The Colgate Scene
March 2000
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Doctors with a mission
by Rebecca Costello

Catholic Health East volunteer Dr. Frank Gaudiano '58, left, performed gynecological surgery for patients in Chulucanas, Peru.
When Doctors Without Borders received the Nobel Peace Prize last fall, the world's spotlight shone on one of the many medical groups giving their time and money to improve the lives of patients who might otherwise not receive help. Some are victims of war, epidemic, or disaster, and others lack health care due to geography or ethnic margin-alization. A number of Colgate alumni are taking part in the effort. The sponsoring groups are many, the countries span the globe, but the desire to help is universal. Here are some of their stories.

Frank Gaudiano '58, a semi-retired gynecologist, went to Peru in the fall of 1998 with Catholic Health East (CHE), which provides medical services in South America and the Caribbean. He discovered the opportunity through his work at Our Lady of Lourdes Medical Center in Camden, NJ.

     "I got permission from my wife -- you can't really do it without the approval of your significant other -- and applied, but they already had a gynecologist. A few months later I got a panicked call. The first doctor had to back out."

     Gaudiano provided gynecological surgery on a team of 14 people that also included an orthopedist, trauma specialist, plastic surgeon, ophthalmologist, two nurse-anesthetists and several nurses who handled everything from post-op rounds and care to scheduling the patients. "The group was just magnificent." The local bishop shared his residence in Chulucanas with the team.

     "A curious characteristic of the healthcare system there is that the patients have to bring their own food in, and buy their own sutures, as well as paying the hospital and doctors," Gaudiano noted.

     The group did 20 to 25 cases a day for seven days. "The pace was dramatically rapid." A "fantastic" network through the church parishes within the country identified patients, who were pre-screened by a local doctor and then by Gaudiano when he arrived.

     "The organization has brought what I characterize as a M.A.S.H. unit; everything there -- anesthesia equipment and surgical tools -- is used only when the group is there. The rest of the time it goes into storage, or the Peruvian government would commandeer it for other purposes."

     Gaudiano remembers a dramatic operation on a woman who had a mass in her abdomen that was choking off her kidney. "If we had never operated, she would have died of kidney failure. Now CHE will cover her dialysis and she will be able to have a reasonably lengthy life."

Dr. Bob Improta '65 and his wife Pat prior to their return to Tirana by Italian Army helicopter. In spring 1999 the couple went to Albania to help with the refugees through International Medical Corps.
Bob Improta '65, a plastic and reconstructive surgeon, and his wife Pat, a nurse, went to Esmeraldas, Ecuador three years ago, under the auspices of Southwest Medical Teams (now called International Relief Teams), and last spring with International Medical Corps they helped with the refugees in Albania.

     "Plastic surgery lends itself very well to volunteerism. While a general surgeon might have to wait for an appendectomy patient to come along, for example, patients with deformities can be screened and lined up ahead of time," Improta explained, "You triage them when they come in and operate on the most complicated cases first."

     The Improtas' group in Ecuador also had an ophthalmologist and anesthesiologist as well as nurses and translators. In surgery for 13 to 14 hours a day, Improta treated patients with burn scars, machete injuries, cleft lips and palates, and cancer.

     "Some of these injuries were 10 years old," Improta noted. "One man had been burned so badly that as the tissue healed it contracted, pulling his chin to his neck so he could barely move his head." Improta released the contracture and did a skin graft. He also treated many cleft lips and palates -- optimally repaired much earlier -- on children who were 4 to 5 years old.

     "There was always some danger involved. We were always under armed guard, because of concern about terrorist attacks." Nevertheless, "It's really rewarding to restore these patients back," Improta stressed.

     In late spring of 1999, the Improtas spent two-and-a-half weeks in the mountains of northern Albania, first in Tirana and then within mortar shelling distance, in Kukes about 26 km from the Kosovo border.

     They did whatever they could -- routine surgery such as appendectomies and repairing orthopedic fractures, even house calls to people who needed mental health treatment ("It was especially hard on the older people"), and removed shrapnel from the wounds of KLA soldiers and others.

     Improta noted that medical practice there is like 1930s medicine in the United States. "We had to gently push the Albanian doctors in the right direction -- diplomatic teaching, I guess you could call it."

     While the Improtas were there, the Peace Accord was signed. "Tanks were parading down the streets and women were throwing flowers," he remembered. "Everyone was so excited. It was an honor to be there at that moment."

     For one day, the group's Australian special forces agent (again, they were under guard at all times) took them over the border to Kosovo, where they opened up the hospital, which had been abandoned by its officials. The group had to assess patients for possible transfer.

     "It was terrible. They had locked all the supply closets and thrown away the keys -- we were afraid to open them, for fear of booby traps."

     Improta also does indigent work at Ventura County General Hospital. "You don't have to go halfway around the world to find the need."

Pediatric anesthesiologist Dr. Joyce Phillips '76 with an Interplast patient after surgery in Iquitos, Peru in 1999
Joyce Phillips '76, a pediatric anesthesiologist from Albuquerque, New Mexico, has done five trips through Interplast International, a group providing plastic surgery to patients in the third world.

     She has been twice to Honduras, and three times to the Peruvian city of Iquitos on the Amazon, accessible only by river or air. Her team treats many of the same kinds of cases that Improta found in Ecuador -- cleft lips and palates, burn scars and injuries.

     "They can really make a difference in a patient's life with minimal equipment." The organization provides many of the drugs and vaporizers used to administer the anesthetic, but other equipment is either not sophisticated or just not available. Blood pressure and heartbeat, for example, are monitored manually. Phillips says this makes her a better doctor at home.

     "When you take away the trappings of technology, human observation is the best monitor you have. It makes your skills better."

     Phillips also noted that "there are not the same distinctions about roles down there, that the nurse does this and the doctor does that. Everyone does whatever job needs to be done."

     The days are long -- 12 to 14 hours -- but the local families, who host the medical teams, are so grateful, "at the end of the day, they usually have a big party for us, and then the next day we get up and do it all over again."

     Though the prospect of undergoing surgery is scary for children, Phillips speaks Spanish well enough to reassure her patients, and she explained that "the kids are so thankful to be getting help that they go willingly, even though it may involve pain or they're frightened."

     Because of the primitive conditions and relative lack of health care, Phillips noted that the surgeons must be selective when screening patients -- if the child is not completely healthy, there's a greater risk -- and it is rare for the group to lose a patient. On her first trip, a child died of complications from anesthesia. "We stayed up all night, taking turns to manually ventilate him, but he died the next morning. That was horrible." Phillips was deeply touched by the way the parents dealt with their loss. "They were not blaming us. They thought that it was a sign from God that their child was born with this condition, and had a sense already that the child would not survive."

     A happy memory for Phillips was of a teenage boy who came for revision of his cleft lip repair (occasionally more than one operation is required).

     "He was really cute and he liked me for some reason. After his surgery he came to visit me and brought me a present."

     Phillips remarked that it's easy for doctors to get cynical in the States, but with the experience of international medicine, "you see the need and have the ability to help. It really recharges your batteries for coming back to the daily grind."

Through Operation Baby Face, plastic surgeon Richard McShane '59 helps children in the Ukraine.
Plastic surgeon Richard McShane '59 works through Operation Baby Face, his sub-segment of Emergency Medical Aid to the Ukraine, at the Specialized Children's Hospital of Lviv.

     "In this community, which is across the country from Kiev where the Chernobyl incident occurred, children remember ash falling out of the sky on their way to school. This exposure has induced tumors in these children."

     McShane has also treated children maimed by land mines and grenades left behind by war and conflict. "This points up a real need for social activism to banish land mines." In addition, he has cared for those children with congenital facial deformities.

     The setup is fairly simple and similar to how the other groups run. "I fly in Friday evening, look at photographs and discuss priorities with the other surgeons. The next day we hold a clinic, and people from all over the Ukraine will line up." He is able to select about 20 people from the hundreds who come. If possible, McShane describes surgery the Ukrainian surgeons can do themselves or those cases they might postpone. "The more difficult cases, I operate on early in the week, so I can follow the case for a few days."

     McShane says this kind of work presents several challenges. "You have to do things in a very safe, predictable way, as you will not be around to deal with post-operative problems. In addition, you don't have the luxury of staged procedures. You have to be prepared to solve unusual problems with innovative plastic surgery techniques at the operating table, with your Ukrainian surgical counterparts looking on."

     For example, he took apart an ear with an acquired defect and found the components he planned to use weren't there. He had to design a new procedure, using a flap of a different nature that he had never used before, so the ear could be reconstructed in one stage.

     "One of the nice things about plastic surgery is that everyone understands and sees what you have done when it works out."

     McShane says though he and his patients don't speak the same language, he finds ways to develop a rapport and calm frightened children. "I usually take a couple of magic tricks in my pocket. I have a fake eyeball, which I pretend to pull out and polish on my sleeve. And everyone understands when you take two tiny foam rabbits from your pocket and then 4 or 5 baby rabbits appear.

     "I get a great deal of personal satisfaction that I can help these children. It's something you can't put a dollar amount on."

Dr. Bill Blaisdell '51 with a young Mayan boy during post-op rounds. Blaisdell and his wife Ann have volunteered their medical expertise in Central America for 15 years.
Bill Blaisdell '51, a retired general surgeon and evangelical Christian, was inspired to volunteer by the principles of the Christian Medical and Dental Society, whose physicians try to make their faith a part of their medical practice. For 15 years he and his wife Ann, a nurse, have worked in Central America, first in Honduras with CMDS, and for the past nine years with AMG (Advancing the Ministries of the Gospel), in the small, mostly Mayan Indian city of Cubulco, Guatemala.

     In response to advance radio and newspaper announcements, many types of patients come into AMG's small 20-bed mission hospital. Four retired general surgeons volunteer their help with the the hospital's family practice doctors, who are Guatemalan and Nicaraguan citizens. "We Americans come down at our own expense, each at different times once a year for about two weeks, to perform whatever surgery we're capable of and that the on-site equipment permits," said Blaisdell. Each surgeon initially sees 50 to 60 people to refine the family doctors' diagnoses and select candidates for surgery, reducing the list to four or five cases a day. Ann, who speaks Spanish, acts as interpreter as well as OR circulating nurse.

     The Indians, many of whom walk from considerable distances, often come in with injuries sustained through hard labor -- hernias from carrying heavy loads on their heads or backs, trauma from such things as machete wounds or burns -- as well as cancer or other general surgery needs. They are asked to pay whatever they can. "It's one way to defray hospital expenses and at the same time give them a sense of dignity and pride, although no one is ever turned away." Blaisdell noted that patients who have paid for treatment are more likely to follow instructions afterward.

     Blaisdell finds one of the biggest challenges, in addition to maintaining continuity of care from trip to trip, is in treating as many diseases as they can.

     "Especially with surgical and nonsurgical cases, their previous medical care has been so poor!" The family doctors try to teach them things like proper nutrition, good sanitation, preventing parasitic infestation and brushing their teeth.

     Last year, Blaisdell met Francesca, a woman in her early 40s whose breast cancer had metastasized. "I felt so downhearted. There was nothing we could offer her for postsurgical follow-up care. We were, however, able to refer her to a hospital in Guatemala City for surgery and post-op medical treatment to try to extend her life." Six months later, though he fully expected her to have died, Blaisdell discovered through e-mail that she was still alive and was trying to obtain a type of holistic medicine she couldn't get in Guatemala.

     "We sent it to her, without expecting it would have any medical benefit, but thought it might give her some hope." On their recent trip in November, the Blaisdells were exiting an Hispanic Sunday church service, and waiting for them out-side were the hospital director and Francesca. She had taken a four-hour bus ride to see and thank them, and "she appeared to be just as healthy as a normal person," beamed Blaisdell. "She may be cured. There's no outward sign of disease.

     "These trips have broadened our appreciation of humanity and point-ed to the suffering that is in the world," said Blaisdell. "It's increased our love for people and the world and deepened our spirituality."

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