When a mother heard that a Yale-led team of doctors was coming to Brazil to perform free plastic surgery in the city of Manuas, she left her home in the rainforest bordering Peru and traveled for 28 days -- mostly by boat along the snakelike Amazon River -- to reach them. She hoped that the American doctors would help correct her young daughter's facial deformity, but when she began her trip, she had no idea whether her child would be among those selected for surgery.
She arrived in Manuas in July of 1996, at the same time that the doctors were visiting Brazil to look at the hospital where they would be working and to assess potential patients. Although the doctors wouldn't perform the actual surgeries until the following February, the mother wasn't about to go back home for fear that something would go wrong and make it impossible for her to return in time. She decided instead to stay in the city, where she lived for six months in the one small room she rented for herself and her daughter.
This woman's story is just one of many that Dr. John Persing and other members of the medical team tell when they recall their journey to Brazil last winter to perform free surgery on some of that country's poorest citizens. Dr. Persing, chief of plastic and reconstructive surgery at the School of Medicine, led the trip, which was arranged through the Yale chapter of Interplast, an international organization of medical professionals who volunteer their services in underdeveloped countries. So successful was that first trip -- and so grateful were the patients -- that the Yale physicians are returning to Brazil this February, and expect to make it an annual event.
During last year's trip, Dr. Persing led a 21-member team that included Yale plastic and general surgeons, anesthesiologists and medical residents, as well as operating room nurses from Yale-New Haven Hospital YNHH and a nurse and pediatrician from California. The Interplast-Yale program was developed by Dr. Ronald Merrell, chair of surgery at the medical school, with the support of Dr. Persing. Both Dr. Merrell and Dr. Persing had volunteered through Interplast prior to coming to Yale, and had wanted to set up a program at the medical school. The trip to Brazil was the first excursion for the Yale chapter.
The medical team spent about two weeks at CeCon Hospital in Manuas, where it kept to a demanding schedule to perform 126 surgeries on 100 patients. Most of the patients were children, and many of them were members of Brazil's large indigenous population living in the rainforest, whose families otherwise would not have been able to afford the medical operations.
"Manuas is a large and fairly modern city with a population of one million people, and the medical care there is quite good," says Dr. Persing, who is also a professor of neurosurgery. "The problem is that there are large numbers of people who need care but cannot afford it, and while there are physicians there who would like to help, they are overwhelmed by the numbers of people who need surgery, and there is a lack of expertise when it comes to providing certain kinds of treatment. Knowing that we couldn't help everyone, we had to ask, 'Who can we give the maximal benefit to?' We decided we could do the most by helping children, particularly those born with cleft lips and palates or other congenital birth defects, as well as those who are disfigured from burn injuries."
In America, Dr. Persing points out, children who are born with cleft lips or palates have surgery to correct the problem within the first year of their lives, regardless of their ability to pay for the surgery. In the Amazon region of Brazil, where such birth defects are common due to lack of prenatal care, malnutrition or other factors, that is not the case, he says.
Sharon Pederson, a YNHH operating room nurse who went on last year's trip and will return to Brazil this February, says that a high priority for the surgeons was correcting cleft lips and palates on babies before their speech patterns have developed. "In Brazil, older children with this deformity are shunned; they can't go to school and are made fun of by their peers," she says. "Adults with these birth defects often cannot get jobs or get married.
"The excitement so many of the people felt about our coming there was because they believed that we could give them or their children a chance in life -- they knew the surgeries would mean they wouldn't have to be ostracized. So they traveled long distances to get to us; some parents even risked their jobs because it was more important to them that their child have the operation," she adds.
Some of those same children will reunite with the Yale doctors and nurses during this year's trip, which will take place Feb. 26- March 13. While there, the medical team expects to perform the same kinds of surgeries it did last year and will provide follow-up care to some of last year's patients. The team will also continue its efforts to treat some of the children and adults who had permanent damage from burns caused during Brazil's annual summer bonfire festivals, according to Dr. Persing.
"There is a large number of people who are injured by fire during these festivals, and yet there really is no proper burn unit there," says Dr. Persing, who last year went with his colleagues to talk to the governor in the state of Amazonias to try to get support for one.
In addition to performing surgery, the American medical team will also hold seminars and present lectures on a variety of medical topics for their Brazilian colleagues, who were appreciative of the opportunity to share in discussions last year, Dr. Persing says.
In fact, the Brazilian pediatricians and nurses assisted during surgical procedures during the team's first trip and were anxious to learn and share information with their American counterparts. "Everybody was very friendly and generous and the hospital staff spent extra hours with us while we worked some late hours," says Dr. Grant Thomson, assistant professor of surgery plastic , who will return to Brazil on this year's Interplast-Yale trip.
The trip was equally educational for the American medical team. "One of the great things about having this experience is that you get a much better perspective about how we practice medicine from stepping outside of our normal routines," says Dr. Merrell, also the Lampman Professor of Surgery and a member of this year's team. "It also gives us an opportunity to test our assumptions about health care by doing it in a different and challenging environment. In Brazil we looked at what we did through the filter of a different culture, and our ability to communicate was challenged, since we mostly worked through translators. And we were in a place where it isn't customary for poor people to have professional care, and that's a humbling experience. Best of all is that the children are so thankful that they kiss your hand or give you the most wonderful hugs you'll ever get in your life."
Dr. Luis Auersvald, a native of Brazil who is a postdoctoral fellow in the department of surgery's Division of Transplantation, served as the team's official translator last year and will again travel to his country in that capacity this year. One of the biggest challenges, he noted, was conveying to the doctors how grateful the patients were. "Sometimes the patients don't have the words to express how great their gratitude is," he says. "Some of them brought gifts of food or brought native hand-crafted items made by the Indians as a way of showing their appreciation. They're just amazed to see us as people who are there to help but don't want anything back in return."
Requiring no translation were the huge smiles that broke out on the faces of many of their patients, say the Interplast-Yale team members. "To see the kids just staring at themselves in a mirror and smiling is more than enough to make us feel that the hard work was worth it," says Dr. Auersvald.
Funding for this year's trip has been provided by private donations and through the generous support of Barbara Jordan of Wayland, Massachusetts, who has an interest in assisting grassroots organizations in their early stages of development. Other Yale members of the team include Drs. Joseph Shin, Daniel Pyo, Douglas Forman, Gerard Burns, Seth Spector, Chris Coppola, Richard Restifo, David Listman, Leo Otake and Dorothy Gaal; and medical student Sheela Natash Magge. Also participating are local medical professionals Ingrid Crocco, Lynn McDermott and Sharon McIntyre, who are all nurses at YNHH; and New Haven surgeon Mark Weinstein.
"For me to go the first time was the realization of a lifelong dream," says Ms. Pederson. "I'm thrilled to be going back. There's nothing like the reward of a child's smile. Going to Brazil is the best thing I've ever done."
Donations of new toys such as stuffed animals, dolls, cars, and coloring books and crayons are welcome by the Interplast-Yale team members. These are used to entertain and comfort children before and after their surgeries. They can be sent to or dropped off at the Section for Plastic Surgery, Room 220, Yale Physician's Building, 800 Howard Ave., New Haven. A fundraiser for Interplast-Yale will be held in March; details will appear in a future issue of this newspaper.
--By Susan Gonzalez