Medical Mission trip to Guatemala 1985
This past week was a strange one weather wise – cold and rainy on both coasts but for a few days, it was actually warmer in Worcester, MA than it was in Orange County, CA (but towards the end of the week, “normal” reappeared and it snowed in MA and hit high 70’s in CA)! This cold weather got Dr. Ekstrom and I thinking about the first time we worked together, in Nuevo Progreso, Guatemala, at the Hospital de la Familia.
At the time, I was in private practice in the San Francisco Bay Area and on the clinical faculty at the University of California San Francisco, and Dr. Ekstrom was a plastic surgery resident at UMass in Worcester. The photo on the far right above shows both of us huddled over a child whose cleft lip we were repairing. We did take care of burn scars, complex hand injuries and the occasional hernia, but the bulk of what we did was help children with birth defects – and not always children.
The first patient you see above was a female in her 30’s who had not had access to surgical care in the past and had never had her cleft lip and cleft lip nasal deformity corrected in the past. The young boy was born with an extra toe growing perpendicular to his little toe – he had obviously never worn a shoe before he met us. Dr. Ekstrom and I made a new ear for the young man in the lower left photo by carving a framework for the ear from a rib cartilage.
During our ten days in the jungle, we did about 150 surgical cases! Anesthesia for all of these patients was particularly challenging as most of the people lived in houses with a central open fire for cooking and warmth, without chimneys – the chronic smoke exposure left all inhabitants with some underlying lung disease similar to COPD. I would organize a surgical team that went down to Nuevo Progreso for about ten days, usually in November, for many years running. A team from the USA went down to this hospital in Guatemala every quarter for about ten days – the rest of the time, a skeleton staff of lay people was there providing essential non-surgical services like child birth.
The Hospital de la Familia Foundation also runs a nutrition center at the hospital for children under the age of 5, year round, as about 70% of children in that age group are malnourished in rural Guatemala. This Foundation has made a huge impact on the lives of local residents……..and in the lives of the doctors and nurses who were fortunate enough to donate their time, skills and medical supplies to help these people.
Spotlight on Plastic Surgery---Ear enhancement surgery
I mentioned above that we reconstructed an ear on a patient with microtia, a congenital deformity in which the external ear does not develop fully – 90% of these cases occur unilaterally. Reconstruction is a multistage process, beginning with harvesting of a block of rib cartilage and carving the cartilage to resemble the cartilage of a normal ear. Frequently, the earlobe can be saved from the microtia fragment, but the rest of the deformed ear is discarded. A skin flap is elevated, the cartilage inserted, and a skin graft is usually used to close the defect which is now behind the ear. Such cases are quite complex and require multiple stages.
25 year old male with microtia, showing carved rib cartilage frame and final result (actual patient of Dr. Bunkis)
In a private practice setting, the most common ear deformities we see are torn earlobes, which can easily be repaired in an office setting. The most common congenital ear deformities we encounter are “protruding ears”. In this situation, all of the ear parts are present but, during development, the ear did not furl properly and is left without an antihelical fold, making the ear look like a big, protruding cup. To repair this deformity, we make an incision behind the ear, tunnel to the front of the ear and use a specialized rasp to break the spring of the cartilage, along the location of the newly created antihelical fold. A few sutures on the backside of the ear hold the tissues in place until they heal. Once the fold has been created, the ear protrudes less and looks “smaller”, even though the ear height and width stay the same. We most frequently do this procedure on children as young as 5 years of age but also see a number of adults who would like their ears pinned back.
Eight year old girl, before and after a setback otoplasty (actual patient of Dr. Bunkis)