospital Dr. Leonardo Martinez V. with Dr. Rene Bendana and Dr. Luis Bueso. We anticipated many cases of cleft lip and palate.
We progressively developed a concept for embarking on these trips. This concept entails bringing plastic and reconstructive surgery and science to these developing countries, using the tremendous impact of immediate surgical rehabilitation of a severe and grotesque deformity as a manifestation of our country’s system and the goodwill of American people. The change that takes place in an 8-year-old girl’s 1ife from the state of grotesque deformity to normal appearance is inspiring.
An important part of the project is the training of the Mexican and Central American doctors and nurses, as well as the training of our resident doctors. We all, everyone from both countries, benefitted from surgical and research experiences not found in any other training program in the United States.
This model was accepted by the local government and professional members in Managua, as in other places. We received the “red carpet treatment” from the First Lady, the President’s wife, Hope de Somoza, Presidenta de Asistencia Socia1, among others. We were encouraged by the Minister of Health, Dr. Rodrigo Portocarrero, to come to perform surgery and institute a medical interchange. We also to presented lectures to the nurses, and trained nurses in fluothane anesthesia techniques. Training of the “recipient” country’s doctors and nurses is integral with the patient care and rehabilitation.
No other university plastic and reconstructive surgery training program in the United States offered these unique and worthwhile opportunities to their own and to those from the country with which we interchange professionally. We intend to continue to augment our clinical research as well as provide sophisticated medical care of exceptionally high impact value.
Of the fifteen surgeries we performed during this time, each one being notable in itself, several were particularly unusual or interesting:
- A woman reconciling with her husband before being discharged and leaving happily with him.
- A man who had a double lip which was removed with local anesthetic.
Some of the cases we encounter are distressing – mature people still handicapped with cleft lip or cleft palate, bearing the social stigma of this deformity (most of these people have never been to school because of their deformity), children with extensive burns receiving limited treatment, many with severe scarring from untreated burns, as well as several cases of syndactylism (one or more fused digits).