The Most Satisfying Cases of My Career
by J. Madison Clark, M.D.Assistant Professor of Otolaryngology, MUSC
Late in the fall of 2000, near the completion of the first six months of my facial plastic and reconstructive surgery fellowship in Portland, I received a page from my future department chair at the Medical University of South Carolina, Dr. Paul Lambert. I left the library where I was putting the finishing touches on my AAFPRS fellowship paper abstract to quickly answer the page. Little did I know how much impact that call would have on my life. Dr. Lambert wondered what level of interest I might have in a medical mission to East Africa to perform cleft lip and palate surgery.
During residency in Chapel Hill, NC, I hadn't really thought much about doing “mission work.” But since I had pursued the fellowship with Drs. Ted Cook and Tom Wang largely because of the unique cleft lip and palate experience, I was certainly interested in the trip from the outset.
The sponsoring organization, Samaritan's Purse, made preparing for the trip relatively straightforward. They helped me with all of the administrative material, including passport, visa, vaccinations, licensure for Kenya, airline tickets, and housing in Kenya. With financial assistance provided from the Humanitarian Efforts Committee and from my family and friends, the trip was made possible.
The most difficult part of the trip was saying goodbye to my pregnant wife and 19-month-old daughter at the airport. The flight took me from Portland to St. Louis to London to Nairobi and lasted from 8 a.m. Friday morning to late Sunday morning. Upon arrival in Nairobi we collected our “packets” (filled with donated medicines and medical supplies) and headed for Bethany Crippled Children's Centre in Kijabe, about 70 km from the Nairobi airport. Kijabe is at an elevation of 7,500 feet, overlooking the Rift Valley and is true to its Swahili name (translated “Cool Winds”). Thankfully, the mosquitoes (I has imagined they would be the size of small dogs with large teeth and brimming with malaria) were nowhere to be found in Kijabe.
After unloading the packets at the hospital and organizing all of the supplies, we met with Dr. Dick Bransford, the general surgeon/neurosurgeon/orthopedist who founded the hospital. He spoke to us about the feeling of “unpreparedness” that he suspected we might be feeling (it hit home with me), and let us know how much our service meant to the children of Kenya.
The first morning in the operating room surprisingly brought a sense of relief. The other three surgeons were outstanding both in their judgment and their technical skills. The OR personnel were some of the best I've ever worked with, and like everyone I met on the trip, very friendly and helpful. We did a total of eight cleft lip and palate cases on the first day, which ran fairly late as everyone got to know one more another.
From
left to right: Figure 1 and 2
After the first day of surgery was finished, I met my most interesting patient of the trip, “Grace” (Figures 1 and 2). She was a three-year-old Masaii girl who had survived a NOMA infection (a polytnicrobial necrotizing gingivitis), which had destroyed her upper lip, anterior palate, and nasal septum, leaving a significant facial deformity. I saw her embarrassment as she tried to eat and food spilled freely due to her incompetent oral sphincter. She presented a reconstructive challenge that tested my training earlier than I had anticipated (Dr. Bransford had accurately predicted it!).
From
left to right: Figure 3 and 4
After the surgical team had conferred, we decided to release the lower third of her nose, do a series of transposition flaps using, de-epithelialized scar to provide a nasal floot/sill, and an Estlander flap to replace half of her upper lip (Figure 3). We explained to the child's mother that this represented the first stage in her overall reconstruction plan. The following morning the case went very well, and I felt as though I had greatly improved her form and function (Figure 4).
I had many other significant cases and interactions with patients and workers at the hospital. Between the two weeks of surgery, a busload of Somali refugees arrived with patients with cleft lips and palates who ranged in age from four months to 40 years; many were teenage girls. They were creative in the use of their decorative head wraps to cover their facial deformities. I also talked with Kenyan mothers who had carried their children on their backs, making the journey by foot, nearly 100 miles.
The team performed operations on a total of 72 patients in the two weeks
that I was there. I can say without reservation that these were some of
the most satisfying cases of my career. I made some lasting friendships
and, on a personal level, achieved a greater global awareness, especially
of the immense need for quality medical care in the third world. The decision
to perform humanitarian work is an individual one, but based on my experience
in East Africa, I would strongly encourage it. I will jump at the chance
to go back.