One of the biggest temptations for plastic surgeons involved in humanitarian missions is to forget about excellence in technique and get easily sidetracked instead by assembly line surgeries which are more often than not,mediocre and also risky for the patients.
Most host countries which receive expat teams are now afraid of poor results and assembly line surgeries.
The percentage of post operative complications in many of these charitable missions is often unreported because it will give a bad image to the visiting medical teams.
Aesthetic plastic surgery cannot be done in a hurry. The fine adjustments take a lot of planning and fine work. A nose job or burns reconstruction can take over an hour even in experienced hands.
A simpler cleft lip could probably be done in a short time but other surgeries take a lot longer.The palate is usually a longer surgery,but the operating time has been significantly reduced by performing the surgery in two stages. Button hole palate repair in the first stage can be done by skilled operators in less than 30 minutes with hardly any bleeding ,using the latest state of the art techniques of aesthetic palatoplasty.The second stage for the hard palate may take upto an hour at least.
The bottom line then,is not factory line productions but carefully chosen cases and successfully implemented techniques, for the benefit of the patient as well as the trainees at these camps.
I couldn't help but notice the stark contrast between the smiles on the faces of the people in the mural (poster?) on the wall in the eatery, and the cleft patient on the cover of the article I was holding.
I met this Somalian father and son who had escaped from the war torn regions of Somalia .After a long journey by boat along with many other refugees,they managed to reach the UNHCR camp for refugees in Basatan, Yemen.
His son had a cleft lip and soft palate deformity.The father requested us to do both operations if possible because they were too poor to travel to the camp for future visits.The operations were done at the same sitting and the patient did well post operatively.
The other patient was brought by his relatively wealthy father and mother from Djibouti.
The child labourer with the red headscarf was brought in from the streets of Sana and taken to our unit where we did his free surgery.His father was overjoyed at the transformation.
No celebrations are planned in advance when a cleft child is about to be born. Some parents are so disillusioned that they choose to have the baby killed before birth. Some kill the baby after birth or give the deformed newborn to an orphange.
I met this young boy during our first mission plastic surgery camp in June 2003. He came from an orphanage in a nearby city.An American woman found him there and paid for his travel and medicines so that he could have a new smile.
His father was horrified when he was born and so gave him away to an orphanage.
But God had other plans for this unwanted cleft child.
The first surgery went well and he looked so different.
The story has a happy ending. His father was contacted by the orphanage and when he saw his son with a brand new smile, he had a change of heart and took him home to look after him.
Primary aesthetic cleft lip surgery is best avoided in older bilateral cleft lip patients. The tissue is a lot tougher and the dento skeletal deformities makes primary aesthetic surgery either very difficult or impossible.Cheiloseptorhinoplasty is a difficult procedure and is best done at a later stage after the preliminary adhesion of the skin and mucosa.
The nasal deformity in an adult cleft patient is also a lot more difficult to correct.The surgery can take hours and is best done at different stages in rural settings,to avoid post operative complications and patient morbidity in the intra operative period.
I usually do a simple lip adhesion,wait for about six months and do the adjustments over 2 to 3 surgeries.
Rich Severson is a leading jazz maestro,a former instructor from the Guitar Institute of Technology California/session player for Chuck Berry and student of America's greatest jazz guitarists,Ted Greene et Joe Pass. It is an honour to be his student and featured on his you tube site among three players he has chosen.
What a great way to retire! :-)..if only one had enough moolah to do so!
2003-2013 Her Majesty's Smilemakers of England for Sheba's cleft children, working in the shadows.Meet the folks from England who changed the lives of thousands of families in Yemen forever.
Following the horrible massacre of US medical mission workers at Jibla Hospital Ibb in December 2002 by a lone terrorist,the expat medical mission work in Yemen came to a near standstill and thousands of Yemeni families were affected.The following year in June, 2003 HMA Ambassador Frances Guy and a small group of expats with some special Yemeni friends started a plastic surgery charity that soon changed the lives of thousands of families across the entire nation.