Miracles on a Shoestring From Interplast Inc.

So many operations. So many doctors. Sometimes I didn’t feel I wanted to live. But I said to myself if you want to be somebody you’ve got to get up and try. --Cesar Cano, a 17-year-old Colombian native who nowlives in Gilroy, Calif.

Cesar Cano was only 11 when the team of American surgeons first saw him. For almost a year, he had lain in a hospital in Medellin, Colombia, about 200 miles northwest of Bogota, where doctors could do little for him.

The boy had been horribly burned in a gasoline explosion in his tiny village, high in the mountainous region of Colombia. His face, neck and upper body were severely damaged, his hands deformed.

But Sue Price, a Peace Corps worker who knew his family, contacted Interplast Inc., a group of volunteer doctors based in Palo Alto, Calif., and asked for help for Cano. Surgeons from Interplast examined Cano and decided his injuries were so grave that he would have to be brought to the United States for extensive operations.

A Nonprofit Group

Interplast is a nonprofit organization of medical personnel, plastic surgeons, nurses, pediatricians and anesthesiologists, who travel to many developing nations to do reconstructive plastic surgery on children who have suffered burns, other severe injuries or who have birth defects. Sometimes, as in Cano’s case, the youngsters must be brought to the United States for extensive surgeries.

“Cesar is pretty unusual for an Interplast patient. There are a couple of other exceptions, but most don’t stay here so long,” said Amy Laden, a social worker who started out as a volunteer with Interplast and is now a full-time staff member. “We have about 30 patients per year here, between 10 and 20 at a given time. But Cesar stayed because of the distance and cost and need for surgeries.”

Laden has made about 15 trips abroad, spending long hours each time talking with and reassuring parents who must decide whether to send their youngsters to the United States for more difficult surgeries.

“I haven’t had one family refuse yet,” she said, sitting at Cano’s side. “It is really tough for them to let them go, but they realize they have a better chance for medical help.”

Once the youngsters are here, Laden lines them up with volunteer host families and assists them in adjusting to the culture shock most experience. Laden, who is fluent in Spanish, helped Cano with his early adjustment to life in California, and now converses with him in English.

“I feel committed to helping Cesar go on,” she said. “He is a remarkable boy, very bright and enormously motivated.”

Cano, 17, feels he has adjusted now to living in the Palo Alto area after six years and going to school between recuperation periods. “I am just as happy here now as I was in Colombia,” he said.

This week, he is scheduled to have his 12th operation, and there still are more ahead.

“The only thing (in English) I knew when I came was ‘good morning,’ ” Cano said during an interview at Stanford University Hospital. But Cano studied English and learned quickly. Now in the ninth grade, he is quite comfortable with his second language.

“The first few months here were really hard for me,” said Cano. “The people were really nice, but I missed my family. My mother came. It was very difficult for her to leave.”

Cesar and his mother, Ruth, lived with one of Interplast’s 30 volunteer families, Marilyn and Elwood Mills of Gilroy, until Ruth Cano got a job “taking care of a lady who had a stroke.” They went home once, in the summer of 1982, to visit the family, but Cesar had to return for more surgery.

Two months ago, Cano’s father, younger brother and two sisters came to join them in Gilroy, where the family now has an apartment. An older brother already was living and working in the Palo Alto area. The elder Cano now has a job in a furniture factory.

So far, Cesar has had enough reconstructive surgery on his hands that he can hold a pencil or pen and draw and paint. Additional operations are planned to help improve his usage even more.

Cano was injured in his father’s restaurant, where, he explained, gasoline or kerosene is used to cook. His father, too, suffered burns from a gasoline fire in 1979, but they were not as severe.

“I put my hands in front of my face, to cover my face from the fire,” he explained. “The doctors said if I didn’t have my hands over my face, I would be blind. When I got here, I couldn’t raise my neck up. It was kind of painful, the recuperation and skin grafts. But I don’t want to stay home and rest because I miss too much school.”

Cesar plans to remain in the United States, and hopes eventually to attend art classes at the university. “My algebra is kind of shaky right now,” he said, smiling. “But I am really more interested in art. I would like to be a graphic designer. I took one art course in school, drawing and painting and airbrushing. And I will take art again next year.

“When I was in Colombia, the U.S. seemed so far away, almost impossible to get here. But I plan to make my home here. There is much change in Colombia. The political situation is bad. And most people are just workers in a factory. There is much more opportunity here.”

Surgeries Donated

Were it not for Interplast, there would have been little or no opportunity for Cesar Cano to lead a normal life. His family did not have the funds for the extensive surgeries required, but Interplast doctors donate the surgeries. And, in most cases, Interplast pays for hospital care, unless it is provided by another nonprofit organization.

In Cesar’s case, Women in Show Business, a North Hollywood-based group, provided funds for his hospital stays.

About half of Interplast’s funding comes from various foundations and corporations, according to the organization’s executive director, Mary Cottrell.

Each year Interplast volunteers travel to Central and South American countries, Western Samoa, the Philippines, Africa and Jamaica. Recently, an Interplast Australia was formed with the support of many Australian Rotary clubs and the Royal Australasian College of Surgeons.

“But the big donations are few and far between, because most foundations want to do something visible in the United States,” said Cottrell. “Most of our work is done in underdeveloped countries.”

Interplast surgical teams make trips to foreign countries almost every month. Many doctors pay their own air fare and expenses; air fare for nurses and residents comes out of Interplast’s budget; medical provisions, medicines and instruments needed for surgery are paid for by Interplast or donated by companies. To minimize costs, the doctors and nurses stay with families in the cities where they perform the surgeries. Interplast receives no federal funds.

“Most of our contributions are in the $5-$10-$25 bracket,” Cottrell said. “But they are very local. Dear, sweet, little old ladies send us a crumpled dollar a month. We’re on a first-name basis. They write us about their gardens and grandchildren.”

(Interplast’s address is 378-J Cambridge Ave., Palo Alto, Calif. 94306.)

Last year, surgeons from Interplast--there are about 200 volunteer doctors now from across the United States and Canada--operated on 1,351 patients overseas, 27 in the United States. Since Interplast officially was begun in 1969, its doctors have performed more than 11,000 surgeries.

Last year alone, according to Cottrell, Interplast surgeons provided $2.6 million worth of medical care on a budget of $380,000. “We could do twice the number of trips,” Cottrell said, “ if we had the money. On a large trip, there are 20 people and 3,000 pounds of medical equipment. The team stays two weeks and does 90 to 100 surgeries. They did 114 on one recent trip. We’re just starting to get into larger fund-raising efforts now.”

Behind the desk in Dr. Donald Laub’s office at the Palo Alto Center for Plastic Surgery hangs a large photo of a smiling boy named Antonio, showing him before and after reconstructive surgery to repair his cleft lip and palate.

It was Antonio who actually was responsible for the idea for Interplast, said Laub, who founded the organization in 1969.

Four years earlier, Laub, then chief of the Department of Plastic and Reconstructive Surgery at Stanford University Medical Center, had been asked to donate his time to operate on Antonio, who had been brought from Mexico to Stanford through the efforts of the Latin American Mission Program.

Such surgery was not available for Antonio in his hometown in Mexico. Laub reasoned that there must be many other children in Mexico who couldn’t get such operations, so he and a handful of surgical colleagues began an informal program of bringing children from Mexico to Stanford, raising money to pay the hospital costs of each patient.

The doctors decided they could do far more good by going to the poorer countries to perform reconstructive surgeries. Interplast (INTERnational PLASTic surgery) was incorporated in 1969, and surgical teams began making regular visits to cities in Mexico and Honduras.

“Plastic surgery lends itself to this,” Laub said. “You don’t need an extraordinary amount of technological equipment. You need light, operating tables, sterilized equipment, good water and doctors who want to help. It doesn’t require lots of technology.”

Interplast’s most common operation is reconstructing cleft lips and palates, but they do a variety of others, mostly for children, some adults.

“Our objectives are to help children who can’t get help other children have available to them,” Laub explained. “And adults who, without repair, are incapacitated and can’t work or get an education or function in society. An operation that takes two hours, and the patient is changed for life, from a parasite in society to a contributing member of that society. There is a tremendous stigma about physical deformity.”

“Here cleft lips and palates are repaired at birth,” Laub said. “But not in the developing countries. Many of these countries don’t have any plastic surgeons. Lesotho (in Africa) has none, Samoa either. In India there are 158 million people and eight plastic surgeons. In Malaysia, 50 million and 20 plastic surgeons. So you can see there is a great need. One child in 800 births has a cleft lip.”

Interplast patients never are charged for their operations, but often they bring doctors presents. “They give us things,” Laub said, grinning. “Chickens, Coca-Colas, an egg, free taxi rides. You can’t say no.”

A second objective of Interplast is education of medical personnel in the countries they visit. “We include an educational program with every trip,” Laub said. “We do lectures and on the job training. And give courses for hospital personnel. We have nurses, anesthesiologists, pediatricians, plus surgeons. Other countries are trying very hard to improve. They may not be perfectly up to date in knowledge and training, except in the capital city.

The organization also has a scholarship program under which doctors from foreign countries can come to the United States to train. “It’s a reverse Peace Corps,” Laub said. “It’s training on an informal basis. They don’t get a diploma, but they get the training and go home to pass on what they’ve learned. It will help our country. It’s an inexpensive way of exerting a tremendous influence of the values of a democratic society. Our intention is to work ourselves out of a job, decreasing the dependency and relating to people as equals.”

Dr. Richard Jobe, Interplast president, likes to stress the educational benefits for Interplast surgeons as well.

“In many places we’re dealing with serious problems we don’t see in private practice and even at the university. As well as serving a great need, we’ve expanded to do more that is education. We’ve now been invited by the hospital in Cesar’s hometown, in Medellin, to have a two-day surgical symposium for the doctors there.”

Late last year, at the invitation of Mrs. Anwar Sadat, Jobe went on an exploratory trip to Egypt. This fall, Interplast doctors will begin a new teaching program in several hospitals in Egypt, dealing primarily with the surgical treatment of birth defects and other disabling problems.

Jobe credits Laub as the driving force behind Interplast and for the fact that it is such a unique organization. “Don’s fantastic,” he said. “His fundamental idea is to be helpful to somebody. An institution is a lengthening shadow of a man.”

“It’s a fantastic education for the people involved,” Jobe said. “A neat experience for everyone, here and there. They get a slant in life they never got before. You walk in a room and there are 400 people. You can’t take care of them all on one trip, but you operate 12 hours a day for a week. You work very hard and the people you work with do, too. It’s a high on life.”

“I think plastic surgeons often get the reputation of just doing cosmetic surgery for people with a lot of money,” said Dr. David Zlotnick, a pediatrician who is a former president of Interplast’s board of directors. “I always say these are plastic surgeons with pediatric hearts. And they say I have a surgeon’s heart.”

Zlotnick and his wife, Caroline, a nurse, have been working with Interplast for 14 years. “We go once a year,” Zlotnick said. “I examine the children and my wife runs the recovery room. I see kids now I saw when they were one or so years old with cleft lips. A one- or two-hour operation changed them. Now they’re 10 and happy, productive kids.”

Zlotnick, whose hobby is photography, has covered the walls of his waiting room with hundreds of photos of children in the South and Central American countries that he and his colleagues have attended.

As the team pediatrician, Zlotnick determines whether or not a child is healthy enough to undergo the operation. “Sometimes they have parasites or respiratory problems, lots of things. Then I can treat them and the surgery can be done later. We’re not down there with reckless abandon cutting everyone who comes through the door.”

Zlotnick talked of seeing mothers who walked for two days to bring their child to Interplast doctors, others who walked across mountains to get help for their child, others who waited outside the hospital for two days.

“They wait because it is their only chance,” said Zlotnick. “These people love their kids as much as we do. And there have been many, many kids and parents you get very attached to. It’s like having relatives there. You get involved with a lot of local people’s lives, you stay with them, eat with them.

“There really is a cultural exchange that goes on,” he added. “A lot of interaction with the people. This has been a very rewarding experience, the most rewarding single aspect to my career. I have gotten a lot more from Interplast than I’ve given.”