I was recently cleaning out some old files and documents a few months ago (you know, all the written stuff that collects somewhere in house, basement, office, etc.) and came across an old leather bound journal that somehow I’d completely forgotten about. I recognized it immediately from the grass stain on the book’s edges and the great dent in the back cover leather. It was my journal from a summer journey to Alaska in 1976 where I worked and traveled all over the state for a three and a half month period.

Like rereading any journal, many of the entries were pretty silly, mostly reflections of an early 20′s guy trying to make some sense of college, women, and well, life in general. Scary thing is, I’ll probably think the same of this Blog in the (not too distant) future!

Anyway, the opening page has a quote that I used to carry with me during other travels – Europe, Peru, Mexico, India, etc. I really can’t remember where I lifted it from, but it may have been taken from something as uninspiring as a National Geographic magazine article on traveling to the swampland. Either way, like so many of the things that we assign some special importance (that are seemingly to others are so completely devoid of any meaning or worth), I wrote it on a piece of waterproof paper (I used to work in a lab where all our lab books were made of the stuff) and then laminated it, and stuffed it in my wallet. In retrospect, I still feel the same now about it as I did then. It still really does resonate. It goes something like this:

“In sea travel, there are diaries made, but in land travel with so much to be observed and experienced, they are omitted”.

The mission thus far, has been a great success. As happens on these journeys, the team finally gets into a groove and aside from the occasional glitches, flows along well. It’s really something to see, how so many differing persons with differing talents, skill sets, personalities and little or no formal written instruction (AKA standard operating procedure) can each contribute so much and make it all happen. I don’t know how this spirit of cooperation evolves so easily in a situation like this, but in my estimation it’s a chore to duplicate back home…….

Often during a mission like this, you have these experiences, these epiphanies that literally drive to you to tears. The most obvious reason is because you feel the desperation and the greater social situation that promotes the development of conditions like cleft lip and palate, and of the poverty and the access to opportunity that we take so much for granted.

I was finishing up a long day in the operating room and was making late afternoon rounds when I was asked to evaluate a young girl who in essence, had just come off the street to have her widely clotted lip and palate repaired. Apparently, she had heard about us through the local paper that did a story on our mission (see the images portion of this Web site). It’s a very sad story that follows, and one that I’ve reflected on quite a bit. It tells of a greater injustice worldwide and while is not any great epiphany, it nonetheless grips you tight and makes you face your thoughts for some time to come. The nurses and other support personnel who experienced it directly likely feel the same.
This young girl of about 15 was slight in build from poor nutrition and had a dramatically wide cleft (see the image portion of this Web site). Apparently she “works” as a beggar for a “relative” who collects the money and (I assume) gives her a part of the meager profits in food. As Tim so keenly observed, that despite her destitute situation, she was a vibrant, radiant young girl who when told that she could have her surgery (we made available special space on the already crowded operating room schedule), began happily walking (nearly dancing) around the hospital ward, smiling widely. Her surgery was scheduled for the next day.

On the day of her surgery, the adult who “accompanied” her said that she wouldn’t sign the consent form and allow this young to have the surgery. She wanted to take the girl back to the street, mumbling something that the surgery was too dangerous. Some team members even went so far as to show this woman the other children who were post operative and how good they looked, how well they were doing. That somehow furthered her resolve to not allow the surgery. The young girl was heartbroken, and began to plead with this one person who could, with one operation completely change her life so she could go out in public without ridicule and shame. It seemed so ironic, here we, as Operation Sunrise had come so far to help patients just like her, and now the chance of a life-transforming operation was about to be lost.

The adult companion became further incensed and using her fist, hit the face of this young girl, grabbing her shoulder and trying to literally drag her down the hospital ward towards the exit. Hospital security was called and this woman who was ostensibly a relative was lead out of the hospital. It seems that the woman was in essence her “pimp”, and the cleft deformity only enhanced her value as a beggar. Apparently people won’t give as much if you don’t have some sort of deformity or another and correcting the facial disfigurement meant less income for this violent, abusive woman.

We finally got consent for the operation by another “relative” of this poor little street urchin, and will make arrangements (as best we can) to make sure she doesn’t return to her life on the street. We also fear that if she does go back to the street with this woman, that the woman will tear apart the girl’s surgically repaired lip to increase again her potential as a beggar. Getting the consent was tough, because we have strict requirement for the proper legal documentation. Later as she was being brought into the operating room, Mary asked me who finally gave consent. I replied, “God did”.

The girl underwent a successful image restoring, life transforming operation on the 19th of May by Justin and Tim. All of us hope for her better future.

I never once forget that perhaps if I really want to make great changes in social inequity, that maybe I should better spend my efforts helping people build a water reservoir, teach better farming or crop methods, community sanitation, etc. Something that might perhaps have a truly more global effect, instead of participating in activities that help just one singular person.

Events like what I describe above, lead me to believe otherwise.

After a 15-hour flight from Chicago to Beijing, I was able to uneventfully pass through China customs. As expected they wanted to know why I had: surgical instruments for cleft lip, palate and rhinoplasty operations, a full size suction machine, canister and tubing, ValleyLab electrocautery with 50 hand pieces, 60 pairs of sterile surgical gloves, shoe and head covers, facemasks, electrical transformers, power strips, and adapter plugs, digital still image and video equipment, headlight and light source, tool kit, etc. etc. etc. I spent more than an hour convincing the rather thorough customs agents that I wasn’t going to sell any of it, and that it would only be used in the surgical care of children with cleft lip and palate. In instances like this, I carry a file folder of pre and postoperative images along with my medical credentials. All it usually takes is a brief presentation of the purpose of our mission and the display of the images. It’s a universal response – the understanding of how one operation can dramatically improve a child’s life.

I’m waived through and place my three footlockers of equipment back on trolley cart, each weighing 65 pounds. Once outside the gate I look for a taxi to head over to our rendezvous point. No sooner after I pass the guarded checkpoint am I inundated with those all too familiar shady offers of “taxi? taxi?”. Fortunately, I see through the crowd our coordinator Walter Wong – the “can do” guy who always seems to make things happen. Not surprisingly, Walter already has transportation arranged and we load the trunks. The mission gets underway.

Preparing for a mission like this, one where the team literally brings most all of the supplies (except for IV fluids and other heavy disposables), never feels like it is ever going to get off the ground or that you’ll ever be leaving anytime soon with everything preplanning accomplished. With so many people involved doing so many differing things, you can easily go insane worrying about covering every little detail. Especially when those little details ensure the children’s safety and success of the mission. Somehow however, it gets done, thanks in large part to the tireless efforts of Tim Marten and the San Francisco team.

The team finally convened in at The Third Hospital of Hebei Medical University, ,Shijiazhuang Heibei, after a 5 hours bus ride from Beijing. It’s an intense, brief and welcoming reunion and despite the jet lag and time zone difference (for those of us from Chicago it’s nearly 12 hours difference) we check into the hotel after a brief dinner begin the preliminary team assignments,

If it’s one thing I’ve learned from missions like this, is that every team member is here because they want to be. For most , it’s a tremendous personal and financial sacrifice to be away from family and professional practice. The overall spirit of cooperation is exceptional. While on the mission, team members will roll up their sleeves and take on any additional tasks just to make things run smoothly. I’ve never worked with such a great group of people covering all facets of medical care – administrative, and (especially!) nursing (ward and recovery) and scrub/circulating personnel, and co-surgeons, etc. What’s more, it’s an interesting multinational group comprised of Australians, New Zealanders, Chinese nationals and Americans. The great reward our team members receive is knowing we’ve provided one of the most priceless gifts that come from helping those less fortunate. The value of providing cleft lip and palate service is inestimable, and resonates over time. For many of us, it recharges those original feelings of why we’ve chosen medicine as our lifelong career.

Today was our first day in the operating room, and we performed around 12 cases, all with great success. Not bad for a first day, and as we “get the rhythm down”, our productivity will improve all under the focus of paramount patient safety.

Well, with that brief overview more will be posted tomorrow on some of the interesting cases and observations, about the great interaction with our new Chinese physician colleagues of the University Hospital. Thanks again for visiting the site!

Best-

Howard S. Kotler, M.D., FACS