Giving back

Bernard M. Jaffe, MD

Professor of Surgery

Department of Surgery

Tulane University

School of Medicine

New Orleans, LA

Despite the well-recognized flaws of our health care and medical education systems, they are the best in the world. That leadership role suggests a mandate to share this knowledge with less fortunate nations and peoples throughout the world. Many individuals and organizations have elected to do so, but a lot more can and should be done.

giving back

One of the leading organizations in this arena is Operation Smile. Created primarily to provide surgical correction for needy youngsters born with cleft lips and palates, this generous organization has shown how well can be accomplished. Under their auspices, American plastic surgeons have performed operations worldwide, and, in many instances, identified talented practitioners in developing countries to bring to the United States for specialized training. It offers a model of philanthropy that many of us could copy to improve surgical care throughout the world.

Another organization that fosters international communication among colleagues is People to People, created by President Eisenhower. Delegations travel to a host of countries on a regular basis, spreading American know-how and good will.

I led a People to People delegation to China and Mongolia 7 years ago and was thrilled to have this opportunity. We visited university, municipal, and military hospitals, as well as regional and rural health clinics. At each stop, we met physicians, nurses, and hospital administrators. Participants were divided into groups and discussed the treatment of surgical diseases in our respective countries and mutual problems in health care delivery. At that time, I was astonished by the incredible quality of the foreign surgeons, who were performing extremely complex surgeries (including open heart and major neurosurgical procedures) successfully with archaic instruments, inadequate supplies, and consummate skill. Diagnoses were established without technical support. Since there were no functioning computed tomography scanners, lesions were identified and localized by physical diagnosis alone. It was an eye-opening experience, and, in many ways, a throwback to American medicine 40 to 50 years ago. Upon completion of our voyage, we had learned a great deal and had reciprocated by teaching and inspiring Chinese and Mongolian surgeons. We also hastily arranged a shipment of badly needed supplies and English-language medical books to Mongolia.

Surgical Rounds

During our recent trip to Southeast Asia, which included a People to People visit to Vietnam and Cambodia, Marlene and I met and developed relationships with two marvelous young plastic surgeons: one in Hanoi and the other in Phnom Penh. We were introduced to them through e-mail by Randy Sherman, chief of plastic surgery at the University of Southern California and an editorial board member of . Randy, who is very active in Operation Smile, met these two surgeons while visiting their hospitals a few years earlier, and he provided both of them with fellowship training in Los Angeles. Let me introduce them to you briefly to illustrate what can be accomplished.

Patients' family members must prepare meals for them at this Cambodian hospital.

Dr. Van Ahn is the only female plastic surgeon in Vietnam. In developing her career, she faced enormous obstacles and met active resistance. Despite the antagonism, she persevered and is now very well respected. Ahn works at the children's hospital in downtown Hanoi from 7 AM to 4 PM, performing operations on most days. She commutes to the hospital using one of the city's 2 million motorcycles. She is paid about $200 per month for her government medical service, which is hardly enough to provide for her daughters, Me and Lan. To earn a living wage, she also attends at a private outpatient clinic until 7 PM, returning home late in the evening to care for her family. Marlene and I were very impressed with Ahn. Despite her demure behavior and petite stature, she is a tough, committed, and effective professional.

Dr. Mok Theavy was the first plastic surgeon in Cambodia. Since there was no one to train him, he taught himself and has become an accomplished microvascular reconstructive surgeon. His lifestyle parallels Ahn's: he works all day for the government in the Khmer-Soviet Friendship Hospital and attends his private clinic during the evening. Theavy had a traditional arranged marriage to Cheat (actually, Sophean Suhakcheat), who is an obstetrician/gynecologist. They have two daughters, Vimol and Vimean. Theavy arranged a return visit for me to coincide with an Operation Smile mission, at which time he set up a number of difficult reoperative surgical procedures for me.

As the authors of our cover story "Operating in the Global Theater" report, traffic accidents constitute the greatest risk to safety in many developing countries. Motor vehicle trauma is the most common cause of mortality in Cambodia, yet the country has no organized trauma care. During my visit, I taught advanced trauma life support to a broad surgical audience. I also brought a shipment of 6-0 to 10-0 sutures for Theavy's microvascular cases. There is still a huge need for these sutures. If any of you have access to them, please send an email to .

Both Ahn and Theavy are impressive individuals who have a genuine understanding of the universal role of surgeons and surgery. Marlene's and my relationship with them exemplify the type of interchange made possible by a professional visit to an underserved area. Serving as a surgical ambassador offers a special feeling of accomplishment and pride. Those of you who have served on medical missions can appreciate the satisfaction they provide.

giving back

Although many surgeons have worked overseas, most of these professional visits have been arranged privately through one of the very few organizations involved or under the auspices of a religious order. Until now, organized surgery has done relatively little to further this vital activity. Acknowledging this deficiency, the American College of Surgeons has developed Operation Giving Back to furnish a mechanism for surgeons to donate their services and provide desperately needed care in remote areas of the world. If you are interested in (and I highly recommend it), please visit the Operation Giving Back to explore the opportunities.