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December 16, 2005

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Publication Date: Friday, December 16, 2005

Interplast brings smiles to the Third World Interplast brings smiles to the Third World (December 16, 2005)

MV-based group of volunteer docs performs surgeries for children with burns, cleft palates

By Diana Reynolds Roome

A child's smile is priceless, but there are thousands of children in the world who are literally unable to smile due to deformities of the mouth and nose caused by cleft palate, cleft-lip, or serious burns. Some of these children cannot swallow or speak properly. For them, as for those with a malformed hand or ear, there are not only functional difficulties but also a feeling of shame that often makes them shy and withdrawn.

For such children and teenagers, happiness requires medical expertise from a team of doctors and nurses. But thousands live in countries where they have no access to skilled plastic surgeons, much less the money to pay them.

That's where Interplast comes in. For more than 35 years, the nonprofit has been organizing specialized medical teams from its headquarters in Mountain View and sending them all over the globe to perform corrective surgery. Volunteer pediatric surgeons, anesthesiologists and nurses travel to South America, Africa and Asia, from Peru and Zambia to Vietnam and Nepal, where many children walk long distances with their families to have the life-changing surgery. Medical teams routinely work in unpredictable and difficult conditions, giving up work or vacation time for no pay. Between them, they perform some 3,000 operations a year, allowing children with profound congenital and accidental disfigurements to function more easily in society.

"It's good medicine for anyone who goes," said Dr. Frederick Mihm, associate medical director of intensive care units at Stanford and a professor of anesthesia. Mihm recently returned to his home in Mountain View (where he's lived for nearly three decades) from an Interplast trip to Chongqing, China. While there, his international team performed 72 operations in two weeks, working in a brand-new hospital that nevertheless had antiquated lights and operating tables. Working with well-trained but non-English-speaking Chinese nurses, they communicated through sign language and by putting up a sheet in the operating room with critical surgical and anesthetics terms.

Since the early 1970s, soon after Dr. Donald Laub started Interplast at Stanford, Mihm has been on 21 trips. One of the major concerns over the years has been the quality of the equipment available on site, for example anesthesia machines, IV catheters and laryngoscopes, which may not be like those the team is used to working with at home.

"The anesthesia machine is much like driving a car -- you come out of a Beamer and go into a 55-year-old Jeep. Little things like that can disrupt your sense of control and throw you off," said Mihm, who as an intensive care anesthesiologist is accustomed to taking difficult cases. "We've even lost electricity in mid-operation. It's a challenge, but you have to like living on the edge a bit to do this."

Nowadays, the Interplast teams transport their own anesthesia circuits and vaporizers, suction equipment and even battery backup in case of sudden power failures, which are all too common in Third World countries.

Essential equipment is costly, and updated electronic equipment has become more critical than ever to Interplast's operations. Small medical teams often work in isolation, far from their colleagues and the resources they would have access to at home. Some of their cases are extremely challenging -- for example, a 12-year-old Nepalese old boy with severe burn scars on his torso, arms and face. The pulling of the scars had had contracted his neck, shoulders, chin and lower lip, painfully distorting his body. His retracted neck and chest interfered with his airways, making it very difficult to use the usual methods of anesthesia for performing skin grafts. Despite their extensive experience, doctors need to proceed carefully in such cases, which are sometimes different from anything they have encountered before. In addition, this boy needed tissue expanders -- routinely used in Western burn surgery but difficult to obtain and very expensive in Nepal.

Using Web-based communication, the doctor in charge was able to consult with colleagues at home and around the world to discuss the case and solicit ideas for dealing with it. This was done as part of an Interplast program called Grand Rounds, which allows doctors to post photographs and case summaries on the Web and receive advice and insights from medical professional in other countries, within hours or even minutes. The posting of Web logs has also been instructive and helps the world understand better the importance of Interplast's work.

The proximity of high-tech companies has made a huge difference in the way doctors are able to keep records and communicate. For example, Palm Inc., maker of the Palm Pilot and a neighbor to Interplast on the Mountain View-Sunnyvale border, for several years has donated its handheld digital organizers to the doctors, who use them to chart and track patient records. (These records can be downloaded into a regular medical database upon the doctors' return.) Meanwhile, volunteers from Cisco Systems helped to build a database on burns and burn victims which doctors can access from anywhere in the world.

Technology has also helped Interplast move into a new phase, in which its medical volunteers become primarily trainers and mentors to local doctors and nurses in the countries they visit. Interplast produces and distributes educational materials on CD-ROM, which can provide advanced medical training. Mihm was able to give a lecture to Chinese physicians, most of whom did not understand English, when his whole lecture was translated into Chinese on PowerPoint.

"We're more about teaching and local empowerment now -- this enables far more patients to be reached," said Susan Hayes, president and CEO of Interplast, who recalls that there was no e-mail communication for doctors in the bush when she first started working for Interplast 10 years ago. "We're building local capacity, and technology has been the single most important factor in allowing us to realize that vision. The change is remarkable -- there are computers everywhere we go now. I've worked on the Internet next to a cow in Nepal and chickens in Vietnam."

Despite the progress, many doctors and nurses still want the direct interaction of working with patients. "They get so much personal and professional satisfaction, and feel so good about what they do," said Hayes. "They also appreciate a one-to-one relationship with the patient and family."

Mihm also enjoys the opportunity to see new countries while having something meaningful to do there. Ultimately, what makes it worthwhile is the moment when he sees the look on the faces of parents seeing their child transformed, and knowing there is a better future ahead for them.

"In Brazil, we operated on a child with a horrible cleft palate," he recalls. "The child was changed so much by the plastic surgery. I watched the parents walk in and see the baby -- for a moment both seemed not to know it was theirs. Then they started crying. It's definitely life-changing when you change a child from a freak to a normal kid."

INFORMATION: To visit Grand Rounds Virtual Tour, read doctors' Weblogs, view the Oscar-winning documentary "A Story of Healing," or make a donation, go to An exhibit of photographs also can be viewed by appointment at Interplast's headquarters at 857 Maude Ave., Mountain View. Call (650) 962-0123.

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