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Lambert hears, answers country's call The following article describes one of many poster presentations set for this year’s faculty convocation Aug. 22. The Catalyst will highlight some of the presentations on MUSC’s international clinical, educational and research opportunities and outreach. Photos provided by doctors. by Heather Woolwine Public Relations The allure of international outreach for many physicians is like that of a multifaceted jewel, with each facet attracting those who desire to answer a call, others who adore travel, and most whose veins course with the simple need to do good.   Judy Bucknam, center, prepares to assist a Dominican Republic resident during surgery in a small community hospital near Santo Domingo. The attraction to international service for Paul Lambert, M.D., encompasses these reasons and more. The Otolaryngology-Department of Head and Neck Surgery chairman and professor began his mentorship with Roberto Batista, M.D., and the Los Alcoresos Hospital in the Dominican Republic just short of 10 years ago. Located about one hour west of Santo Domingo, this small community hospital was started by the Christian Medical and Dental Society and was later acquired by Medical Mission International.   In 1996, Lambert and his oldest daughter, MUSC fourth-year medical student Lara Lambert, traveled to the Dominican Republic to explore the possibility of practicing ear surgery in the developing nation. Through a connection with a company called ComCare which produced solar powered hearing aids, Lambert was introduced to the need for ear surgery in that country. At the time, Batista was in his final year of training, and like Lambert, eager to develop human-itarian efforts for his countrymen and women.   The one-story hospital had no history of performing ENT (ear, nose, throat) surgeries and the operations it did were executed in four small operating rooms (OR).   “About a year later, once we were ready to proceed, I was fortunate to get companies to donate equipment for our trip, including two OR-quality microscopes and two OR-quality drill systems identical to the type of equipment that we used here,” Lambert said.   Dr. Roberto Batista, right, takes notes while discussing a patient's post-operative care with his mother. On that first venture and prior to joining MUSC, Lambert and his University of Virginia colleagues,  performed surgeries for 10 patients while beginning to teach Batista the delicate art of ear surgery.   “The idea has always been to upgrade the skills of the physicians indigenous to that area and teach them to become the best ear surgeons that they can be, while at the same time hold some classes to help with the overall ENT education of medical residents based out of Santo Domingo,” he said.   In 1997, about 30 ENT physicians existed to serve the entire country of 8 million people, translating into less than one physician for every 250,000 people. “In addition, there was only one medical institution graduating ENTs, and it was only turning out one new physician per year,” Lambert added. “There was and still is a tremendous need.”   Since that first trip, Lambert and his various colleagues from Virginia, Ohio State and MUSC have trekked to the Dominican Republic once or twice per year.   Batista became the country’s leading ear surgeon. “He’s really become an excellent surgeon, the best in the country. He has traveled here several times since our relationship with the hospital began,” Lambert said.   During the missions, Lambert, Batista and two additional surgeons oper-ate continuously in three of the four ORs. (One OR must remain free for emergencies.) Lambert said that Batista compiles and screens a list of candidates pre-approved for surgery that can include up to 30 people. For continuity of care, Batista follows up with patients for their post-operative care.   “With Batista’s national reputation and word of mouth that international physicians are coming to the hospital, we now have a two-to-three year waiting list. I’ve seen some incredible pathology while working there and, unfortunately, people on the list have died while waiting to be treated. Some of those people had such severe ear infections that they contracted meningitis. What we see down there is what most people only read about in textbooks.”   For instance, Lambert encountered an 18-year-old girl who was ashamed to go out in public because of a foul-smelling discharge that continuously oozed from her ear. A small rock had somehow lodged into her ear canal and then eroded into her ear  bone, thus creating the infection. She dealt with the problem for seven years before seeking and receiving treatment.   As the first ENT surgeons to conduct procedures in that particular hospital, Lambert performed the country’s first cochlear implant and the first procedure to alleviate congenital aural atresia, a condition characterized by the absence of an ear canal and drum and a misshapen outer ear.   At this time, Lambert, Batista and his colleagues have performed approximately 300 surgeries for the people of the Santo Domingo area.   “Saying that something like this is a calling is not an unreasonable word to use, but it is more than that,” Lambert said. “I wanted to introduce all three of my children to situations faced by Third World countries, travel, develop the camaraderie that colleagues have when they do mission work together, and really offer a unique training and educational experience for fellows and residents. When we are there, performing about 30 surgeries in a week is very focused and repetitive. That’s the same amount of experience that happens in two to three months here. It’s time well spent in many ways but from an educational standpoint, it’s incredibly valuable.” Operation Dominican Republic: A nurse’s perspective “There are so many things. I have talked about it to everyone I know. It was such a great feeling to know we helped 30 patients. Yes, we did work from sunrise to sunset, but how good you felt at the end of the day. When we arrived and were setting up the operating rooms, the families who were waiting for the surgeries were very patient and grateful. The children were so brave and went into the OR suites never crying, and they never complained after surgery. Although I am not very good with the language, it was so easy to communicate with the people there. This was my first trip and I had no idea what to expect. It was so rewarding to see families with their children, never being rude or complaining if we were not able to do the surgery or running behind. They just waited in the hot sun. They would bring the children and stay all day and then stay all night with them in the hospital. I met a wonderful doctor, Dr. Roberto Batista, who makes all the arrangements for the procedures and follows the patients after their surgeries. Roberto and I e-mail and send gifts; ours was an instant friendship.   This experience made me realize that we take so much of our own health care for granted, by seeing the people of the Dominican Republic and how they know it’s a privilege to have doctors devote time to their children. For the children who could not hear and who had one ear operated on before, they knew what it meant to have the gift of hearing, and they were excited to have Dr. Lambert come back to operate on the second ear. We saw some children with no ear canal; what a stigma it must be for a child to not have the ear, when they are just children and want to be normal. The hospital staff was so attentive to our needs, and even where we stayed it was always a great expression of the staff. I cannot wait to return, because I have a calling to help them, and the best way I can do it is with Dr. Lambert. I could go on and on… it has changed my life to see those children and know there is a child who is experiencing hearing for the first time and will hear his or her mother whisper into their ear when they have pain or sorrow.” —Judi Bucknam, R.N., Ambulatory Care manager     Friday, July 21, 2006 Catalyst Online is published weekly, updated as needed and improved from time to time by the MUSC Office of Public Relations for the faculty, employees and students of the Medical University of South Carolina. Catalyst Online editor, Kim Draughn, can be reached at 792-4107 or by email, catalyst@musc.edu. Editorial copy can be submitted to Catalyst Online and to The Catalyst in print by fax, 792-6723, or by email to catalyst@musc.edu. 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