“Only” An Oral Surgeon- Doctor Oscar Asensio

Cirujano Oral

Antigua, Guatemala

 

Dr. Asensio became a Stanford faculty member: Clinical Assistant Professor of Surgery (Plastic), specializing in repair of cleft lip and palate and, of course, teaching our residents and students about the value of humanitarian work.

Dr. Asensio, though living in a so-called third world nation, was a fine gentleman, proud and dignified, a high-class, altruistic humanitarian, a magnificent surgeon and friend, and contributor to the cleft lip and palate subspecialty. He was ambitious, and possessed a great self-starting quality in that he had set up his own clinic for surgery on children for cleft lip and palate.

The clinic was meticulously clean and up-to-date, and devoted to charity work: the repair of the clefts of poor patients in a large area around Antigua, Guatemala. He devised quite cleverly, and with a great amount of planning and thinking about the principles derived from the embryology of cleft lip, the muscle misplacement in cleft—his own technique for cleft lip repair, using knowledge of wound healing. The repair as Asensio developed it differed from the repair most common in the world, and produced results which impressed us: Dr. L. Vistnes, Rick Siegel, and myself. We visited and reviewed his work in Antigua. He was spectacular, yet he was “only” (our words) an oral surgeon.

He performed the surgery under a local, not general, anesthetic, but with an anesthetist. He sat at the head of the table, with the child receiving sedation administered by the nurse anesthetist via I.V. and the oral route: a bottle and nipple and whisky.

His results were the best we had ever seen. Yet we had thought we were in Guatemala to help those with third world standards! We soon realized we could learn from them, namely Dr. Asensio.

We had discovered a slice of the first world in the third world. We were elated, not put off nor threatened. We immediately formed a collegial relationship and became friends working towards the same goal. Our commonality towards humanitarianism quickly dissolved differences in our language and our anesthetic techniques.

Our operative technique in many ways was different. Even our attitude vastly differed. But we bound ourselves together. With Asensio, we learned one of our first lessons in travel to other countries, i.e. to notice all of the common points, and do not concentrate on the differences.[1] It is as if we had a lifelong annuity in the area of friendship.

We saw his slides and the demonstration of his operation on the blackboard, as well as in the actual operating room. We questioned him thoroughly regarding incision placement, plane of the tissue undermining, and his method to lengthen the short lip of this congenital birth defect. We asked questions regarding his estimation of the techniques extant in this world at that time. We critically compared this to the work of the king[2] of cleft lip repair, the surgeon who knew very well he was king, and who himself was chauvinistic in favor of his own technique. Oscar showed us Millard’s cases; Oscar had taken photos of his own. He directed our thinking to the view of the nose from the foot of the bed up toward the nose, specifically the boxy nose formed by the technique used by the renowned Dr. Millard, compared to Oscar’s own natural noses. Perhaps the boxy nose result was caused by Dr. Millard’s stress, as guessed by someone in the Guatemalan’s operating room. It was an “away” game, not on his own court.

We examined the scar and the length of the lip (nose floor to vermillion or red lip), the muscular action, and the general appearance, comparing the two approaches to the same problem. And we entered into the attractive position of mutual appreciation club or mutual benefit or symbiotic mode if you will. In us, Asensio saw an affiliation with a world-renowned University Medical School, and with a group of enthusiastic young Turks admiring his work. We envisioned a never-to-be-equaled opportunity to learn something new and to present it to the world, and particularly to our residents. We saw a place for our residents to learn the technique, and they in turn could become world class.

After the dual consideration of our Board of Directors and consultation from those who were more experienced, we entered into a compact, or convenio, with Dr. Oscar Asensio: the residents would take their families and their malleable brains to Antigua, and be at the side of Professor Asensio for a three-month rotation. One of our faculty members would take up residence in Antigua for one month. The rotation was devised so that we would be the Plastic and Reconstructive Surgery service for Pedro Betancourt Hospital,[3] the charity hospital for Antigua.

We were given a tour of the Pedro Betancourt Hospital in order to select the ward, or sala, which we would like to use for our future patients. We noticed each sala had an alcove about 10 feet above floor level for a saint to look out upon the sixteen lucky patients in that room.

We selected the patron saint who had a cleft palate, the cleft palate being caused by congenital syphilis, which was a more common cause of cleft palate than that it is today in Beverly Hills.

Many interesting events of course followed this unlikely marriage: The meeting of our Chief Resident, Ronald Iverson, and Dr. Asensio, Richard J. Siegel and the first Asensio repair that I did with him, Dr. Asensio’s graniferous motion before he did any tiny surgical motion, Dr. Siegel’s insistence on eating lettuce and “all natural foods,” that is, those purchased at the market and at roadside stands and never taking antibiotics (leading to typhoid fever), Dr. Asensio’s visit to Stanford, Asensio’s reprimand to me for climbing Agua Volcano instead of watching him perform surgery, his request for salary, our backing out of the contract, our need to steal back our truck from his home (an off-duty CIA agent performing this act), and our hiring of Sergio (our servant at our Antigua home) to come to our home in Palo Alto, the de facto incubator program.

The owners of our home in Antigua hired decorators of great talent to tastefully and beautifully refurbish it. The comment of my wife on first entering this ruins, our new house, was, “Gay!” And indeed the excellence of the ability of the decorators was astounding. The bath area was outside; that is, there was no roof to this atrium. There were several palms and a flower area in the central courtyard, surrounded Spanish-style with a rectangular hallway filled with all sorts of historical artifacts. In the mornings we were able to be in on the closed educational rounds of Oscar. In the afternoon, we were enjoying the local life, climbing Agua Volcano, or visiting with Dr. Luis Bueso, who had driven up from San Pedro Sula, Honduras.

[1] How often have you listened to a travelog type presentation of a professor’s visit to another country and heard repeatedly, “They do their sterile technique much differently than ours, they reuse the rubber gloves over and over, they re-sterilize the gauze, the nurses do not have formal education, etc.”? They could relate, “Just like us, all the doctors are trying hard with all available resources. They are devoted to their work. We liked them immediately. Wherever you go you have an immediate friend when you meet a doctor.”

 

[2]  Dr. Ralph Millard.

[3] Here’s the fascinating story of Pedro Betancourt, the first Physician’s Assistant in Guatemala. We were told that Pedro Betancourt was a humble person who would try to help those who were ill and nurse them back to health. He became renowned for his ability to cure people. The richest man in town was in flagrante dilecto with his mistress when she had an epileptic seizure and then became entered into the postictal state of complete relaxed paralysis; he assumed that he had killed her that night. He quickly summoned Pedro Betancourt. Pedro nursed the “victim” with his healing power. Nobody knew that she would’ve returned to normal state in the normal course of events. However, Mr. Señor was so grateful that his reputation was saved, that he gave Pedro half of his entire fortune for the miracle which he performed. Pedro then formed “our” hospital in 1686 from the ruins of a convent.

 

 

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