Politics Can Be Your Friend, Doctor Part II

The Interplast November 9, 2009 recall of a meeting in 1969 in Tegucigalpa, Honduras, presidential palace, with the Minister of Health, the General of the Army, and the second-in-line, Secretary of State.

As a newly appointed Assistant Professor in a little known surgery department, I was motivated by the educational principle; and our concept was to spread out the advances, wouldn’t it be fantastic to spread out the new skills and knowledge to the rest of the world.  After all, we know it here at the center, but let’s bring this good news from the highly resourced medical places to the mid-resourced places. This would be a good starting point. Here is a cartoon here.

mountains

It was early in the morning. They nodded their heads up and down, meaning a non-verbal “yes.” They opened their eyes a little bit more 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 agriculture, finance, teaching, business, architecture, fishing, hunting, manufacturing, arboriculture, advertising, or law. The idea of doing and teaching medicine and surgery as an international interchange in developing countries was not an entirely new concept, as many individual role models had accomplished great things: Tom Dooley (Laos), Albert Schweitzer (Africa), Michael Wood, Archibald McIndoe, Tom Rees (Flying Doctors Service of East Africa), Paul Brand (Bangalore, India, leprosy), Robert A 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 and smallpox.

The U.S. State Department Aid to International Development Program (AID) has used medicine to a certain extent to successfully accomplish the purposes of our foreign policy, and had teamed with the AMA in a volunteer program, and university-to-university academic interchange under AID 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 first about the person – a new friend, albeit in a straight business milieu in this exact situation, whom you form a bond with, not between two persons but among many persons present, which union easily results in action or “help.” For example, the Minister of Health, and the Army General, the two people sitting in front of us visualized help to their countrymen and desired to help us right then. His official position and uniform and nice suit indicated that the political stance of the Honduran government and the profession (medical, military, commercial, historical) would make him say, “No,” if we were to send a similar email request or electronic media 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 still, it was hard for him to be able to go directly to, “Yes.” The conflict was that I presented it as good for his countrymen, and it seemed at that moment as if this might be the right thing for them to do, personally for their job also. No one of the three was awake enough to recall that he had to say, “No. Go home, go home,” as the Mexican government had done. They did not verbalize, “Our professors, our politicians, and our commercial community want you not to be on our turf.”[1] This was from a person to another person, not a policy to policy. The background of helping people and the service concept really helped, and it was the “bleeding heart” approach. It was, really, educational interchange for any purpose; they wanted to use it politically or for personal promotion. This was the approach to their mind.

As for my motives, I knew that 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 and contributing an invention, some invention even as small as a can opener but significant to many people. Indeed this was my dream and it was my general line of pursuit.[2,3] Perhaps it resonated with the persons as persons.

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.”

Here we turn the calendar back 1 year, to Mexico.

We had a grand idea and we all knew the idea was grand. On our first trip to Mexico, to Culiacán, Sinaloa, we performed thirty-nine cases [6] and enjoyed great success. Of course we were proud of our record, we immediately 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 when we arrived 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 the key people in the central government, who were embarrassed because their socialistic [4] 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 the major Mexican newspaper in the capital, by implying that we thought too highly of ourselves, and in fact they quoted us as using the words of MacArthur: We shall return.

After leaving Mexico at the personal request of one of the three political bosses of LA (Latin American) medicine and the agreement reversal 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 had been so good; it had to have a Plan B and Plan C if we failed cordiality once again. So we called the USAID 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 2 key persons: the chief medical officer of the American Embassy of each country as well as the wife of the president of each republic, 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, in the state of 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 personally built in the highlands of remote Guatemala was trying to tell us a different theory. The theory was liberation theology [5] and its effect might supersede Hippocrates’s 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 a perfect Plan B to Jacaltenango on a grand needs assessment tour of Central America. Six months earlier we had reached the place on mule back on a five-hour ride through incredible mountainous cliff trails, beautiful and dangerous scenery. A road had been punched through in the meantime, and we were able to reach Jacaltenango, an Indian village, via four-wheel drive. We came invited to the hospital that the nuns had packed in piece by piece by mule in 1958. Actually, we had the plan of going to each country in Central America, to those places that had responded as possibly interested in an interchange and desiring to find out more about the help we had offered by mail.

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 has come here 1½ years ago 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 turf 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 Miami surgeon, Gil Snyder, previously of Salt Lake City. I later had some nice correspondence with him. He had expressed caution with the charging of a fee to the patients, even if donated back to the program.[7]

We headed off to Rene Bendaña, the senior (90 year old) brother of the private Bendaña clinic.

We were forthwith chauffeured to the Tegucigalpa airport and arrived in the hospital in the north before noon time. On our debriefing, we agreed that the meeting in Tegucigalpa was productive because Dr. Rene Bendaña, urologist, through his social worker at Leonardo Martinez Hospital, had many cleft lip and palate cases unrepaired. We found the hospital and the nice social worker, but no doctor. And we knew full well the political importance of the doctor who would be a prominent member of their Colegio Medical Society which controls medical practice and by whom and when in the San Pedro Sula Area.

Where is Dr. Bendaña?

He is not home.

Wow! In front of myself, Kees, superb physician assistant and experienced in heart surgery valve replacement, and Phil Collins, master politician and community developer, I myself, a completely unstoppable educator bent on finding good cases pabulum upon which dreams and motives and goals promoting my residents careers, making them very useful and very capable, of research on etiology and of teaching plastic surgery and known on almost a national scale, of spreading the skill and knowledge and over a surgical body of knowledge to many lands.

Here on a wide courtyard on the benches was the Holy Grail, the unrepaired clefts, ready with name tags and little pieces of paper, expectant but wary of us unproved guys, but looking OK. No doctor, very important. I found a phone book in the admin office with help of the social worker and called Rene’s number. No answer. The book had his address.

The taxi brought us to his side door. A generous older wooden home with screen door. The maid finally came to the door.

Where is he?

At the farm each Sunday at noon.

Damn. We went with social worker and two other nurses and performed needs assessment. Patients, Ag chemicals, old paternal age? Pregnancy ok? Sickly child?

History and physical, photos, record start for each – we were happy. We had fallen into a bed of roses. Thanks to all – we retired to the place where all Midwesterners go in times when their objective was incomplete. We went to the Guanacaste Bar.[8] We ordered a couple of Salva Vida beers – 5%.[9] A nice man in a pink guabera sat down next to me, a stool between us.

I’m Dr. Luis Bueso Arias. I can help you but you must do as I say in.. in medical politics.

He gave the example:

Ivan, the pediatrician in town.

I wondered about the pink shirt.

Oh, my brother is a presidential candidate, and pink is the color of his campaign. We all have pink guaberas.

From that point on, I always wore one of my three pink guaberas in SPS.

[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]The Mexican government post-revolution in +-1910 had an actual physical and philosophical half-and-half blend of socialistic and capitalistic systems

[5](fr: Wikipedia) Liberation theology is a movement in Christian theology that construes the teaching 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.

[6]Including 2 hypospadias

[7]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.

[8]Successor of mahogany, after the harvesting of England and the U.S.

[9]These beers had been introduced as a replacement to rum. Workers in the fields, who had taken to drinking rum, had begun to have a high incidence of Collins syndrome, marked by a downward leftward slash on the face. Collins, as it were, was the British manufacturers of the machete.

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