San Pedro Sula

San Pedro Sula, Honduras, the kidnap and violence capital of the world.

What in the hell do you want to do in Honduras, DON? It’s dangerous, you don’t know the culture you don’t know the language, your job is up here in the center of learning, the center of skill and knowledge in your chosen field of reconstructive plastic surgery?

Where are the unrepaired cleft lips and palates? Where are the big tough cases? Where are the opportunities for teaching, for role modeling in patient care and where should the physician educator work?

Here we have the mountains beyond mountains of skill and knowledge.

mountains

 

 

You should be happy that you’ve landed in medical nirvana in that regard. But this is also a desert,  for a doctor, and it is almost impossible for people to live here. The competition and the temptation to plagiarize or counterfeit  research is evident; it’s overpopulated in a peculiar way.

On the other hand, in the developing world, in the medium resource world, they were struggling to become just as we are, because they have been overexposed to our way of life through our demonstration in colonialism. We had a chance to help them become medium resource countries or “second world”. I have a feeling that our founder Hippocrates would feel he had arrived in his nirvana for “physician educator” in the places we identified in 1968 through  1973.

It was with the label physician educator that I became labeled. I arrived at the new medical school called Stamford by those guys leading Connecticut at Yale. In the shadow of the tower there was both heaven and barren desert for the physician educator. Where was the human pathology toward which to direct our skill and knowledge in medical pathology?? Here we had a non-connect. They had aspiration to live and do as we do and live.

The answer was obvious; it was perhaps in jail with those segregated there because of a social crime. At Elmwood Rehabilitation Center for Women or at Deuell Vocational Institute for Juvenile Delinquency near Folsom, California where Lombroso’s theory might be given a good test.*  Or was it at Menlo Veterans Administration Psychiatric Domiciliary for 2000 veterans where patient care by the Stanford plastic surgery residency program could thrive? In order to obtain human pathology we hitched up with the physiatry department at Stanford, combining clinical services; we made rounds with the world-famous physical medicine and rehab expert Prof. Feldman and learned the latest and best theories every morning. We saw the tough cases: incurable multiple pressure sores from paraplegia, upper extremity disability cases for tendon transplants and severe sequela from auto accidents and burns. We lectured on these subjects throughout Northern California to medical societies showing “plastic surgery technique for the general practitioner.”

The answer we received, thank you for the up-to-date and great surgery lectures, but we don’t have many pressure sores, bad burns, or car wreck problems cases for you.

I am skilled, attracted and have the long-range purpose of bringing plastic surgery breakthroughs, the skill and knowledge, to parts of the world that are begging for them. We had caught this virus, had tested the waters, had received negative feedback, even being kicked out three times, and had begun our program of teaching, research and patient care in Mexicali, Baja California Norte with great success, and everyone benefiting. This was the closure of 22 coincidences (q.v. that story).

The thought was this program which fulfills the requirements of my job at Stanford so perfectly must be preserved. However, it may come to a sudden end; therefore let us set up not only plan B, but also plan C! Just as in the movie The Guns of Navarone, a very select team of three super specialists was gathered to do survey or needs assessment in each country in Central America. That is, every place within 2,500 miles of our home base at Stanford. Our first stop after 1 year’s worth correspondence, plus was Tegucigalpa, Honduras.

Fast forward a bit, we then went to the age old and reliable method for social contact and patient gathering in medicine. We met LBA, our future patron in the bar. It was the Quanacaste bar in the Gran Sula Hotel fronting on the city square and near the beloved Cathedral. “I am the local pediatrician here, the last gringos like you offering services got kicked out. I can help you get plenty of patients and plenty of work and you can help us a lot, but you need me to steer you around politically.”

On a Saturday morning at 8 AM in the president’s palace with minister of education minister of foreign affairs and the military general: and once again we heard for the 10th repetition: “no, your program is attractive, we don’t need you, we have a surgeon from Miami Dr. Gil Snyder, who has come here last year and did 4 cases of hypospadias.”

“We know a 92-year-old urologist in San Pedro Sula on our north coast of Honduras who knows about these needs.” I’ll call him now. He said, picking up the phone with “Hello René Bendaña (pronounced Bandanya) I have three visiting experts here who would like to see evaluate our needs for the unrepaired cleft lips, hypospadias and burn scar contractures…I’ll send them up there. They’ll be there at 11:45 AM”

We were dumped on Eastern Airlines in a 747 and were at the hospital of René named hospital Leonardo Martinez V. A 110-year-old public hospital where many of the physicians of San Pedro Sula spent their morning hours in service, tending to the care for those who “had not” in Northern Honduras. We were quickly told the doctor was not in. We persisted, did not giv

After exhausting all of his local spots, our reaction was “defeated again, GD, it” let’s try plan a again at the Guanacaste bar in the Grand Sula Hotel on the main square across from the church.

Kees Ploeg, the first physicians assistant of Dr. Laub, and the first at Stanford in my physicians assistant training program, was seated on stool number one at the bar. In stool number two was Philip Collins, Executive Director of LAMP, Latin American Mission Program in Mexicali, Baja California, Mexico. These two were super specialists whose spirits were transplanted directly from the Guns of Navarone island. Kees, the competent but uncertified lab factotum, was accustomed to doing cardiac valve placement and kidney transplantation, both in dogs. And Felipe Philip Collins was our first highly successful international plastic surgical interchange– to supplant my job at Stanford, which lacked the human pathology for teaching research and patient care.

BTW, unbeknownst to each other of our little group, Kees was juvenile delinquent sentenced to three years with the Sea Scouts, a variant of the Boy Scouts. He lived on a sea-scout boat parked in Palo Alto Harbor; Collins was the FBI witness protection program; alas, he had ratted on the Mafia, and was a leading candidate on the Mafia hit list in Chicago and had been transferred to the most forbidding place in the unknown world, the Desierto de Altar in Mexicali. We were all three operating on the letter to Garcia principles of get the job done.

On stool number three at the Guanacaste bar was DRL. We had each a bottle in front of us of salva vida cerveca beer. Peculiarly another guy was seated uninvited but quite kind, friendly, and “I am Dr. Luis Bueso, the pediatrician here, I have experience with you gringos coming here to help with surgery and ending up being kicked out by the Colegio medico. They were my good friends, and highly qualified, but they had some degree of naïveté. They charged the patients on a sliding scale and donated back to the hospital to help the underserved obtain medical care. It was apparent to the governing body, the Colegio, that Honduran money was in the hands, albeit temporarily, from Honduras to the hands of gringos. And perhaps this was another instance of the gringos coming here and making money at the expense of the Honduran economy. And voilà, out they went. Dr. Olhweiler had been a gringo pilot for the airlines and was pure but naïve and did not follow my advice,” were the words of Dr. Bueso. David was so touched by the cleft lips and palate and the conditions in San Pedro that at an advanced age of 37 became a medical student and certified in orthopedics. Incredibly, all in order to do his part to correct the disparities!

“Do what I say and I will protect you, and you will be okayed by the Colegio Medico when they send out there for evaluators (spies) to check you out. “If okay by you Dr. Bueso, we can come back here in six weeks and we would be able to carry out a clinic at a needs assessment with you. Perhaps it may come to pass that we will be able to conceive and construct & sign a formal convenio or letter of intention as prelude to an international surgery program. Hopefully integrated, across the board in all areas and phases in the spirit and even the plan of our humble University of Stanford.”

We sampled their beer. It was Sala Vida (lifesaver). The banana company introduced this 10% beer to substitute for the high octane local rum which is responsible for the Collins syndrome. Collins is the manufacturer of the machete in England, which has caused my 500 cases of Collins syndrome. Large-scale facial disasters and amputations of the upper extremity in various sections. “In my practice, I have many many cleft lip and palates for you: many hand injuries, many congenital hand anomalies. However the medical society here, the Colegio Medico knows that gringos, although they smile and seem nice. They always have a scheme unbeknownst to us, to take our money to their own country. It is neocolonialism and I call it a Coca-Colismo.” After a half hour’s talk we decided to return in six months for needs assessment then collaborative model execution. The letter of intention, the LOI, formal signing between representatives of both countries (really just ourselves and apprentices), and a celebration for that (formal event). A task analysis would be done and then, after that, implementation of the program and feedback.

banana-company

It all worked, 4,500 cases later and 2,500 gratis huge impact surgeries later, I’m here to tell you I think I’ve begun to know something. And in fact I plan that going forward I will learn this business COLD.

The love of medicine and the desire to help others were the reasons which caused the two of us, Luis Bueso and Don Laub to unite and to form the plastic surgery program from Stanford University which changed the lives of about 15,000 Hondurans.

The newspaper, “La Prensa” said in Spanish:

These two specialists were the pioneers of the San Pedro brigades. The two have made a mark on the history of the country. Laub originated in North America, and Luis was a Honduran boy, both have many types of surgical interventions. And even in this way after 40 years of Laub, failing to learn Spanish, both have given, happiness to thousands of children, teenagers and adults. Even though the patient’s have come from all parts of the country, the center of the work is at Lael Nardo, Mark Dean a hospital in San Pedro Sula (then a population of 200,000 now 500,000).

trip-log

The visits occur twice a year during the first and last months. They stay (their estadia) is a little more than a week, time enough to operate 50 to 100 cases, children from two years to adults. These two want to leave a legacy. DRL is a plastic and reconstructive surgery, chief of that ship at Stanford University in the USA. “I feel that Hondurans are happy people and I like to help them.” He kept on repeating these words in the little Spanish. He has learned in those 40 years. DRL pointed out that the purpose of this brigade. Besides helping people directly, is the interchange of ideas and experiences with the Honduran doctors. We wish to leave a legacy which will “lead to specializing in more complicated cases”. The North American galeno has performed an endless number of surgeries in the length of his years here, but he is now dedicated only to directing. “ He is like a director of an orchestra and directs it very well”. These are the words of commentary by colleagues, Luis Bueso. L Delano remembers that in 2002 Laub suffered a brain tumor malignant that complicated his health and for this reason he does not participate in the surgical interventions. Opportunities are open for others. Bueso relates that in 1968 the surgery program started as “Stanford University”. In 1972, they changed the name of the program to Interplast, which means international plastic surgery. The work which these binaries do in the brigade is enjoyed and accompanied with the collaborators specialists in anesthesia and in nursing for the operating room nurses and care nurses on the clinical wards. Thanks to the good pediatricians and general medicine doctors. There are relations within the group with networking organizations. 40 medical education trips have been able to be made to the US. He noted that the doors have been opened and connections have been made on behalf of our professional community here. Bueso expressed admiration for the medical team which not only brings its surgery equipment, medications and personnel, but also they pay for their expenses during their stay. The only thing we Hondurans have to do is to invite them to eat once; and then they pay for everything in exchange for nothing. He said that each trip costs between $15-$20,000, which is distributed between the 10 doctors who are the ones who make the trip each year. “Thanks to them, the country has gained thousands of lempiras. That is gaining thousands because we have alcanzado mucho logros”, Bueso pointed out. Everyone in the country thanks you.

Special treatment has happened: in spite of the many patients muestran insolentes mientras son tratados, los especialistas les ofrecen siempre un trato especial. Laub adores Honduras. He feels very happy when he comes here. He expressed that he loves to go out and know the place.

Bueso mentioned between jokes that the North Americans are so amiable and sympathetic that many Honduran nurses dream of “conquering” one of them. Bueso said, “I only hope that the president Mel Zelaya does not deport them simply because they are North American in the manner characteristic of Venezuela, Bolivia, and our country here who have deported North American ambassadors. Please note that in the picture of us in the newspaper, we have on two T-shirts with happy dialogue between the Tucan and the Macau, emblematic of the happy relationship between Laub and myself and between who they represent North America and Honduras.

It sounds like a cliché, but it is not a cliché: the Interplast people happen to be like-minded and I will try to describe why it is that they find each other without formal introduction, for example, at a cocktail party or at the Gran Sula Hotel at the Guanacaste bar.

surgery-practice

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